Medical Procedure Costs

00591288830

HYDROXOCOBALAMIN 1,000 MCG/ML

Prescription Drug - Generic

$1

—

00591292754

LEVALBUTEROL TAR HFA 45 MCG INH

Prescription Drug - Generic

$3

—

00591298539

PHENADOZ 12.5 MG SUPPOSITORY

Prescription Drug - Generic

$4

—

00591299239

PHENADOZ 25 MG SUPPOSITORY

Prescription Drug - Generic

$4

—

00591313830

NIZATIDINE 300 MG CAPSULE

Prescription Drug - Generic

$1

—

00591319301

AFEDITAB CR 30 MG TABLET

Prescription Drug - Generic

$0

—

00591319401

AFEDITAB CR 60 MG TABLET

Prescription Drug - Generic

$0

—

00591321630

TESTOSTERONE 25 MG/2.5 GM PKT

Prescription Drug - Generic

$3

—

00591321901

BUTALBITAL-ASPIRIN-CAFFEINE CP

Prescription Drug - Generic

$1

—

00591322126

TESTOSTERONE ENAN 200 MG/ML

Prescription Drug - Generic

$14

—

00591322801

HYDROCODONE-ACETAMINOPHEN 10-750 TABLET

Prescription Drug - Generic

$1

—

00591355101

OXYCODONE-ASPIRIN 4.83-325 MG

Prescription Drug - Generic

$1

—

00591363101

HYDROMORPHONE HCL ER 32 MG TAB

Prescription Drug - Generic

$40

—

00591390087

MEMANTINE 5-10 MG TITRATION PK

Prescription Drug - Generic

$0

—

00591543801

QUINIDINE SULFATE 200 MG TAB

Prescription Drug - Generic

$0

—

00591571401

AMOXAPINE 50 MG TABLET

Prescription Drug - Generic

$1

—

00591571501

AMOXAPINE 100 MG TABLET

Prescription Drug - Generic

$1

—

00591578201

ATENOLOL-CHLORTHAL 50-25 TB

Prescription Drug - Generic

$0

—

00597000160

AGGRENOX 25 MG-200 MG CAPSULE

Prescription Drug - Brand

$9

—

00597000302

APTIVUS 250 MG CAPSULE

Prescription Drug - Brand

$17

—

00597000701

CATAPRES 0.2 MG TABLET

Prescription Drug - Brand

$4

—

00597001259

DULCOLAX EC 5 MG TABLET

Prescription Drug - Brand

$0

—

00597002402

COMBIVENT RESPIMAT 20-100 MCG

Prescription Drug - Brand

$124

—

00597002901

MOBIC 7.5 MG TABLET

Prescription Drug - Brand

$10

—

00597003001

MOBIC 15 MG TABLET

Prescription Drug - Brand

$14

—

00597003134

CATAPRES-TTS 1 PATCH

Prescription Drug - Brand

$67

—

00597003234

CATAPRES-TTS 2 PATCH

Prescription Drug - Brand

$113

—

00597003334

CATAPRES-TTS 3 PATCH

Prescription Drug - Brand

$163

—

00597003937

MICARDIS 20 MG TABLET

Prescription Drug - Brand

$7

—

00597004037

MICARDIS 40 MG TABLET

Prescription Drug - Brand

$5

—

00597004137

MICARDIS 80 MG TABLET

Prescription Drug - Brand

$4

—

00597004237

MICARDIS HCT 80-25 MG TABLET

Prescription Drug - Brand

$4

—

00597004337

MICARDIS HCT 40-12.5 MG TABLET

Prescription Drug - Brand

$4

—

00597004437

MICARDIS HCT 80-12.5 MG TABLET

Prescription Drug - Brand

$4

—

00597004660

VIRAMUNE 200 MG TABLET

Prescription Drug - Brand

$15

—

00597007547

SPIRIVA 18 MCG CP-HANDIHALER

Prescription Drug - Brand

$16

—

00597007575

SPIRIVA HANDIHALER 18 MCG CAP

Prescription Drug - Brand

$12

—

00597008717

ATROVENT 17 MCG HFA INHALER

Prescription Drug - Brand

$23

—

00597010061

SPIRIVA RESPIMAT 2.5 MCG INH

Prescription Drug - Brand

$126

—

00597010860

PRADAXA 110 MG CAPSULE

Prescription Drug - Brand

$3

—

00597010930

MIRAPEX ER 0.375 MG TABLET

Prescription Drug - Brand

$24

—

00597011330

MIRAPEX ER 1.5 MG TABLET

Prescription Drug - Brand

$23

—

00597011530

MIRAPEX ER 3 MG TABLET

Prescription Drug - Brand

$24

—

00597011630

MIRAPEX ER 4.5 MG TABLET

Prescription Drug - Brand

$24

—

00597012150

ZANTAC 150 MG TABLET

Prescription Drug - Brand

$0

—

00597012254

ZANTAC 75 MG TABLET

Prescription Drug - Brand

$0

—

00597012330

VIRAMUNE XR 400 MG TABLET

Prescription Drug - Brand

$27

—

00597012637

TWYNSTA 80-5 MG TABLET

Prescription Drug - Brand

$7

—

00597012737

TWYNSTA 80-10 MG TABLET

Prescription Drug - Brand

$7

—

00597014090

TRADJENTA 5 MG TABLET

Prescription Drug - Brand

$17

—

My Cost List