Medical Procedure Costs

00597014660

JENTADUETO 2.5 MG-500 MG TAB

Prescription Drug - Brand

$8

—

00597014760

JENTADUETO 2.5 MG-850 MG TAB

Prescription Drug - Brand

$8

—

00597014860

JENTADUETO 2.5 MG-1,000 MG TAB

Prescription Drug - Brand

$8

—

00597015290

JARDIANCE 10 MG TABLET

Prescription Drug - Brand

$11

—

00597015390

JARDIANCE 25 MG TABLET

Prescription Drug - Brand

$11

—

00597015561

STIOLTO RESPIMAT INHALER (60)

Prescription Drug - Brand

$116

—

00597015960

SYNJARDY 5-500 MG TABLET

Prescription Drug - Brand

$6

—

00597016061

SPIRIVA RESPIMAT 1.25 MCG INH

Prescription Drug - Brand

$126

—

00597016490

GLYXAMBI 25 MG-5 MG TABLET

Prescription Drug - Brand

$11

—

00597016860

SYNJARDY 12.5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00597017560

SYNJARDY 5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00597018060

SYNJARDY 12.5-500 MG TABLET

Prescription Drug - Brand

$6

—

00597018290

GLYXAMBI 10 MG-5 MG TABLET

Prescription Drug - Brand

$11

—

00597019261

STRIVERDI RESPIMAT INHAL SPRAY

Prescription Drug - Brand

$66

—

00597026010

GLUCAGEN DIAGNOSTIC 1 MG VIAL

Prescription Drug - Brand

$167

—

00597027094

JENTADUETO XR 2.5 MG-1,000 MG

Prescription Drug - Brand

$8

—

00597027581

JENTADUETO XR 5 MG-1,000 MG TB

Prescription Drug - Brand

$17

—

00597028090

SYNJARDY XR 10-1,000 MG TABLET

Prescription Drug - Brand

$11

—

00597028530

MIRAPEX ER 0.75 MG TABLET

Prescription Drug - Brand

$24

—

00597029074

SYNJARDY XR 5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00597029588

SYNJARDY XR 25-1,000 MG TABLET

Prescription Drug - Brand

$11

—

00597030093

SYNJARDY XR 12.5-1,000 MG TAB

Prescription Drug - Brand

$6

—

00597035556

PRADAXA 75 MG CAPSULE

Prescription Drug - Brand

$3

—

00597036082

PRADAXA 150 MG CAPSULE

Prescription Drug - Brand

$3

—

00597037597

CYLTEZO(CF) PEN 40 MG/0.8 ML

Prescription Drug - Brand

$3,199

—

00597038068

TRIJARDY XR 10-5-1,000 MG TAB

Prescription Drug - Brand

$11

—

00597038586

TRIJARDY XR 12.5-2.5-1,000 MG

Prescription Drug - Brand

$6

—

00597039071

TRIJARDY XR 25-5-1,000 MG TAB

Prescription Drug - Brand

$11

—

00597039582

TRIJARDY XR 5-2.5-1,000 MG TAB

Prescription Drug - Brand

$6

—

0059U

Test for presence of antibodies to Merkel cell polyoma virus oncoprotein in

Pathology/Laboratory

$323

—

00603014921

DOC-Q-LAX TABLET

Prescription Drug - Generic

$0

—

00603015032

DOC-Q-LACE 100 MG SOFTGEL

Prescription Drug - Generic

$0

—

00603018102

FIBERTAB 625 MG TABLET

Prescription Drug - Generic

$0

—

00603021021

MYTAB GAS 80 MG TABLET CHEW

Prescription Drug - Generic

$0

—

00603021120

MYTAB GAS MAX STR 125 MG TAB

Prescription Drug - Generic

$0

—

00603021321

MAGNESIUM OXIDE 420 MG TABLET

Prescription Drug - Generic

$0

—

00603024118

Q-DRYL 25 MG CAPSULE

Prescription Drug - Generic

$0

—

00603026329

Q-PAP 325 MG TABLET

Prescription Drug - Generic

$0

—

00603026832

Q-PAP EX-STR 500 MG TABLET

Prescription Drug - Generic

$0

—

00603028321

SENNALAX-S TABLET

Prescription Drug - Generic

$0

—

00603038046

SEA SOFT 0.65% NASAL MIST

Prescription Drug - Generic

$0

—

00603064888

TRIXAICIN 0.025% CREAM

Prescription Drug - Generic

$0

—

00603064988

TRIXAICIN HP 0.075% CREAM

Prescription Drug - Generic

$0

—

00603072854

CODITUSS DM SYRUP

Prescription Drug - Generic

$0

—

00603074758

DOC-Q-LACE 60 MG/15 ML SYRUP

Prescription Drug - Generic

$0

—

00603082358

Q-DRYL 12.5 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

00603083873

Q-PAP 80 MG/0.8 ML DROPS

Prescription Drug - Generic

$0

—

00603083958

Q-PAP 160 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

00603083994

Q-PAP 160 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

00603084354

CHILDREN'S Q-PAP 160 MG/5 ML

Prescription Drug - Generic

$0

—

My Cost List