Medical Procedure Costs

59651026301

CLOZAPINE ODT 150 MG TABLET

Prescription Drug - Generic

$14

—

59651026401

CLOZAPINE ODT 200 MG TABLET

Prescription Drug - Generic

$21

—

59651030501

CHLORZOXAZONE 375 MG TABLET

Prescription Drug - Generic

$1

—

59651030701

CHLORZOXAZONE 750 MG TABLET

Prescription Drug - Generic

$1

—

59651032930

MONTELUKAST SOD 4 MG GRANULES

Prescription Drug - Generic

$1

—

59651055101

AMPICILLIN 500 MG CAPSULE

Prescription Drug - Generic

$0

—

59651056501

DICLOXACILLIN 250 MG CAPSULE

Prescription Drug - Generic

$1

—

59651056601

DICLOXACILLIN 500 MG CAPSULE

Prescription Drug - Generic

$1

—

59651063310

ISOTRETINOIN 25 MG CAPSULE

Prescription Drug - Generic

$11

—

59651071246

TRETINOIN 0.01% GEL

Prescription Drug - Generic

$2

—

59676022528

OLYSIO 150 MG CAPSULE

Prescription Drug - Brand

$781

—

59676027801

EDURANT 25 MG TABLET

Prescription Drug - Brand

$48

—

59676030201

PROCRIT 2,000 UNITS/ML VIAL

Prescription Drug - Brand

$52

—

59676030401

PROCRIT 4,000 UNITS/ML VIAL

Prescription Drug - Brand

$104

—

59676031001

PROCRIT 10,000 UNITS/ML VIAL

Prescription Drug - Brand

$260

—

59676032004

PROCRIT 20,000 UNITS/ML VIAL

Prescription Drug - Brand

$520

—

59676034001

PROCRIT 40,000 UNITS/ML VIAL

Prescription Drug - Brand

$1,036

—

59676056101

PREZISTA 400 MG TABLET

Prescription Drug - Brand

$20

—

59676056201

PREZISTA 600 MG TABLET

Prescription Drug - Brand

$35

—

59676056630

PREZISTA 800 MG TABLET

Prescription Drug - Brand

$70

—

59676057001

INTELENCE 100 MG TABLET

Prescription Drug - Brand

$11

—

59676057101

INTELENCE 200 MG TABLET

Prescription Drug - Brand

$24

—

59676057530

PREZCOBIX 800 MG-150 MG TABLET

Prescription Drug - Brand

$80

—

59676080030

SYMTUZA 800-150-200-10 MG TAB

Prescription Drug - Brand

$153

—

59746001032

RISPERIDONE 0.5 MG ODT

Prescription Drug - Generic

$1

—

59746002022

RISPERIDONE 1 MG ODT

Prescription Drug - Generic

$1

—

59746003022

RISPERIDONE 2 MG ODT

Prescription Drug - Generic

$1

—

59746004022

RISPERIDONE 3 MG ODT

Prescription Drug - Generic

$1

—

59746005022

RISPERIDONE 4 MG ODT

Prescription Drug - Generic

$2

—

59762001601

CLINDAMYCIN 75 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

59762002801

DICLOFENAC-MISOPROST 50-200 TB

Prescription Drug - Generic

$2

—

59762002901

DICLOFENAC-MISOPROST 75-200 TB

Prescription Drug - Generic

$2

—

59762005502

MEDROXYPROGESTERONE 2.5 MG TAB

Prescription Drug - Generic

$0

—

59762005701

ALPRAZOLAM XR 0.5 MG TABLET

Prescription Drug - Generic

$0

—

59762005802

MEDROXYPROGESTERONE 5 MG TAB

Prescription Drug - Generic

$0

—

59762005901

ALPRAZOLAM XR 1 MG TABLET

Prescription Drug - Generic

$0

—

59762006601

ALPRAZOLAM XR 2 MG TABLET

Prescription Drug - Generic

$0

—

59762006701

SERTRALINE 20 MG/ML ORAL SOLN

Prescription Drug - Generic

$1

—

59762006801

ALPRAZOLAM XR 3 MG TABLET

Prescription Drug - Generic

$0

—

59762010406

SULFASALAZINE DR 500 MG TAB

Prescription Drug - Generic

$0

—

59762011901

PHENELZINE SULFATE 15 MG TAB

Prescription Drug - Generic

$1

—

59762012201

TRANDOLAPRIL-VERAPAMIL ER 4-240 MG TABLET

Prescription Drug - Generic

$4

—

59762017006

TOLTERODINE TARTRATE 1 MG TAB

Prescription Drug - Generic

$0

—

59762026002

COLESTIPOL HCL GRANULES PACKET

Prescription Drug - Generic

$3

—

59762026003

COLESTIPOL HCL GRANULES

Prescription Drug - Generic

$0

—

59762040704

RISEDRONATE SOD DR 35 MG TAB

Prescription Drug - Generic

$26

—

59762045001

COLESTIPOL MICRONIZED 1 GM TAB

Prescription Drug - Generic

$1

—

59762053102

PHENYTOIN 125 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

59762054001

GLIPIZIDE XL 2.5 MG TABLET

Prescription Drug - Generic

$0

—

59762054102

GLIPIZIDE XL 5 MG TABLET

Prescription Drug - Generic

$0

—

My Cost List