Medical Procedure Costs

70710116201

MECLIZINE 25 MG TABLET

Prescription Drug - Generic

$0

—

70710119003

NORELGESTROM-EE 150-35 MCG/DAY

Prescription Drug - Generic

$36

—

70710119108

ESTRADIOL 0.025 MG PATCH(2/WK)

Prescription Drug - Generic

$7

—

70710119208

ESTRADIOL 0.0375 MG PATCH(2/WK)

Prescription Drug - Generic

$7

—

70710119308

ESTRADIOL 0.05 MG PATCH (2/WK)

Prescription Drug - Generic

$7

—

70710119408

ESTRADIOL 0.075 MG PATCH(2/WK)

Prescription Drug - Generic

$7

—

70710119508

ESTRADIOL 0.1 MG PATCH (2/WK)

Prescription Drug - Generic

$7

—

70710119607

RIVASTIGMINE 4.6 MG/24HR PATCH

Prescription Drug - Generic

$2

—

70710119707

RIVASTIGMINE 9.5 MG/24HR PATCH

Prescription Drug - Generic

$2

—

70710119807

RIVASTIGMINE 13.3 MG/24HR PTCH

Prescription Drug - Generic

$2

—

70710122101

CARBIDOPA 25 MG TABLET

Prescription Drug - Generic

$1

—

70710123304

BETAMETHASONE DP 0.05% CRM

Prescription Drug - Generic

$0

—

70710124003

ZITUVIO 25 MG TABLET

Prescription Drug - Brand

$10

—

70710124103

ZITUVIO 50 MG TABLET

Prescription Drug - Brand

$10

—

70710124203

ZITUVIO 100 MG TABLET

Prescription Drug - Brand

$10

—

70710128905

TRIAZOLAM 0.25 MG TABLET

Prescription Drug - Generic

$0

—

70710130207

MESALAMINE 1,000 MG SUPP

Prescription Drug - Generic

$2

—

70710134403

RAMELTEON 8 MG TABLET

Prescription Drug - Generic

$1

—

70710134809

VENLAFAXINE HCL ER 37.5 MG TAB

Prescription Drug - Generic

$0

—

70710135103

COLCHICINE 0.6 MG TABLET

Prescription Drug - Generic

$0

—

70710136403

EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE 100-150 MG TAB

Prescription Drug - Generic

$10

—

70710145701

AZITHROMYCIN 100 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

70710146002

AZITHROMYCIN 200 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

70710146707

COLESTIPOL HCL 1 GM TABLET

Prescription Drug - Generic

$1

—

70710151406

FONDAPARINUX 2.5 MG/0.5 ML SYR

Prescription Drug - Generic

$20

—

70710151606

FONDAPARINUX 7.5 MG/0.6 ML SYR

Prescription Drug - Generic

$43

—

70710151706

FONDAPARINUX 10 MG/0.8 ML SYR

Prescription Drug - Generic

$38

—

70710152101

TRIAZOLAM 0.125 MG TABLET

Prescription Drug - Generic

$0

—

70710159101

ACETAZOLAMIDE ER 500 MG CAP

Prescription Drug - Generic

$0

—

70710166601

BACLOFEN 15 MG TABLET

Prescription Drug - Generic

$2

—

70710171001

KETOROLAC 10 MG TABLET

Prescription Drug - Generic

$0

—

70710173804

ICOSAPENT ETHYL 0.5 GM CAPSULE

Prescription Drug - Generic

$0

—

70710178606

ZITUVIMET 50-500 MG TABLET

Prescription Drug - Brand

$5

—

70710178706

ZITUVIMET 50-1,000 MG TABLET

Prescription Drug - Brand

$5

—

70710180506

ZITUVIMET XR 50-1,000 MG TABLET

Prescription Drug - Brand

$5

—

70710180603

ZITUVIMET XR 100-1,000 MG TAB

Prescription Drug - Brand

$10

—

70710184607

SCOPOLAMINE 1 MG/3 DAY PATCH

Prescription Drug - Generic

$4

—

70727049725

RHOPRESSA 0.02% OPHTH SOLUTION

Prescription Drug - Brand

$132

—

70727052925

ROCKLATAN 0.02%-0.005% EYE DRP

Prescription Drug - Brand

$140

—

70748012906

LEFLUNOMIDE 10 MG TABLET

Prescription Drug - Generic

$0

—

70748013006

LEFLUNOMIDE 20 MG TABLET

Prescription Drug - Generic

$0

—

70748017326

SEVELAMER HCL 800 MG TABLET

Prescription Drug - Generic

$1

—

70748021206

DASATINIB 100 MG TABLET

Prescription Drug - Generic

$29

—

70748027013

RISPERIDONE ER 25 MG VIAL

Prescription Drug - Generic

$487

—

70748027213

RISPERIDONE ER 50 MG VIAL

Prescription Drug - Generic

$927

—

70748030806

DOXYCYCLINE IR-DR 40 MG CAP

Prescription Drug - Generic

$9

—

70748031101

GLUCAGON 1 MG EMERGENCY KIT

Prescription Drug - Generic

$198

—

70748032214

MINZOYA-28 TABLET

Prescription Drug - Generic

$5

—

70748033204

PREDNISOLONE AC 1% EYE DROP

Prescription Drug - Generic

$4

—

70748035501

RIVAROXABAN 1 MG/ML SUSPENSION

Prescription Drug - Generic

$2

—

My Cost List