Medical Procedure Costs

00023602205

NORCO 10-325 TABLET

Prescription Drug - Brand

$5

—

00023608210

INFED 100 MG/2 ML VIAL

Prescription Drug - Brand

$19

—

00023611803

CONDYLOX 0.5% GEL

Prescription Drug - Brand

$172

—

00023614230

RAPAFLO 8 MG CAPSULE

Prescription Drug - Brand

$8

—

00023614730

RAPAFLO 4 MG CAPSULE

Prescription Drug - Brand

$8

—

00023615004

CRINONE 4% GEL

Prescription Drug - Brand

$17

—

00023615108

CRINONE 8% GEL

Prescription Drug - Brand

$28

—

00023615308

OXYTROL 3.9 MG/24HR PATCH

Prescription Drug - Brand

$81

—

00023649810

UBRELVY 50 MG TABLET

Prescription Drug - Brand

$109

—

00023650116

UBRELVY 100 MG TABLET

Prescription Drug - Brand

$109

—

00023663010

REFRESH RELIEVA 0.5-0.9% DROP

Prescription Drug - Brand

$1

—

00023663410

REFRESH RELIEVA PF 0.5-0.9% DP

Prescription Drug - Brand

$1

—

00023695210

REFRESH DIGITAL EYE DROPS

Prescription Drug - Brand

$1

—

00023695430

REFRESH DIGITAL PF EYE DROPS

Prescription Drug - Brand

$0

—

00023833503

TAZORAC 0.05% GEL

Prescription Drug - Brand

$13

—

00023869450

AZELEX 20% CREAM

Prescription Drug - Brand

$13

—

00023884205

ALOCRIL 2% EYE DROPS

Prescription Drug - Brand

$42

—

00023915530

TAZORAC 0.05% CREAM

Prescription Drug - Brand

$13

—

00023915630

TAZORAC 0.1% CREAM

Prescription Drug - Brand

$14

—

00023916360

RESTASIS 0.05% EYE EMULSION

Prescription Drug - Brand

$10

—

00023917715

ALPHAGAN P 0.15% EYE DROPS

Prescription Drug - Brand

$40

—

00023920105

ELESTAT 0.05% EYE DROPS

Prescription Drug - Brand

$44

—

00023920515

REFRESH LIQUIGEL 1% EYE DROP

Prescription Drug - Brand

$1

—

00023921105

COMBIGAN EYE DROPS

Prescription Drug - Brand

$26

—

00023921115

COMBIGAN 0.2%-0.5% EYE DROPS

Prescription Drug - Brand

$39

—

00023923201

BOTOX COSMETIC 100 UNITS VIAL

Prescription Drug - Brand

$598

—

00023927705

ACULAR LS 0.4% OPHTH SOL

Prescription Drug - Brand

$55

—

00023932115

ALPHAGAN P 0.1% DROPS

Prescription Drug - Brand

$37

—

00023963708

OXYTROL FOR WOMEN 3.9 MG/24HR

Prescription Drug - Brand

$3

—

00024117190

PLAVIX 75 MG TABLET

Prescription Drug - Brand

$8

—

00024414260

MULTAQ 400 MG TABLET

Prescription Drug - Brand

$13

—

00024540131

AMBIEN 5 MG TABLET

Prescription Drug - Brand

$21

—

00024550131

AMBIEN CR 6.25 MG TABLET

Prescription Drug - Brand

$21

—

00024576105

SOLIQUA 100 UNIT-33 MCG/ML PEN

Prescription Drug - Brand

$57

—

00024580090

XYZAL 5 MG TABLET

Prescription Drug - Brand

$4

—

00024583701

FLOMAX 0.4 MG CAPSULE

Prescription Drug - Brand

$9

—

00024585090

AVAPRO 75 MG TABLET

Prescription Drug - Brand

$4

—

00024585130

AVAPRO 150 MG TABLET

Prescription Drug - Brand

$7

—

00024585230

AVAPRO 300 MG TABLET

Prescription Drug - Brand

$9

—

00024585590

AVALIDE 150-12.5 MG TABLET

Prescription Drug - Brand

$7

—

00024585630

AVALIDE 300-12.5 MG TABLET

Prescription Drug - Brand

$10

—

00024586903

TOUJEO SOLOSTAR 300 UNITS/ML

Prescription Drug - Brand

$80

—

00024587102

TOUJEO MAX SOLOSTAR 300 UNIT/ML

Prescription Drug - Brand

$83

—

00024591001

KEVZARA 200 MG/1.14 ML SYRINGE

Prescription Drug - Brand

$2,066

—

00024591401

DUPIXENT 300 MG/2 ML SYRINGE

Prescription Drug - Brand

$1,010

—

00024591502

DUPIXENT 300 MG/2 ML PEN

Prescription Drug - Brand

$1,008

—

00024591801

DUPIXENT 200 MG/1.14 ML SYRING

Prescription Drug - Brand

$1,775

—

00024591902

DUPIXENT 200 MG/1.14 ML PEN

Prescription Drug - Brand

$1,773

—

00024592201

KEVZARA 200 MG/1.14 ML PEN INJ

Prescription Drug - Brand

$2,080

—

00024592505

ADMELOG SOLOSTAR 100 UNIT/ML

Prescription Drug - Brand

$12

—

My Cost List