Medical Procedure Costs

00169770521

NORDITROPIN FLEXPRO 10 MG/1.5

Prescription Drug - Brand

$1,143

—

00169770821

NORDITROPIN FLEXPRO 15 MG/1.5

Prescription Drug - Brand

$1,718

—

0016M

Molecular pathology test for genetic analysis of bladder tumor (Decipher

Pathology/Laboratory

$3,490

—

0016U

RNA test for detecting gene abnormality associated with blood and lymphatic

Pathology/Laboratory

$164

—

00172435860

RANITIDINE 300 MG TABLET

Prescription Drug - Generic

$0

—

00172731320

CYCLOSPORINE MODIFIED 100 MG/ML

Prescription Drug - Generic

$3

—

00173013555

WELLBUTRIN SR 150 MG TABLET

Prescription Drug - Brand

$8

—

00173017855

WELLBUTRIN 100 MG TABLET

Prescription Drug - Brand

$3

—

00173038879

BECONASE AQ 0.042% SPRAY

Prescription Drug - Brand

$11

—

00173039340

ZANTAC 300 MG TABLET

Prescription Drug - Brand

$11

—

00173045301

FLONASE 0.05% NASAL SPRAY

Prescription Drug - Brand

$6

—

00173047800

IMITREX 6 MG/0.5 ML CARTRIDGES

Prescription Drug - Brand

$437

—

00173047900

IMITREX 6 MG/0.5 ML PEN INJECT

Prescription Drug - Brand

$462

—

00173052100

SEREVENT DISKUS 50 MCG

Prescription Drug - Brand

$7

—

00173052300

IMITREX 20 MG NASAL SPRAY

Prescription Drug - Brand

$89

—

00173052400

IMITREX 5 MG NASAL SPRAY

Prescription Drug - Brand

$89

—

00173052700

LAMICTAL 25 MG DISPER TABLET

Prescription Drug - Brand

$11

—

00173056200

AMERGE 2.5 MG TABLET

Prescription Drug - Brand

$54

—

00173056510

VALTREX 1 GRAM CAPLET

Prescription Drug - Brand

$20

—

00173059402

LAMICTAL TB START KIT (ORANGE)

Prescription Drug - Brand

$11

—

00173060002

FLOVENT 50 MCG DISKUS

Prescription Drug - Brand

$3

—

00173060102

FLOVENT 250 MCG DISKUS

Prescription Drug - Brand

$4

—

00173060202

FLOVENT 100 MCG DISKUS

Prescription Drug - Brand

$3

—

00173063302

LAMICTAL 25 MG TABLET

Prescription Drug - Brand

$10

—

00173064255

LAMICTAL 100 MG TABLET

Prescription Drug - Brand

$11

—

00173064360

LAMICTAL 150 MG TABLET

Prescription Drug - Brand

$11

—

00173064460

LAMICTAL 200 MG TABLET

Prescription Drug - Brand

$12

—

00173066200

EPIVIR HBV 100 MG TABLET

Prescription Drug - Brand

$14

—

00173066518

MEPRON 750 MG/5 ML SUSPENSION

Prescription Drug - Brand

$7

—

00173067502

MALARONE 250-100 MG TABLET

Prescription Drug - Brand

$7

—

00173068101

RELENZA 5 MG DISKHALER

Prescription Drug - Brand

$3

—

00173068224

VENTOLIN HFA 90 MCG INHALER

Prescription Drug - Brand

$3

—

00173069500

ADVAIR 100-50 DISKUS

Prescription Drug - Brand

$2

—

00173069600

ADVAIR 250-50 DISKUS

Prescription Drug - Brand

$3

—

00173069700

ADVAIR 500-50 DISKUS

Prescription Drug - Brand

$4

—

00173071522

ADVAIR HFA 45-21 MCG INHALER

Prescription Drug - Brand

$20

—

00173071620

ADVAIR HFA 115-21 MCG INHALER

Prescription Drug - Brand

$25

—

00173071720

ADVAIR HFA 230-21 MCG INHALER

Prescription Drug - Brand

$35

—

00173071820

FLOVENT HFA 44 MCG INHALER

Prescription Drug - Brand

$18

—

00173071920

FLOVENT HFA 110 MCG INHALER

Prescription Drug - Brand

$22

—

00173072020

FLOVENT HFA 220 MCG INHALER

Prescription Drug - Brand

$34

—

00173072200

WELLBUTRIN SR 200 MG TABLET

Prescription Drug - Brand

$14

—

00173073601

IMITREX 50 MG TABLET

Prescription Drug - Brand

$73

—

00173073701

IMITREX 100 MG TABLET

Prescription Drug - Brand

$72

—

00173074000

CEFTIN 125 MG/5 ML ORAL SUSP

Prescription Drug - Brand

$1

—

00173074110

CEFTIN 250 MG/5 ML ORAL SUSP

Prescription Drug - Brand

$2

—

00173075300

VERAMYST 27.5 MCG NASAL SPRAY

Prescription Drug - Brand

$18

—

00173075400

LAMICTAL XR 25 MG TABLET

Prescription Drug - Brand

$14

—

00173075500

LAMICTAL XR 50 MG TABLET

Prescription Drug - Brand

$28

—

00173075600

LAMICTAL XR 100 MG TABLET

Prescription Drug - Brand

$30

—

My Cost List