Medical Procedure Costs

72603047601

VARENICLINE 0.5 MG TABLET

Prescription Drug - Generic

$0

—

72603047701

VARENICLINE 1 MG TABLET

Prescription Drug - Generic

$0

—

72603047801

VARENICLINE STARTING MONTH BOX

Prescription Drug - Generic

$1

—

72603047901

PITAVASTATIN 2 MG TABLET

Prescription Drug - Generic

$1

—

72603048001

PITAVASTATIN 4 MG TABLET

Prescription Drug - Generic

$1

—

72603050510

LIDOCAINE HCL 2% 100 MG/5 ML

Prescription Drug - Generic

$0

—

72603055802

MIRTAZAPINE 7.5 MG TABLET

Prescription Drug - Generic

$0

—

72603059010

NALOXONE 0.4 MG/ML VIAL

Prescription Drug - Generic

$4

—

72603061101

AZELASTINE 0.1% (137 MCG) SPRY

Prescription Drug - Generic

$0

—

72603065025

CYANOCOBALAMIN 1,000 MCG/ML VL

Prescription Drug - Generic

$2

—

72603066002

LEVOTHYROXINE 25 MCG TABLET

Prescription Drug - Generic

$0

—

72603066101

LEVOTHYROXINE 50 MCG TABLET

Prescription Drug - Generic

$0

—

72603066201

LEVOTHYROXINE 75 MCG TABLET

Prescription Drug - Generic

$0

—

72603066301

LEVOTHYROXINE 88 MCG TABLET

Prescription Drug - Generic

$0

—

72603066402

LEVOTHYROXINE 100 MCG TABLET

Prescription Drug - Generic

$0

—

72603066501

LEVOTHYROXINE 112 MCG TABLET

Prescription Drug - Generic

$0

—

72603066601

LEVOTHYROXINE 125 MCG TABLET

Prescription Drug - Generic

$0

—

72603066701

LEVOTHYROXINE 137 MCG TABLET

Prescription Drug - Generic

$0

—

72603066802

LEVOTHYROXINE 150 MCG TABLET

Prescription Drug - Generic

$0

—

72603066901

LEVOTHYROXINE 175 MCG TABLET

Prescription Drug - Generic

$0

—

72603070101

LEVOTHYROXINE 200 MCG TABLET

Prescription Drug - Generic

$0

—

72603070301

FLUOCINONIDE 0.05% SOLUTION

Prescription Drug - Generic

$0

—

72603072001

CANDESARTAN CILEXETIL 16 MG TB

Prescription Drug - Generic

$0

—

72603072101

CANDESARTAN CILEXETIL 32 MG TB

Prescription Drug - Generic

$1

—

72603072225

LIDOCAINE HCL 1% 200 MG/20 ML

Prescription Drug - Generic

$0

—

72603074425

LIDOCAINE HCL 2% 400 MG/20 ML

Prescription Drug - Generic

$0

—

72603081001

REPAGLINIDE 0.5 MG TABLET

Prescription Drug - Generic

$0

—

72603081101

REPAGLINIDE 1 MG TABLET

Prescription Drug - Generic

$0

—

72603081201

REPAGLINIDE 2 MG TABLET

Prescription Drug - Generic

$0

—

72603081601

METHENAMINE HIPP 1 GM TABLET

Prescription Drug - Generic

$0

—

72603082510

LIDOCAINE HCL 2% 1,000 MG/50 ML

Prescription Drug - Generic

$0

—

72603084001

FENOFIBRATE 54 MG TABLET

Prescription Drug - Generic

$0

—

72603084102

FENOFIBRATE 160 MG TABLET

Prescription Drug - Generic

$0

—

72603087001

NEBIVOLOL 2.5 MG TABLET

Prescription Drug - Generic

$0

—

72603087102

NEBIVOLOL 5 MG TABLET

Prescription Drug - Generic

$0

—

72603087202

NEBIVOLOL 10 MG TABLET

Prescription Drug - Generic

$0

—

72603087302

NEBIVOLOL 20 MG TABLET

Prescription Drug - Generic

$0

—

72603087418

ESTRADIOL 10 MCG VAGINAL INSRT

Prescription Drug - Generic

$7

—

72603087503

DROSPIRENONE-EE 3-0.02 MG TAB

Prescription Drug - Generic

$0

—

72603087801

KETOCONAZOLE 2% SHAMPOO

Prescription Drug - Generic

$0

—

72606002210

ADALIMUMAB-AATY(CF) 40 MG/0.4 ML AUTOINJECTOR

Prescription Drug - Generic

$495

—

72606003009

YUFLYMA(CF) 40 MG/0.4 ML AUTOINJECTOR

Prescription Drug - Brand

$914

—

72611071925

KETOROLAC 15 MG/ML VIAL

Prescription Drug - Generic

$1

—

72611074125

MIDAZOLAM HCL 2 MG/2 ML VIAL

Prescription Drug - Generic

$0

—

72611074910

MIDAZOLAM HCL 50 MG/10 ML VIAL

Prescription Drug - Generic

$0

—

72618300002

NURTEC ODT 75 MG TABLET

Prescription Drug - Brand

$129

—

72626270101

SOFOSBUVIR-VELPATASVIR 400-100

Prescription Drug - Generic

$278

—

72664021701

URSODIOL 300 MG CAPSULE

Prescription Drug - Generic

$0

—

72819015703

PALIPERIDONE ER 1.5 MG TABLET

Prescription Drug - Generic

$1

—

72819015803

PALIPERIDONE ER 3 MG TABLET

Prescription Drug - Generic

$1

—

My Cost List