Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

Vibra Hospital Of Denver

Thornton, CO · CCN 062014 · Rates published

5,626 distinct procedures filed
60 distinct payers
273,352 rate rows
2026-07-31 last MRF observed
Data quality

264,033 of 273,352 rate rows are consumer-grade (96.6%)

9,319 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
template filing: same amount across many unrelated codes — excluded 9,164
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 98
placeholder amount (≤ $0.02) — excluded from medians 33
percent-of-charges filed in the dollar field — excluded from medians 15
per-diem day rate — not a per-procedure price 8
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://vhdenver.com/wp-content/uploads/sites/27/2026/03/030501948_vibra-hospital-of-denver_standardcharges.csv
Found on page https://vhdenver.com/about-us/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-09-21
Content fingerprint 60a74fef210e169a… · 12,996,594 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
3
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 14 $169,421.95 $169,421.95 $169,421.95 nat. median
$10,971
outlier · 15.4×
4
OTHER 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 14 $139,348.20 $139,348.20 $139,348.20 nat. median
$7,428
outlier · 18.8×
164
OTHER 		Major Chest Procedures With Cc 14 $115,003.01 $115,003.01 $115,003.01 nat. median
$102
outlier · 1132.3×
163
OTHER 		Major Chest Procedures With Mcc 14 $115,003.01 $115,003.01 $115,003.01 nat. median
$18,226
outlier · 6.3×
165
OTHER 		Major Chest Procedures Without Cc/mcc 14 $115,003.01 $115,003.01 $115,003.01 nat. median
$11,098
outlier · 10.4×
11527070442
OTHER 		Sodium Fluoride/Potassium Nit 22 $0.75 $63.20 $114,904.33 —
115421101
OTHER 		Midodrine Hcl 2.5 Mg 22 $0.75 $42.30 $114,904.33 —
115442201
OTHER 		Dantrolene Sodium 50 Mg 22 $0.75 $42.30 $114,904.33 —
10019012039
OTHER 		Esmolol Hcl 100 Mg 22 $0.75 $42.30 $114,904.33 —
10019005561
OTHER 		Brevibloc 2500 Mg 22 $0.75 $622.08 $114,904.33 —
11534016616
OTHER 		Sodium Polystyrene Sulfonate 22 $0.75 $42.30 $114,904.33 —
11086003010
OTHER 		Salicylic Acid 6% Gel 22 $0.75 $204.80 $114,904.33 —
11509000372
OTHER 		Vagisil 22 $0.75 $42.30 $114,904.33 —
11509000367
OTHER 		Vagisil 5 %-2 % 22 $0.75 $42.30 $114,904.33 —
0791T
CPT 		St Virtual Gait Trn Ea 15 Min 22 $0.75 $105.00 $114,904.33 nat. median
$145
outlier · 793.6×
10122032501
OTHER 		Cardene I.v. 22 $0.75 $42.30 $114,904.33 —
10122031410
OTHER 		Cardene I.v. 22 $0.75 $487.92 $114,904.33 —
10006070038
OTHER 		Calcium Carbonate/Vit D3 500/ 22 $0.75 $42.30 $114,904.33 —
10122061010
OTHER 		Clevidipine Butyrate IV 22 $0.75 $410.72 $114,904.33 —
10122090112
OTHER 		Zyflo 22 $0.75 $150.36 $114,904.33 —
10135012601
OTHER 		Aspirin 325 Mg 22 $0.75 $42.30 $114,904.33 —
10135067191
OTHER 		Clotrimazole 22 $0.75 $160.52 $114,904.33 —
115173901
OTHER 		Methylphenidate Hcl ER 22 $0.75 $42.30 $114,904.33 —
10147089103
OTHER 		Galantamine Hbr 22 $0.75 $42.30 $114,904.33 —
10147092205
OTHER 		haloperidoL Decanoate 22 $0.75 $236.88 $114,904.33 —
10019055390
OTHER 		Transderm-scop 22 $0.75 $42.30 $114,904.33 —
10000031806
OTHER 		Mederma Scar Cream 22 $0.60 $42.30 $114,904.33 —
10223020103
OTHER 		Cetacaine Spray 22 $0.75 $732.32 $114,904.33 —
10119002003
OTHER 		Glycerin/Propyl Glycol 0.3%-1% 22 $0.75 $42.30 $114,904.33 —
10310028313
OTHER 		Orajel 3x Toothache-gum 22 $0.75 $42.30 $114,904.33 —
10331000167
OTHER 		Witch Hazel Topical Solution 22 $0.60 $42.30 $114,904.33 —
10310043028
OTHER 		Orajel 20-0.26% 22 $0.75 $42.30 $114,904.33 —
10119002239
OTHER 		Soothe 22 $0.75 $42.30 $114,904.33 —
10310032503
OTHER 		Orajel 20%/0.5% 22 $0.75 $42.30 $114,904.33 —
10361077831
OTHER 		E-z Disk 22 $0.75 $42.30 $114,904.33 —
10370010203
OTHER 		buPROPion Hcl 300 Mg 22 $0.75 $42.30 $114,904.33 —
10481011108
OTHER 		Lugol's 22 $0.75 $43.76 $114,904.33 —
10631009160
OTHER 		Eurax 22 $0.75 $2,428.42 $114,904.33 —
10631028605
OTHER 		Lac-hydrin Five 22 $0.75 $53.04 $114,904.33 —
10631040701
OTHER 		Proctosol-hc 22 $0.75 $336.00 $114,904.33 —
10702002501
OTHER 		Phentermine Hcl 22 $0.75 $42.30 $114,904.33 —
10702002901
OTHER 		Phentermine Hcl 22 $0.75 $42.30 $114,904.33 —
10702005601
OTHER 		oxyCODONE Hcl 10 Mg 22 $0.75 $42.30 $114,904.33 —
10702007001
OTHER 		oxyMORphone Hcl 22 $0.75 $42.30 $114,904.33 —
10702007006
OTHER 		oxyMORphone Hcl 5mg 22 $0.75 $42.30 $114,904.33 —
10702007701
OTHER 		Phendimetrazine Tartrate 35mg 22 $0.75 $42.30 $114,904.33 —
10147015001
OTHER 		Itraconazole Oral 22 $0.75 $42.30 $114,904.33 —
10019036040
OTHER 		Forane 22 $0.75 $115.10 $114,904.33 —
11017041009
OTHER 		Tinactin 22 $0.75 $42.30 $114,904.33 —
10310031840
OTHER 		Orajel 3x Mouth Sores 22 $0.75 $42.30 $114,904.33 —

Other procedures at this hospital

Browse this hospital's 5,626 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
3 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 24 14 $169,421.95 $169,421.95 $169,421.95 $169,421.95 $169,421.95 2026-05-09
4 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 24 14 $139,348.20 $139,348.20 $139,348.20 $139,348.20 $139,348.20 2026-05-09
165 OTHER Major Chest Procedures Without Cc/mcc 24 14 $115,003.01 $115,003.01 $115,003.01 $115,003.01 $115,003.01 2026-05-09
163 OTHER Major Chest Procedures With Mcc 24 14 $115,003.01 $115,003.01 $115,003.01 $115,003.01 $115,003.01 2026-05-09
164 OTHER Major Chest Procedures With Cc 24 14 $115,003.01 $115,003.01 $115,003.01 $115,003.01 $115,003.01 2026-05-09
173089314 OTHER Fluticasone/Umeclidin/Vilanter 52 22 $1,471.20 $1,471.20 $0.75 $1,471.20 $114,904.33 2026-05-09
17433987603 OTHER Enemeez 52 22 $15.68 $15.68 $0.75 $42.30 $114,904.33 2026-05-09
17433987703 OTHER Enemeez 52 22 $15.68 $15.68 $0.75 $42.30 $114,904.33 2026-05-09
173069704 OTHER Advair Diskus 52 22 $356.11 $356.11 $0.75 $356.11 $114,904.33 2026-05-09
173068224 OTHER Ventolin Hfa 52 22 $109.06 $109.06 $0.75 $109.06 $114,904.33 2026-05-09
173091610 OTHER Fluticasone/Vilanterol 50-25 M 52 22 $1,954.66 $1,954.66 $0.75 $1,954.66 $114,904.33 2026-05-09
173075700 OTHER LaMICtal Xr 52 22 $153.50 $153.50 $0.75 $153.50 $114,904.33 2026-05-09
173087414 OTHER Arnuity Ellipta 52 22 $466.99 $466.99 $0.75 $466.99 $114,904.33 2026-05-09
173088710 OTHER Trelegy Ellipta 100-62.5 52 22 $3,156.86 $3,156.86 $0.75 $3,156.86 $114,904.33 2026-05-09
173071520 OTHER Advair Hfa 45-21 Mcg 52 22 $1,203.84 $1,203.84 $0.75 $1,203.84 $114,904.33 2026-05-09
169517603 OTHER Vagifem 52 22 $102.10 $102.10 $0.75 $102.10 $114,904.33 2026-05-09
169418113 OTHER Semaglutide 52 22 $4,648.90 $4,648.90 $0.75 $4,648.90 $114,904.33 2026-05-09
173069504 OTHER Advair Diskus 52 22 $218.50 $218.50 $0.75 $218.50 $114,904.33 2026-05-09
10019005561 OTHER Brevibloc 2500 Mg 52 22 $622.08 $622.08 $0.75 $622.08 $114,904.33 2026-05-09
0791T CPT St Virtual Gait Trn Ea 15 Min 156 22 $105.00 $105.00 $0.75 $105.00 $114,904.33 2026-05-09
10019012039 OTHER Esmolol Hcl 100 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
173069604 OTHER Advair Diskus 52 22 $218.50 $218.50 $0.75 $218.50 $114,904.33 2026-05-09
173089201 OTHER Mepolizumab Injection 52 22 $17,706.38 $17,706.38 $0.75 $17,706.38 $114,904.33 2026-05-09
10147089103 OTHER Galantamine Hbr 52 22 $24.42 $24.42 $0.75 $42.30 $114,904.33 2026-05-09
169431430 OTHER Semaglutide 52 22 $154.96 $154.96 $0.75 $154.96 $114,904.33 2026-05-09
173073500 OTHER Imitrex 25 Mg 52 22 $166.74 $166.74 $0.75 $166.74 $114,904.33 2026-05-09
173087310 OTHER Incruse Ellipta 52 22 $1,699.68 $1,699.68 $0.75 $1,699.68 $114,904.33 2026-05-09
173087306 OTHER Incruse Ellipta 52 22 $360.24 $360.24 $0.75 $360.24 $114,904.33 2026-05-09
173054700 OTHER Mepron 52 22 $159.17 $159.17 $0.75 $159.17 $114,904.33 2026-05-09
173088214 OTHER Breo Ellipta 200-25mcg 52 22 $753.02 $753.02 $0.75 $753.02 $114,904.33 2026-05-09
169430730 OTHER Semaglutide 52 22 $154.96 $154.96 $0.75 $154.96 $114,904.33 2026-05-09
10119002239 OTHER Soothe 52 22 $32.74 $32.74 $0.75 $42.30 $114,904.33 2026-05-09
173051700 OTHER Flolan .5 Mg 52 22 $89.71 $89.71 $0.75 $89.71 $114,904.33 2026-05-09
115703301 OTHER Fludrocortisone Acetate .1 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10006070038 OTHER Calcium Carbonate/Vit D3 500/ 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10370010203 OTHER buPROPion Hcl 300 Mg 52 22 $19.07 $19.07 $0.75 $42.30 $114,904.33 2026-05-09
169406012 OTHER Victoza Pen 52 22 $1,304.45 $1,304.45 $0.75 $1,304.45 $114,904.33 2026-05-09
169477212 OTHER Semaglutide (2 Mg/dose) 52 22 $4,648.90 $4,648.90 $0.75 $4,648.90 $114,904.33 2026-05-09
10122061010 OTHER Clevidipine Butyrate IV 52 22 $410.72 $410.72 $0.75 $410.72 $114,904.33 2026-05-09
10631040701 OTHER Proctosol-hc 52 22 $336.00 $336.00 $0.75 $336.00 $114,904.33 2026-05-09
10702002501 OTHER Phentermine Hcl 52 22 $6.17 $6.17 $0.75 $42.30 $114,904.33 2026-05-09
10122090112 OTHER Zyflo 52 22 $150.36 $150.36 $0.75 $150.36 $114,904.33 2026-05-09
10702005601 OTHER oxyCODONE Hcl 10 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10135012601 OTHER Aspirin 325 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
169413013 OTHER Semaglutide Injection 52 22 $4,648.90 $4,648.90 $0.75 $4,648.90 $114,904.33 2026-05-09
173051900 OTHER Flolan 1.5 Mg 52 22 $216.67 $216.67 $0.75 $216.67 $114,904.33 2026-05-09
173088714 OTHER Trelegy Ellipta 52 22 $1,471.20 $1,471.20 $0.75 $1,471.20 $114,904.33 2026-05-09
173085702 OTHER Ph 12 Diluent For Flolan 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11017041009 OTHER Tinactin 52 22 $27.60 $27.60 $0.75 $42.30 $114,904.33 2026-05-09
11086003010 OTHER Salicylic Acid 6% Gel 52 22 $204.80 $204.80 $0.75 $204.80 $114,904.33 2026-05-09
10147092205 OTHER haloperidoL Decanoate 52 22 $236.88 $236.88 $0.75 $236.88 $114,904.33 2026-05-09
113034405 OTHER Nicotine Polacrilex 2 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10019055390 OTHER Transderm-scop 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
173071722 OTHER Fluticasone/Salmeterol 230-21m 52 22 $1,227.60 $1,227.60 $0.75 $1,227.60 $114,904.33 2026-05-09
173044902 OTHER Imitrex 6 Mg 52 22 $969.79 $969.79 $0.75 $969.79 $114,904.33 2026-05-09
173068101 OTHER Relenza 5 Mg 52 22 $283.20 $283.20 $0.75 $283.20 $114,904.33 2026-05-09
173085914 OTHER Breo Ellipta 100-25mcg 52 22 $753.02 $753.02 $0.75 $753.02 $114,904.33 2026-05-09
173086910 OTHER Anoro Ellipta 52 22 $2,279.23 $2,279.23 $0.75 $2,279.23 $114,904.33 2026-05-09
173052100 OTHER Salmeterol Xinafoate 52 22 $2,032.61 $2,032.61 $0.75 $2,032.61 $114,904.33 2026-05-09
11534016616 OTHER Sodium Polystyrene Sulfonate 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
115421101 OTHER Midodrine Hcl 2.5 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
173064460 OTHER LaMICtal 52 22 $58.83 $58.83 $0.75 $58.83 $114,904.33 2026-05-09
10310032503 OTHER Orajel 20%/0.5% 52 22 $28.22 $28.22 $0.75 $42.30 $114,904.33 2026-05-09
10119002090 OTHER Opcon-a 52 22 $23.18 $23.18 $0.75 $42.30 $114,904.33 2026-05-09
121177505 OTHER Codeine Phosphate/Guaifenesin 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121176230 OTHER Mag-al Plus Xs 52 22 $18.16 $18.16 $0.75 $42.30 $114,904.33 2026-05-09
10310043028 OTHER Orajel 20-0.26% 52 22 $18.68 $18.68 $0.75 $42.30 $114,904.33 2026-05-09
116200104 OTHER Chlorhexidine Gluconate 0.12% 52 22 $30.00 $30.00 $0.75 $42.30 $114,904.33 2026-05-09
10006070013 OTHER Mag Delay 64 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
169430330 OTHER Semaglutide 52 22 $154.96 $154.96 $0.75 $154.96 $114,904.33 2026-05-09
10361077831 OTHER E-z Disk 52 22 $13.09 $13.09 $0.75 $42.30 $114,904.33 2026-05-09
10122031410 OTHER Cardene I.v. 52 22 $487.92 $487.92 $0.75 $487.92 $114,904.33 2026-05-09
11701003132 OTHER Hydrophilic Cream 52 22 $99.40 $99.40 $0.75 $99.40 $114,904.33 2026-05-09
11701003816 OTHER Micro-guard 52 22 $32.88 $32.88 $0.75 $42.30 $114,904.33 2026-05-09
10481011108 OTHER Lugol's 52 22 $43.76 $43.76 $0.75 $43.76 $114,904.33 2026-05-09
10122032501 OTHER Cardene I.v. 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10631009160 OTHER Eurax 52 22 $2,428.42 $2,428.42 $0.75 $2,428.42 $114,904.33 2026-05-09
11701006723 OTHER Critic-aid Clear Af 52 22 $31.64 $31.64 $0.75 $42.30 $114,904.33 2026-05-09
10631028605 OTHER Lac-hydrin Five 52 22 $53.04 $53.04 $0.75 $53.04 $114,904.33 2026-05-09
11845007141 OTHER Riboflavin (Vitamin B2) 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11845009661 OTHER Cyanocobalamin (Vitamin B-12) 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11845013665 OTHER Lutein 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11845013789 OTHER Gluc Su/Chondro Su A/Vit C/Mn 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11845014028 OTHER Lutein 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10702002901 OTHER Phentermine Hcl 52 22 $6.28 $6.28 $0.75 $42.30 $114,904.33 2026-05-09
11917004964 OTHER Petrolatum,white 52 22 $27.96 $27.96 $0.75 $42.30 $114,904.33 2026-05-09
11917004966 OTHER Petrolatum,white 52 22 $15.96 $15.96 $0.75 $42.30 $114,904.33 2026-05-09
11917007171 OTHER Oral Analgesic 52 22 $23.96 $23.96 $0.75 $42.30 $114,904.33 2026-05-09
10702007001 OTHER oxyMORphone Hcl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11917013546 OTHER Cranberry Conc/Ascorbic Acid 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10702007006 OTHER oxyMORphone Hcl 5mg 52 22 $14.28 $14.28 $0.75 $42.30 $114,904.33 2026-05-09
10135067191 OTHER Clotrimazole 52 22 $160.52 $160.52 $0.75 $160.52 $114,904.33 2026-05-09
10702007701 OTHER Phendimetrazine Tartrate 35mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11994001104 OTHER Definity 1.1 Mg 52 22 $835.50 $835.50 $0.75 $835.50 $114,904.33 2026-05-09
173071720 OTHER Advair Hfa 230-21mcg 52 22 $2,110.66 $2,110.66 $0.75 $2,110.66 $114,904.33 2026-05-09
173087614 OTHER Arnuity Ellipta 52 22 $625.25 $625.25 $0.75 $625.25 $114,904.33 2026-05-09
172208960 OTHER hydroCHLOROthiazide 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10019036040 OTHER Forane 52 22 $115.10 $115.10 $0.75 $115.10 $114,904.33 2026-05-09
121043130 OTHER Magnesium Hydroxide 52 22 $9.36 $9.36 $0.75 $42.30 $114,904.33 2026-05-09
121048905 OTHER diphenhydrAMINE Hcl - Ud 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121053005 OTHER Ferrous Sulfate 52 22 $16.28 $16.28 $0.75 $42.30 $114,904.33 2026-05-09
121058104 OTHER haloperidoL Lactate Oral 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121058105 OTHER haloperidoL Lactate 2 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121059515 OTHER Sod Citra-citric Acid 500-334m 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121059530 OTHER Sodium Citrate-citric Ac 3g-2g 52 22 $8.68 $8.68 $0.75 $42.30 $114,904.33 2026-05-09
121063805 OTHER Guaifenesin/Dextromethorphan - 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121064610 OTHER Amantadine Hcl Oral Soln 52 22 $17.24 $17.24 $0.75 $42.30 $114,904.33 2026-05-09
121064616 OTHER Amantadine Hcl Oral 97 22 $73.80 $73.80 $0.75 $73.80 $114,904.33 2026-05-09
121065304 OTHER fluPHENAZine Hcl 52 22 $12.55 $12.55 $0.75 $42.30 $114,904.33 2026-05-09
121065402 OTHER fluPHENAZine Hcl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10000031806 OTHER Mederma Scar Cream 52 22 $1.50 $1.50 $0.60 $42.30 $114,904.33 2026-05-09
173013555 OTHER buPROPion Hcl Sr 52 22 $37.79 $37.79 $0.75 $42.30 $114,904.33 2026-05-09
11509000372 OTHER Vagisil 52 22 $16.61 $16.61 $0.75 $42.30 $114,904.33 2026-05-09
17139040004 OTHER Binosto 52 22 $360.00 $360.00 $0.75 $360.00 $114,904.33 2026-05-09
10223020103 OTHER Cetacaine Spray 52 22 $732.32 $732.32 $0.75 $732.32 $114,904.33 2026-05-09
172731320 OTHER Cyclosporine Oral Soln (bulk) 277 22 $1,198.20 $1,198.20 $0.75 $1,198.20 $114,904.33 2026-05-09
11523716201 OTHER Claritin-d 12 Hour 5 Mg-120mg 52 22 $5.79 $5.79 $0.75 $42.30 $114,904.33 2026-05-09
173086906 OTHER Umeclidinium Brm/Vilanterol Tr 52 22 $547.78 $547.78 $0.75 $547.78 $114,904.33 2026-05-09
10119002003 OTHER Glycerin/Propyl Glycol 0.3%-1% 52 22 $20.11 $20.11 $0.75 $42.30 $114,904.33 2026-05-09
17139061740 OTHER Estrogel 52 22 $768.00 $768.00 $0.75 $768.00 $114,904.33 2026-05-09
121085416 OTHER Sulfatrim Pediatric 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121104516 OTHER Nystatin Suspension 100,000 Un 52 22 $463.96 $463.96 $0.75 $463.96 $114,904.33 2026-05-09
121127600 OTHER Guaifenesin/Dextromethorphan 52 22 $11.08 $11.08 $0.75 $42.30 $114,904.33 2026-05-09
121148800 OTHER guaiFENesin - Ud 52 22 $7.72 $7.72 $0.75 $42.30 $114,904.33 2026-05-09
121159810 OTHER levETIRAcetam Oral 1000 Mg/10m 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
10310028313 OTHER Orajel 3x Toothache-gum 52 22 $28.22 $28.22 $0.75 $42.30 $114,904.33 2026-05-09
115521116 OTHER Colestipol Hcl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121176130 OTHER Mag-al Plus 52 22 $15.16 $15.16 $0.75 $42.30 $114,904.33 2026-05-09
16729002215 OTHER Pioglitazone Hcl 45 Mg 52 22 $46.47 $46.47 $0.75 $46.47 $114,904.33 2026-05-09
16714068401 OTHER Simvastatin 40 Mg 52 22 $19.66 $19.66 $0.75 $42.30 $114,904.33 2026-05-09
115552210 OTHER Fenofibrate 160 Mg 52 22 $9.51 $9.51 $0.75 $42.30 $114,904.33 2026-05-09
121197100 OTHER Acetaminophen 52 22 $9.76 $9.76 $0.75 $42.30 $114,904.33 2026-05-09
121282321 OTHER Acetaminophen - Ud 650mg/20.3m 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121467540 OTHER Valproic Acid (As Sodium Salt) 52 22 $9.44 $9.44 $0.75 $42.30 $114,904.33 2026-05-09
121472105 OTHER FLUoxetine Hcl Oral - Ud 52 22 $27.36 $27.36 $0.75 $42.30 $114,904.33 2026-05-09
121472215 OTHER Senna 52 22 $19.32 $19.32 $0.75 $42.30 $114,904.33 2026-05-09
121476605 OTHER Calcium Carbonate 500 Mg 52 22 $12.28 $12.28 $0.75 $42.30 $114,904.33 2026-05-09
121482015 OTHER Theophylline Anhydrous - Ud 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121496705 OTHER Sennosides - Ud 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
116200116 OTHER Chlorhexidine Gluconate 0.12% 52 22 $48.00 $48.00 $0.75 $48.00 $114,904.33 2026-05-09
12277050604 OTHER Mg217 Psoriasis 52 22 $41.96 $41.96 $0.75 $42.30 $114,904.33 2026-05-09
10331000167 OTHER Witch Hazel Topical Solution 52 22 $1.50 $1.50 $0.60 $42.30 $114,904.33 2026-05-09
11701002214 OTHER Atrac-tain 52 22 $46.84 $46.84 $0.75 $46.84 $114,904.33 2026-05-09
12496120203 OTHER Suboxone 2 Mg-0.5mg 52 22 $24.05 $24.05 $0.75 $42.30 $114,904.33 2026-05-09
12496120403 OTHER Suboxone 4mg-1mg 52 22 $43.10 $43.10 $0.75 $43.10 $114,904.33 2026-05-09
11701002223 OTHER Urea/Alpha Hydroxy Acids 10%-4 52 22 $29.24 $29.24 $0.75 $42.30 $114,904.33 2026-05-09
12546062749 OTHER Halls 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
12547017162 OTHER Benadryl Itch Stopping 52 22 $16.90 $16.90 $0.75 $42.30 $114,904.33 2026-05-09
126001661 OTHER Prevident 5000 52 22 $91.78 $91.78 $0.75 $91.78 $114,904.33 2026-05-09
126008008 OTHER Peroxyl Dental Rinse 52 22 $19.15 $19.15 $0.75 $42.30 $114,904.33 2026-05-09
11701004514 OTHER Baza Antifungal 52 22 $52.56 $52.56 $0.75 $52.56 $114,904.33 2026-05-09
12843037312 OTHER Phillips' Milk Of Magnesia 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
12870000101 OTHER Silver Nitrate Applicator 75 % 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11701004523 OTHER Baza Antifungal 52 22 $29.20 $29.20 $0.75 $42.30 $114,904.33 2026-05-09
11701005032 OTHER Critic-aid 52 22 $58.60 $58.60 $0.75 $58.60 $114,904.33 2026-05-09
13010250 OTHER Azulfidine 52 22 $10.09 $10.09 $0.75 $42.30 $114,904.33 2026-05-09
13107003601 OTHER Dextroamphetamine Sulfate 52 22 $12.60 $12.60 $0.75 $42.30 $114,904.33 2026-05-09
13107007201 OTHER Dextroamphetamine/Amphetamine 52 22 $6.86 $6.86 $0.75 $42.30 $114,904.33 2026-05-09
13107007301 OTHER Dextroamphetamine/Amphetamine 52 22 $6.86 $6.86 $0.75 $42.30 $114,904.33 2026-05-09
131181067 OTHER Vimpat 52 22 $464.02 $464.02 $0.75 $464.02 $114,904.33 2026-05-09
131247735 OTHER Vimpat 50 Mg 52 22 $56.53 $56.53 $0.75 $56.53 $114,904.33 2026-05-09
131247860 OTHER Vimpat 52 22 $97.23 $97.23 $0.75 $97.23 $114,904.33 2026-05-09
131247960 OTHER Vimpat 52 22 $102.97 $102.97 $0.75 $102.97 $114,904.33 2026-05-09
131248035 OTHER Vimpat 200 Mg 52 22 $93.63 $93.63 $0.75 $93.63 $114,904.33 2026-05-09
131541072 OTHER Vimpat Oral Soln 142 22 $209.60 $209.60 $0.75 $209.60 $114,904.33 2026-05-09
132020140 OTHER Fleet Enema 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
132070336 OTHER Bisacodyl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
13264902 OTHER Genotropin 52 22 $145.71 $145.71 $0.75 $145.71 $114,904.33 2026-05-09
13265002 OTHER Genotropin 52 22 $291.47 $291.47 $0.75 $291.47 $114,904.33 2026-05-09
132874302 OTHER Summer's Eve Douche 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11917001006 OTHER Glycerin Adult 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
135008969 OTHER Citrucel 52 22 $36.19 $36.19 $0.75 $42.30 $114,904.33 2026-05-09
135019902 OTHER Citrucel 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
135020001 OTHER Abreva 10 % 52 22 $123.92 $123.92 $0.75 $123.92 $114,904.33 2026-05-09
135022806 OTHER Tums Ultra 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
135057401 OTHER Gaviscon 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
13533013101 OTHER Tetanus, Diphtheria Tox,adult 52 22 $134.35 $134.35 $0.75 $134.35 $114,904.33 2026-05-09
13533063402 OTHER Hypertet S-d 250 Unit 52 22 $3,116.02 $3,116.02 $0.75 $3,116.02 $114,904.33 2026-05-09
13533080071 OTHER Gamunex-c 52 22 $6,804.00 $6,804.00 $0.75 $6,804.00 $114,904.33 2026-05-09
11917007913 OTHER Ubidecarenone 200 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
13668009190 OTHER Pramipexole Di-hcl 52 22 $11.80 $11.80 $0.75 $42.30 $114,904.33 2026-05-09
13668009390 OTHER Pramipexole Dihydrochloride 52 22 $11.80 $11.80 $0.75 $42.30 $114,904.33 2026-05-09
13668009590 OTHER Pramipexole Di-hcl 52 22 $11.80 $11.80 $0.75 $42.30 $114,904.33 2026-05-09
11917013858 OTHER Folic Acid/Vit B Complex And C 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11917015683 OTHER Calcium Carb/Magnesium Hydrox 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
13811053630 OTHER Multivitamin With Dha 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11980017405 OTHER Pred Mild 0.12 % 52 22 $769.92 $769.92 $0.75 $769.92 $114,904.33 2026-05-09
13913001203 OTHER Cambia 52 22 $473.05 $473.05 $0.75 $473.05 $114,904.33 2026-05-09
13925015901 OTHER Lidocaine Hcl 52 22 $233.40 $233.40 $0.75 $233.40 $114,904.33 2026-05-09
13925016604 OTHER prednisoLONE Sodium Phosphate 52 22 $392.60 $392.60 $0.75 $392.60 $114,904.33 2026-05-09
10147015001 OTHER Itraconazole Oral 52 22 $9.26 $9.26 $0.75 $42.30 $114,904.33 2026-05-09
173068220 OTHER Ventolin Hfa 90 Mcg 52 22 $273.70 $273.70 $0.75 $273.70 $114,904.33 2026-05-09
169368712 OTHER Levemir 97 22 $517.68 $517.68 $0.75 $517.68 $114,904.33 2026-05-09
169368512 OTHER NovoLOG Mix 70-30 (bulk Vial) 97 22 $347.23 $347.23 $0.75 $347.23 $114,904.33 2026-05-09
12090001904 OTHER Lantiseptic 52 22 $15.46 $15.46 $0.75 $42.30 $114,904.33 2026-05-09
143117301 OTHER captopriL 50 Mg 52 22 $9.04 $9.04 $0.75 $42.30 $114,904.33 2026-05-09
143145501 OTHER PHENobarbitaL 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143145801 OTHER PHENobarbitaL 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143150001 OTHER PHENobarbitaL 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143301801 OTHER Colchicine 52 22 $29.99 $29.99 $0.75 $42.30 $114,904.33 2026-05-09
143914025 OTHER ceFAZolin Sodium 52 22 $42.12 $42.12 $0.75 $42.30 $114,904.33 2026-05-09
143920901 OTHER Chloroprocaine HCL/Pf 20 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143921001 OTHER Chloroprocaine HCL/Pf 30 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143927301 OTHER Dihydroergotamine Mesylat 1 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143950701 OTHER Etomidate 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143950910 OTHER Ketamine Hcl 52 22 $12.23 $12.23 $0.75 $42.30 $114,904.33 2026-05-09
143955901 OTHER Argatroban In Ns 50 mg/50mL 52 22 $950.40 $950.40 $0.75 $950.40 $114,904.33 2026-05-09
143956601 OTHER azaTHIOprine Sodium 100 Mg 52 22 $1,200.00 $1,200.00 $0.75 $1,200.00 $114,904.33 2026-05-09
143957501 OTHER Lidocaine Hcl Local Inj 2% 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143963410 OTHER Nicardipine In Nacl, Iso-osm 52 22 $390.34 $390.34 $0.75 $390.34 $114,904.33 2026-05-09
143968301 OTHER Flumazenil .1 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143968401 OTHER Flumazenil 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143968910 OTHER niCARdipine Hcl 52 22 $122.50 $122.50 $0.75 $122.50 $114,904.33 2026-05-09
143971810 OTHER Milrinone Lactate/D5w 52 22 $153.12 $153.12 $0.75 $153.12 $114,904.33 2026-05-09
143978601 OTHER Enalaprilat Dihydrate 1.25 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143978710 OTHER Enalaprilat Dihydrate 1.25 Mg 52 22 $25.48 $25.48 $0.75 $42.30 $114,904.33 2026-05-09
143980250 OTHER Doxycycline Hyclate 52 22 $9.01 $9.01 $0.75 $42.30 $114,904.33 2026-05-09
143987501 OTHER Amiodarone Hcl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143987825 OTHER cefOXitin Sodium 1 Gram 52 22 $47.52 $47.52 $0.75 $47.52 $114,904.33 2026-05-09
143988701 OTHER Amoxicillin 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
143988901 OTHER Amoxicillin 52 22 $14.16 $14.16 $0.75 $42.30 $114,904.33 2026-05-09
143997922 OTHER cefUROXime Sodium 52 22 $14.03 $14.03 $0.75 $42.30 $114,904.33 2026-05-09
121065816 OTHER Trihexyphenidyl Hcl 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
11509000367 OTHER Vagisil 5 %-2 % 52 22 $12.77 $12.77 $0.75 $42.30 $114,904.33 2026-05-09
121067016 OTHER Ethosuximide Oral Soln 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
172392760 OTHER diazePAM 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
14789001101 OTHER Isoproterenol Hcl Inj 52 22 $2,160.00 $2,160.00 $0.75 $2,160.00 $114,904.33 2026-05-09
121067516 OTHER Valproic Acid Oral 52 22 $290.00 $290.00 $0.75 $290.00 $114,904.33 2026-05-09
121067716 OTHER Tricitrates 500-550/5 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
169750111 OTHER NovoLOG 97 22 $347.23 $347.23 $0.54 $347.23 $114,904.33 2026-05-09
121067816 OTHER Nortriptyline Hcl Oral Soln 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
115173901 OTHER Methylphenidate Hcl ER 52 22 $30.74 $30.74 $0.75 $42.30 $114,904.33 2026-05-09
121075908 OTHER prednisoLONE Sodium Phos 15 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
169633910 OTHER NovoLOG Flexpen 52 22 $134.11 $134.11 $0.75 $134.11 $114,904.33 2026-05-09
121076616 OTHER Calcium Carbonate 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
15584010101 OTHER Atripla 52 22 $479.15 $479.15 $0.75 $479.15 $114,904.33 2026-05-09
121077504 OTHER Codeine Phosphate/Guaifenesin 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
172640649 OTHER Cromolyn Sodium 20 Mg 52 22 $27.20 $27.20 $0.75 $42.30 $114,904.33 2026-05-09
121082601 OTHER oxyCODONE Hcl Oral Conc (rx-ud 52 22 $29.17 $29.17 $0.75 $42.30 $114,904.33 2026-05-09
11527070442 OTHER Sodium Fluoride/Potassium Nit 52 22 $63.20 $63.20 $0.75 $63.20 $114,904.33 2026-05-09
121085340 OTHER Sulfamethoxazole/Trimethoprim 52 22 $71.60 $71.60 $0.75 $71.60 $114,904.33 2026-05-09
16110081230 OTHER Fluoroplex 1 % 52 22 $4,454.16 $4,454.16 $0.75 $4,454.16 $114,904.33 2026-05-09
121176030 OTHER Mag-al 52 22 $22.68 $22.68 $0.75 $42.30 $114,904.33 2026-05-09
115443301 OTHER Dantrolene Sodium 100 Mg 52 22 $8.67 $8.67 $0.75 $42.30 $114,904.33 2026-05-09
10310031840 OTHER Orajel 3x Mouth Sores 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
16500004012 OTHER Alka-seltzer Original 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
16500008619 OTHER Multivitamin w/Extra C 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
16500009713 OTHER Flintstones Complete 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
16571012606 OTHER Tolterodine Tartrate 52 22 $13.23 $13.23 $0.75 $42.30 $114,904.33 2026-05-09
16571020206 OTHER Diclofenac Sodium 52 22 $5.89 $5.89 $0.75 $42.30 $114,904.33 2026-05-09
16571067516 OTHER PHENobarbitaL 30mg/7.5mL (rx-u 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
16571076924 OTHER Escitalopram Oral Soln (rx-ud) 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
121174405 OTHER guaiFENesin 100 Mg 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
115442201 OTHER Dantrolene Sodium 50 Mg 52 22 $6.91 $6.91 $0.75 $42.30 $114,904.33 2026-05-09
173069500 OTHER Advair Diskus 52 22 $748.75 $748.75 $0.75 $748.75 $114,904.33 2026-05-09
173069600 OTHER Advair Diskus 52 22 $939.74 $939.74 $0.75 $939.74 $114,904.33 2026-05-09
16729004953 OTHER Temozolomide 52 22 $230.25 $230.25 $0.75 $230.25 $114,904.33 2026-05-09
16729008110 OTHER Naltrexone Hcl 50 Mg 52 22 $17.08 $17.08 $0.75 $42.30 $114,904.33 2026-05-09
16729012953 OTHER Temozolomide 52 22 $1,611.46 $1,611.46 $0.75 $1,611.46 $114,904.33 2026-05-09
16729029212 OTHER Dalfampridine 52 22 $193.79 $193.79 $0.75 $193.79 $114,904.33 2026-05-09
16729031008 OTHER paricalcitoL 52 22 $20.16 $20.16 $0.75 $42.30 $114,904.33 2026-05-09
16729034710 OTHER Lurasidone Hcl 52 22 $204.13 $204.13 $0.75 $204.13 $114,904.33 2026-05-09
16729056101 OTHER hydrOXYchloroQUINE Sulfate 52 22 $8.96 $8.96 $0.75 $42.30 $114,904.33 2026-05-09
121178105 OTHER Acetaminophen Oral Susp - Ud 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
168000215 OTHER Triamcinolone Acetonide 52 22 $44.40 $44.40 $0.75 $44.40 $114,904.33 2026-05-09
168000315 OTHER Triamcinolone Acetonide 52 22 $17.86 $17.86 $0.75 $42.30 $114,904.33 2026-05-09
168000580 OTHER Triamcinolone Acetonide 0.025% 52 22 $44.59 $44.59 $0.75 $44.59 $114,904.33 2026-05-09
168000680 OTHER Triamcinolone Acetonide 0.1% O 52 22 $55.78 $55.78 $0.75 $55.78 $114,904.33 2026-05-09
168003315 OTHER Betamethasone Valerate 0.1 % 52 22 $81.36 $81.36 $0.75 $81.36 $114,904.33 2026-05-09
168004015 OTHER Betamethasone Valerate 52 22 $111.88 $111.88 $0.75 $111.88 $114,904.33 2026-05-09
168004160 OTHER Betamethasone Valerate 0.1 % 52 22 $288.00 $288.00 $0.75 $288.00 $114,904.33 2026-05-09
168005546 OTHER Betamethasone Diprop 0.05% - 4 52 22 $422.60 $422.60 $0.75 $422.60 $114,904.33 2026-05-09
168005646 OTHER Betamethasone Dip 0.05% Oint 52 22 $491.88 $491.88 $0.75 $491.88 $114,904.33 2026-05-09
168005760 OTHER Betamethasone Dipropion 0.05 % 52 22 $191.95 $191.95 $0.75 $191.95 $114,904.33 2026-05-09
168005960 OTHER Fluocinolone Acetonide 52 22 $160.32 $160.32 $0.75 $160.32 $114,904.33 2026-05-09
168006415 OTHER Fluocinolone Acetonide 0.025 % 52 22 $135.07 $135.07 $0.75 $135.07 $114,904.33 2026-05-09
168006460 OTHER Fluocinolone Acetonide 0.025 % 52 22 $405.07 $405.07 $0.75 $405.07 $114,904.33 2026-05-09
168008031 OTHER Hydrocortisone 2.5% Cream 52 22 $15.84 $15.84 $0.75 $42.30 $114,904.33 2026-05-09
168009930 OTHER Ketoconazole 2% Cream - 30gm 52 22 $208.44 $208.44 $0.75 $208.44 $114,904.33 2026-05-09
168013460 OTHER Fluocinonide 52 22 $192.00 $192.00 $0.75 $192.00 $114,904.33 2026-05-09
168014630 OTHER Hydrocortisone 2.5% Oint 52 22 $15.84 $15.84 $0.75 $42.30 $114,904.33 2026-05-09
168016360 OTHER clobetasoL Propionate 0.05% Cr 52 22 $1,835.84 $1,835.84 $0.75 $1,835.84 $114,904.33 2026-05-09
168020230 OTHER Clindamycin Phosphate 1% Gel ( 52 22 $414.60 $414.60 $0.75 $414.60 $114,904.33 2026-05-09
168020360 OTHER Clindamycin Phosphate 52 22 $576.92 $576.92 $0.75 $576.92 $114,904.33 2026-05-09
168025846 OTHER Clotrimazole/Betam 1 %-0.05 % 52 22 $174.24 $174.24 $0.75 $174.24 $114,904.33 2026-05-09
168026345 OTHER Alclometasone Dipropionate 52 22 $390.04 $390.04 $0.75 $390.04 $114,904.33 2026-05-09
168026730 OTHER Betamethasone/Propylene Glyc 52 22 $381.84 $381.84 $0.75 $381.84 $114,904.33 2026-05-09
168026950 OTHER clobetasoL Prop 0.05% - 50mL 52 22 $825.24 $825.24 $0.75 $825.24 $114,904.33 2026-05-09
168033230 OTHER Fluticasone Propionate 0.05% C 52 22 $117.31 $117.31 $0.75 $117.31 $114,904.33 2026-05-09
168034646 OTHER Terconazole 0.4% Vaginal Cream 52 22 $171.98 $171.98 $0.75 $171.98 $114,904.33 2026-05-09
168035730 OTHER Lidocaine/Prilocain 2.5 %-2.5% 52 22 $72.38 $72.38 $0.75 $72.38 $114,904.33 2026-05-09
16837024625 OTHER Pepcid Complete 52 22 $5.00 $5.00 $0.75 $42.30 $114,904.33 2026-05-09
169183311 OTHER Insulin Regular 100 Unit/ml 52 22 $0.64 $0.64 $0.26 $42.30 $114,904.33 2026-05-09
169183411 OTHER NovoLIN N (Bulk 10mL Vial) 97 22 $231.36 $231.36 $0.26 $231.36 $114,904.33 2026-05-09
169183711 OTHER Insulin Nph/Regular 70/30 (bul 97 22 $231.36 $231.36 $0.26 $231.36 $114,904.33 2026-05-09
169255013 OTHER Tresiba Flextouch U-200 52 22 $976.18 $976.18 $0.75 $976.18 $114,904.33 2026-05-09
169266015 OTHER Tresiba Flextouch U-100 52 22 $488.11 $488.11 $0.75 $488.11 $114,904.33 2026-05-09
169266211 OTHER Tresiba (Bulk Vial) 97 22 $1,626.96 $1,626.96 $0.75 $1,626.96 $114,904.33 2026-05-09
169280015 OTHER Saxenda 52 22 $1,295.04 $1,295.04 $0.75 $1,295.04 $114,904.33 2026-05-09
173071620 OTHER Advair Hfa 52 22 $1,530.82 $1,530.82 $0.75 $1,530.82 $114,904.33 2026-05-09
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