Medical Procedure Costs

00006057782

JANUMET 50-1,000 MG TABLET

Prescription Drug - Brand

$5

—

00006070520

NOROXIN 400 MG TABLET

Prescription Drug - Brand

$4

—

00006071044

FOSAMAX PLUS D 70 MG-2,800 UNITS

Prescription Drug - Brand

$42

—

00006073554

ZOCOR 10 MG TABLET

Prescription Drug - Brand

$4

—

00006171131

SINGULAIR 4 MG TABLET CHEW

Prescription Drug - Brand

$7

—

00006306603

EMEND 125 MG POWDER PACKET

Prescription Drug - Brand

$326

—

00006306901

PIFELTRO 100 MG TABLET

Prescription Drug - Brand

$61

—

00006308001

ISENTRESS HD 600 MG TABLET

Prescription Drug - Brand

$35

—

00006351936

TRUSOPT 2% EYE DROPS

Prescription Drug - Brand

$7

—

00006384130

SINGULAIR 4 MG GRANULES

Prescription Drug - Brand

$7

—

00006384371

INVANZ 1 GM VIAL

Prescription Drug - Brand

$122

—

00006386203

EMEND TRIPACK

Prescription Drug - Brand

$246

—

00006500701

DELSTRIGO 100-300-300 MG TAB

Prescription Drug - Brand

$93

—

00006502804

VERQUVO 2.5 MG TABLET

Prescription Drug - Brand

$23

—

00006502904

VERQUVO 5 MG TABLET

Prescription Drug - Brand

$23

—

00006503004

VERQUVO 10 MG TABLET

Prescription Drug - Brand

$23

—

00006536306

STEGLATRO 5 MG TABLET

Prescription Drug - Brand

$11

—

00006536406

STEGLATRO 15 MG TABLET

Prescription Drug - Brand

$11

—

00006536706

STEGLUJAN 5-100 MG TABLET

Prescription Drug - Brand

$17

—

00006536806

STEGLUJAN 15-100 MG TABLET

Prescription Drug - Brand

$18

—

00006536906

SEGLUROMET 2.5-500 MG TABLET

Prescription Drug - Brand

$6

—

00006537006

SEGLUROMET 7.5-500 MG TABLET

Prescription Drug - Brand

$6

—

00006537306

SEGLUROMET 2.5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00006537406

SEGLUROMET 7.5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00007337013

COREG CR 10 MG CAPSULE

Prescription Drug - Brand

$9

—

00007337113

COREG CR 20 MG CAPSULE

Prescription Drug - Brand

$9

—

00007337213

COREG CR 40 MG CAPSULE

Prescription Drug - Brand

$9

—

00007337313

COREG CR 80 MG CAPSULE

Prescription Drug - Brand

$9

—

00007365030

DYAZIDE 37.5-25 CAPSULE

Prescription Drug - Brand

$2

—

00007413920

COREG 3.125 MG TABLET

Prescription Drug - Brand

$5

—

00007414020

COREG 6.25 MG TABLET

Prescription Drug - Brand

$5

—

00007414120

COREG 12.5 MG TABLET

Prescription Drug - Brand

$5

—

00007414220

COREG 25 MG TABLET

Prescription Drug - Brand

$5

—

00007488313

REQUIP XL 6 MG TABLET

Prescription Drug - Brand

$14

—

00007488513

REQUIP XL 2 MG TABLET

Prescription Drug - Brand

$5

—

00007488713

REQUIP XL 4 MG TABLET

Prescription Drug - Brand

$9

—

00007488813

REQUIP XL 8 MG TABLET

Prescription Drug - Brand

$14

—

00007489220

REQUIP 1 MG TABLET

Prescription Drug - Brand

$5

—

00007518025

ALTABAX 1% OINTMENT

Prescription Drug - Brand

$14

—

00008084181

PROTONIX DR 40 MG TABLET

Prescription Drug - Brand

$14

—

00008084381

PROTONIX DR 20 MG TABLET

Prescription Drug - Brand

$14

—

00008084402

PROTONIX 40 MG SUSPENSION

Prescription Drug - Brand

$14

—

00008092355

PROTONIX IV 40 MG VIAL

Prescription Drug - Brand

$4

—

00008103006

RAPAMUNE 1 MG/ML ORAL SOLN

Prescription Drug - Brand

$32

—

00008104010

RAPAMUNE 0.5 MG TABLET

Prescription Drug - Brand

$17

—

00008104110

RAPAMUNE 1 MG TABLET

Prescription Drug - Brand

$33

—

00008104205

RAPAMUNE 2 MG TABLET

Prescription Drug - Brand

$67

—

00008112312

DUAVEE 0.45-20 MG TABLET

Prescription Drug - Brand

$6

—

00008121030

PRISTIQ ER 25 MG TABLET

Prescription Drug - Brand

$14

—

00008121130

PRISTIQ ER 50 MG TABLET

Prescription Drug - Brand

$14

—

My Cost List