Medical Procedure Costs

63323037805

OCTREOTIDE 1,000 MCG/5 ML VIAL

Prescription Drug - Generic

$5

—

63323042405

FLUMAZENIL 0.1 MG/ML VIAL

Prescription Drug - Generic

$1

—

63323046757

SENSORCAINE 0.5% VIAL

Prescription Drug - Brand

$0

—

63323048227

XYLOCAINE 1%-EPI 1:100,000

Prescription Drug - Brand

$0

—

63323048327

XYLOCAINE 2%-EPI 1:100,000

Prescription Drug - Brand

$0

—

63323058313

GLUCAGON 1 MG VIAL

Prescription Drug - Brand

$236

—

63323069130

ACETYLCYSTEINE 10% VIAL

Prescription Drug - Generic

$0

—

63323081502

AMIKACIN SULF 500 MG/2 ML VIAL

Prescription Drug - Generic

$3

—

63323085115

HYDROMORPHONE 50 MG/5 ML VIAL

Prescription Drug - Generic

$3

—

63323085150

HYDROMORPHONE 500 MG/50 ML VL

Prescription Drug - Generic

$3

—

63323085325

HYDROMORPHONE 2 MG/ML VIAL

Prescription Drug - Generic

$3

—

63402019030

LUNESTA 1 MG TABLET

Prescription Drug - Brand

$14

—

63402019110

LUNESTA 2 MG TABLET

Prescription Drug - Brand

$14

—

63402019303

LUNESTA 3 MG TABLET

Prescription Drug - Brand

$23

—

63402020230

APTIOM 200 MG TABLET

Prescription Drug - Brand

$44

—

63402020430

APTIOM 400 MG TABLET

Prescription Drug - Brand

$44

—

63402020660

APTIOM 600 MG TABLET

Prescription Drug - Brand

$44

—

63402020830

APTIOM 800 MG TABLET

Prescription Drug - Brand

$44

—

63402030101

LONHALA MAGNAIR 25 MCG REFILL

Prescription Drug - Brand

$20

—

63402030230

LATUDA 20 MG TABLET

Prescription Drug - Brand

$47

—

63402030430

LATUDA 40 MG TABLET

Prescription Drug - Brand

$47

—

63402030630

LATUDA 60 MG TABLET

Prescription Drug - Brand

$47

—

63402030830

LATUDA 80 MG TABLET

Prescription Drug - Brand

$47

—

63402031230

LATUDA 120 MG TABLET

Prescription Drug - Brand

$70

—

63402051224

XOPENEX 0.63 MG/3 ML SOLUTION

Prescription Drug - Brand

$3

—

63459010130

PROVIGIL 100 MG TABLET

Prescription Drug - Brand

$53

—

63459020130

PROVIGIL 200 MG TABLET

Prescription Drug - Brand

$80

—

63459020530

NUVIGIL 50 MG TABLET

Prescription Drug - Brand

$7

—

63459021530

NUVIGIL 150 MG TABLET

Prescription Drug - Brand

$35

—

63459022030

NUVIGIL 200 MG TABLET

Prescription Drug - Brand

$35

—

63459022530

NUVIGIL 250 MG TABLET

Prescription Drug - Brand

$35

—

63459040430

GABITRIL 4 MG TABLET

Prescription Drug - Brand

$11

—

63459041230

GABITRIL 12 MG TABLET

Prescription Drug - Brand

$10

—

63459041630

GABITRIL 16 MG TABLET

Prescription Drug - Brand

$13

—

63459054428

FENTORA 400 MCG BUCCAL TABLET

Prescription Drug - Brand

$141

—

63459054628

FENTORA 600 MCG BUCCAL TABLET

Prescription Drug - Brand

$183

—

63459054828

FENTORA 800 MCG BUCCAL TABLET

Prescription Drug - Brand

$224

—

63459070060

AMRIX ER 15 MG CAPSULE

Prescription Drug - Brand

$66

—

63459070160

AMRIX ER 30 MG CAPSULE

Prescription Drug - Brand

$67

—

63481002509

FROVA 2.5 MG TABLET

Prescription Drug - Brand

$150

—

63481018316

FORTESTA 10 MG GEL PUMP

Prescription Drug - Brand

$7

—

63481036706

SUMAVEL DOSEPRO 6 MG/0.5 ML

Prescription Drug - Brand

$343

—

63481042105

COLY-MYCIN S OTIC SUSP DROP

Prescription Drug - Brand

$22

—

63481052910

CORTISPORIN-TC EAR SUSPENSION

Prescription Drug - Brand

$22

—

63481062370

PERCOCET 5-325 MG TABLET

Prescription Drug - Brand

$29

—

63481062870

PERCOCET 7.5-325 MG TABLET

Prescription Drug - Brand

$32

—

63481062970

PERCOCET 10-325 MG TABLET

Prescription Drug - Brand

$41

—

63481068447

VOLTAREN 1% GEL

Prescription Drug - Brand

$1

—

63481068706

LIDODERM 5% PATCH

Prescription Drug - Brand

$25

—

63481081260

OPANA ER 5 MG TABLET

Prescription Drug - Brand

$2

—

My Cost List