Medical Procedure Costs

60687025246

ONDANSETRON 4 MG/5 ML SOLUTION CUP

Prescription Drug - Generic

$0

—

60687043199

HEALTHYLAX POWDER PACKET

Prescription Drug - Generic

$1

—

60687047911

CARBAMAZEPINE 100 MG TAB CHEW

Prescription Drug - Generic

$0

—

60687053478

ATOVAQUONE 750 MG/5 ML SUSPENSION CUP

Prescription Drug - Generic

$1

—

60687055633

MESALAMINE DR 400 MG CAPSULE

Prescription Drug - Generic

$2

—

60687057911

HYDROMORPHONE 2 MG TABLET

Prescription Drug - Generic

$0

—

60687059011

HYDROMORPHONE 4 MG TABLET

Prescription Drug - Generic

$0

—

60687060611

DICLOFENAC SOD EC 50 MG TAB

Prescription Drug - Generic

$0

—

60687062211

SENNOSIDES-DOCUSATE SODIUM TAB

Prescription Drug - Generic

$0

—

60687071711

DILTIAZEM 30 MG TABLET

Prescription Drug - Generic

$0

—

60687075405

LINEZOLID 100 MG/5 ML SUSP

Prescription Drug - Generic

$2

—

60687084782

LACOSAMIDE 200 MG/20 ML CUP

Prescription Drug - Generic

$0

—

60758077305

KETOROLAC 0.4% OPHTH SOLUTION

Prescription Drug - Generic

$13

—

60758088005

FLUOROMETHOLONE 0.1% DROPS

Prescription Drug - Generic

$15

—

60758088010

FLUOROMETHOLONE 0.1% EYE DROP

Prescription Drug - Generic

$13

—

60793010401

TAPAZOLE 5 MG TABLET

Prescription Drug - Generic

$0

—

60793010501

TAPAZOLE 10 MG TABLET

Prescription Drug - Generic

$0

—

60793011501

CYTOMEL 5 MCG TABLET

Prescription Drug - Brand

$0

—

60793011601

CYTOMEL 25 MCG TABLET

Prescription Drug - Brand

$1

—

60793011701

CYTOMEL 50 MCG TABLET

Prescription Drug - Brand

$4

—

60793013601

SKELAXIN 800 MG TABLET

Prescription Drug - Brand

$10

—

60793014601

SONATA 10 MG CAPSULE

Prescription Drug - Brand

$11

—

60793043020

EMBEDA ER 20-0.8 MG CAPSULE

Prescription Drug - Brand

$6

—

60793043120

EMBEDA ER 30-1.2 MG CAPSULE

Prescription Drug - Brand

$10

—

60793043320

EMBEDA ER 50-2 MG CAPSULE

Prescription Drug - Brand

$13

—

60793043420

EMBEDA ER 60-2.4 MG CAPSULE

Prescription Drug - Brand

$15

—

60793043520

EMBEDA ER 80-3.2 MG CAPSULE

Prescription Drug - Brand

$20

—

60793043720

EMBEDA ER 100-4 MG CAPSULE

Prescription Drug - Brand

$25

—

60793060301

AVINZA 45 MG CAPSULE

Prescription Drug - Brand

$8

—

60793060501

AVINZA 30 MG CAPSULE

Prescription Drug - Brand

$5

—

60793060601

AVINZA 60 MG CAPSULE

Prescription Drug - Brand

$10

—

60793060701

AVINZA 90 MG CAPSULE

Prescription Drug - Brand

$15

—

60793070110

BICILLIN L-A 1,200,000 UNITS

Prescription Drug - Brand

$77

—

60793070210

BICILLIN L-A 2,400,000 UNITS

Prescription Drug - Brand

$183

—

60793085010

LEVOXYL 25 MCG TABLET

Prescription Drug - Brand

$1

—

60793085110

LEVOXYL 50 MCG TABLET

Prescription Drug - Brand

$1

—

60793085210

LEVOXYL 75 MCG TABLET

Prescription Drug - Brand

$1

—

60793085310

LEVOXYL 88 MCG TABLET

Prescription Drug - Brand

$1

—

60793085410

LEVOXYL 100 MCG TABLET

Prescription Drug - Brand

$1

—

60793085510

LEVOXYL 112 MCG TABLET

Prescription Drug - Brand

$1

—

60793085610

LEVOXYL 125 MCG TABLET

Prescription Drug - Brand

$1

—

60793085710

LEVOXYL 137 MCG TABLET

Prescription Drug - Brand

$1

—

60793085810

LEVOXYL 150 MCG TABLET

Prescription Drug - Brand

$1

—

60793085910

LEVOXYL 175 MCG TABLET

Prescription Drug - Brand

$1

—

60793086010

LEVOXYL 200 MCG TABLET

Prescription Drug - Brand

$1

—

60842002102

AUVI-Q 0.1 MG AUTO-INJECTOR

Prescription Drug - Brand

$298

—

60842002202

AUVI-Q 0.15 MG AUTO-INJECTOR

Prescription Drug - Brand

$298

—

60842002302

AUVI-Q 0.3 MG AUTO-INJECTOR

Prescription Drug - Brand

$298

—

60842003001

EVZIO 0.4 MG AUTO-INJECTOR

Prescription Drug - Brand

$4,507

—

60846020101

ACTIVELLA 0.5-0.1 MG TABLET

Prescription Drug - Brand

$9

—

My Cost List