Medical Procedure Costs

65862067899

ALPRAZOLAM 1 MG TABLET

Prescription Drug - Generic

$0

—

65862067905

ALPRAZOLAM 2 MG TABLET

Prescription Drug - Generic

$0

—

65862069299

PHENYTOIN SOD EXT 100 MG CAP

Prescription Drug - Generic

$0

—

65862070680

AMOXICILLIN 125 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

65862070780

AMOXICILLIN 250 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

65862073730

AMLODIPINE-VALSARTAN 5-160 MG

Prescription Drug - Generic

$0

—

65862073830

AMLODIPINE-VALSARTAN 5-320 MG

Prescription Drug - Generic

$1

—

65862073930

AMLODIPINE-VALSARTAN 10-160 MG

Prescription Drug - Generic

$0

—

65862074030

AMLODIPINE-VALSARTAN 10-320 MG

Prescription Drug - Generic

$1

—

65862074430

GALANTAMINE ER 8 MG CAPSULE

Prescription Drug - Generic

$1

—

65862074530

GALANTAMINE ER 16 MG CAPSULE

Prescription Drug - Generic

$1

—

65862074630

GALANTAMINE ER 24 MG CAPSULE

Prescription Drug - Generic

$1

—

65862075150

CEFIXIME 100 MG/5 ML SUSP

Prescription Drug - Generic

$2

—

65862077685

MILI 0.25-0.035 MG TABLET

Prescription Drug - Generic

$0

—

65862077785

TRI-MILI 28 TABLET

Prescription Drug - Generic

$0

—

65862077885

TRI-LO-MILI TABLET

Prescription Drug - Generic

$0

—

65862080630

ARMODAFINIL 150 MG TABLET

Prescription Drug - Generic

$1

—

65862080730

ARMODAFINIL 250 MG TABLET

Prescription Drug - Generic

$1

—

65862082930

PRASUGREL 5 MG TABLET

Prescription Drug - Generic

$0

—

65862083030

PRASUGREL 10 MG TABLET

Prescription Drug - Generic

$0

—

65862083430

AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 5-160-12.5 MG TAB

Prescription Drug - Generic

$7

—

65862083530

AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 5-160-25 MG TAB

Prescription Drug - Generic

$6

—

65862083630

AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-160-12.5 MG TAB

Prescription Drug - Generic

$7

—

65862083730

AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-160-25 MG TAB

Prescription Drug - Generic

$7

—

65862083830

AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-320-25 MG TAB

Prescription Drug - Generic

$8

—

65862084401

CLOZAPINE 25 MG TABLET

Prescription Drug - Generic

$0

—

65862084501

CLOZAPINE 50 MG TABLET

Prescription Drug - Generic

$1

—

65862084605

CLOZAPINE 100 MG TABLET

Prescription Drug - Generic

$1

—

65862084701

CLOZAPINE 200 MG TABLET

Prescription Drug - Generic

$1

—

65862084888

AYUNA-28 TABLET

Prescription Drug - Generic

$0

—

65862084988

AFIRMELLE-28 TABLET

Prescription Drug - Generic

$0

—

65862086495

SIMPESSE 0.15-0.03-0.01 MG TAB

Prescription Drug - Generic

$0

—

65862086594

ICLEVIA 0.15 MG-0.03 MG TABLET

Prescription Drug - Generic

$0

—

65862087011

RISEDRONATE SODIUM 150 MG TAB

Prescription Drug - Generic

$17

—

65862088628

SIMLIYA 28 DAY TABLET

Prescription Drug - Generic

$0

—

65862088830

GLIPIZIDE ER 2.5 MG TABLET

Prescription Drug - Generic

$0

—

65862088905

GLIPIZIDE ER 5 MG TABLET

Prescription Drug - Generic

$0

—

65862089001

GLIPIZIDE ER 10 MG TABLET

Prescription Drug - Generic

$0

—

65862089788

NYLIA 7-7-7-28 TABLET

Prescription Drug - Generic

$0

—

65862089888

NYLIA 1-35 28 TABLET

Prescription Drug - Generic

$0

—

65862092205

TRAMADOL-ACETAMINOPHEN 37.5-325 MG TAB

Prescription Drug - Generic

$0

—

65862092585

INCASSIA 0.35 MG TABLET

Prescription Drug - Generic

$0

—

65862092836

SUMATRIPTAN-NAPROXEN 85-500 MG

Prescription Drug - Generic

$13

—

65862093488

AUROVELA 24 FE 1 MG-20 MCG TAB

Prescription Drug - Generic

$0

—

65862093574

AUROVELA 21 1.5-30 TABLET

Prescription Drug - Generic

$0

—

65862093988

AUROVELA 1 MG-20 MCG TABLET

Prescription Drug - Generic

$0

—

65862094088

AUROVELA FE 1-20 TABLET

Prescription Drug - Generic

$0

—

65862094188

AUROVELA FE 1.5 MG-30 MCG TAB

Prescription Drug - Generic

$0

—

65862094760

DORZOLAMIDE-TIMOLOL 2-0.5%(PF)

Prescription Drug - Generic

$1

—

65865

Incise inner eye adhesions

Surgery - Eye

$414

—

My Cost List