Medical Procedure Costs

00002143380

TRULICITY 0.75 MG/0.5 ML PEN

Prescription Drug - Brand

$488

—

00002143480

TRULICITY 1.5 MG/0.5 ML PEN

Prescription Drug - Brand

$488

—

00002143611

EMGALITY 120 MG/ML PEN

Prescription Drug - Brand

$735

—

00002144509

TALTZ 80 MG/ML AUTOINJECTOR (3-PACK)

Prescription Drug - Brand

$7,371

—

00002144511

TALTZ 80 MG/ML AUTOINJECTOR

Prescription Drug - Brand

$7,348

—

00002144527

TALTZ 80 MG/ML AUTOINJECTOR (2-PACK)

Prescription Drug - Brand

$7,436

—

00002145780

MOUNJARO 15 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002146080

MOUNJARO 12.5 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002147180

MOUNJARO 10 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002148480

MOUNJARO 7.5 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002149580

MOUNJARO 5 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002150680

MOUNJARO 2.5 MG/0.5 ML PEN

Prescription Drug - Brand

$539

—

00002197590

AXIRON 30 MG/ACTUATION SOLN

Prescription Drug - Brand

$6

—

00002223680

TRULICITY 3 MG/0.5 ML PEN

Prescription Drug - Brand

$488

—

00002237711

EMGALITY 120 MG/ML SYRINGE

Prescription Drug - Brand

$735

—

00002245780

ZEPBOUND 15 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002246080

ZEPBOUND 12.5 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002247180

ZEPBOUND 10 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002248480

ZEPBOUND 7.5 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002249580

ZEPBOUND 5 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002250680

ZEPBOUND 2.5 MG/0.5 ML PEN

Prescription Drug - Brand

$526

—

00002311509

EMGALITY 300 MG DOSE (100 MG/ML X 3 SYRINGES)

Prescription Drug - Brand

$612

—

00002318280

TRULICITY 4.5 MG/0.5 ML PEN

Prescription Drug - Brand

$488

—

00002322730

STRATTERA 10 MG CAPSULE

Prescription Drug - Brand

$13

—

00002322830

STRATTERA 25 MG CAPSULE

Prescription Drug - Brand

$13

—

00002322930

STRATTERA 40 MG CAPSULE

Prescription Drug - Brand

$14

—

00002323560

CYMBALTA 20 MG CAPSULE

Prescription Drug - Brand

$8

—

00002323830

STRATTERA 18 MG CAPSULE

Prescription Drug - Brand

$13

—

00002323930

STRATTERA 60 MG CAPSULE

Prescription Drug - Brand

$14

—

00002324090

CYMBALTA 30 MG CAPSULE

Prescription Drug - Brand

$9

—

00002325030

STRATTERA 80 MG CAPSULE

Prescription Drug - Brand

$15

—

00002325130

STRATTERA 100 MG CAPSULE

Prescription Drug - Brand

$15

—

00002327030

CYMBALTA 60 MG CAPSULE

Prescription Drug - Brand

$9

—

00002411230

ZYPREXA 2.5 MG TABLET

Prescription Drug - Brand

$10

—

00002411630

ZYPREXA 7.5 MG TABLET

Prescription Drug - Brand

$18

—

00002411730

ZYPREXA 10 MG TABLET

Prescription Drug - Brand

$23

—

00002418230

OLUMIANT 2 MG TABLET

Prescription Drug - Brand

$92

—

00002418430

EVISTA 60 MG TABLET

Prescription Drug - Brand

$6

—

00002431208

REYVOW 50 MG TABLET

Prescription Drug - Brand

$89

—

00002441530

ZYPREXA 15 MG TABLET

Prescription Drug - Brand

$34

—

00002445485

ZYPREXA ZYDIS 10 MG TABLET

Prescription Drug - Brand

$19

—

00002445685

ZYPREXA ZYDIS 20 MG TABLET

Prescription Drug - Brand

$37

—

00002446230

CIALIS 5 MG TABLET

Prescription Drug - Brand

$9

—

00002446330

CIALIS 10 MG TABLET

Prescription Drug - Brand

$66

—

00002446430

CIALIS 20 MG TABLET

Prescription Drug - Brand

$54

—

00002446579

CIALIS 2.5 MG TABLET

Prescription Drug - Brand

$11

—

00002447930

OLUMIANT 4 MG TABLET

Prescription Drug - Brand

$185

—

00002449108

REYVOW 100 MG TABLET

Prescription Drug - Brand

$89

—

00002512101

EFFIENT 5 MG TABLET

Prescription Drug - Brand

$15

—

00002751001

HUMALOG 100 UNIT/ML VIAL

Prescription Drug - Brand

$6

—

My Cost List