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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | MICONAZ(R) TOPICAL CREAM 2% | 701308 | 550063730 | 9.6 | |||
0 | MICONAZ(R) TOPICAL POWDER 2% | 701309 | 15.1 | ||||
0 | MICOZOL(R) TOPICAL CREAM 2% | 701310 | 550063730 | 7.1 | |||
0 | MICROGYNON 30 ORAL TABLET 30 MCG + 150 MCG | 701311 | 547011001 | 0.58 | |||
Box | |||||||
0 | MIDARINE(R) Intra-Venus AMPOULE 50 mg/ml | 701312 | 545064850 | 2.97 | |||
0 | MIKACIN(R) Intra-Venus AMPOULE 100 mg/2ml | 701313 | 13.36 | ||||
0 | MIKACIN(R) Intra-Venus AMPOULE 500 mg/2ml | 701314 | 540014420 | 21.75 | |||
0 | LUCENTIS Intraocular INJECTION 10 mg/ml 1 | 701223 | 541054419 | 7,048.30 | |||
0 | LUDIOMIL(R) ORAL TABLET 25 mg Box | 701224 | 545031470 | 0.85 | |||
0 | LUMIGAN EYE DROPS 0.01 % ( 3 ml ) Bottle | 701225 | 550013324 | 67.3 | |||
0 | LUPRON DEPOT(R) Intra-muscular INJECTION 3.75 | 701226 | 547014131 | 423.9 |
MICONAZ(R) TOPICAL CREAM 2%
9.6
MICONAZ(R) TOPICAL POWDER 2%
15.1
MICOZOL(R) TOPICAL CREAM 2%
7.1
MICROGYNON 30 ORAL TABLET 30 MCG + 150 MCG
0.58
Box
MIDARINE(R) Intra-Venus AMPOULE 50 mg/ml
2.97
MIKACIN(R) Intra-Venus AMPOULE 100 mg/2ml
13.36
MIKACIN(R) Intra-Venus AMPOULE 500 mg/2ml
21.75
LUCENTIS Intraocular INJECTION 10 mg/ml 1
7,048.30
LUDIOMIL(R) ORAL TABLET 25 mg Box
0.85
LUMIGAN EYE DROPS 0.01 % ( 3 ml ) Bottle
67.3
LUPRON DEPOT(R) Intra-muscular INJECTION 3.75
423.9
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