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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
mg/2ml 1 | |||||||
0 | LUPRON DEPOT(R) Intra-muscular INJECTION 7.5 mg/2ml 1 | 701227 | 547014132 | 718.45 | |||
0 | LUSTRAL(R) ORAL TABLET 50 mg | 701228 | 4.56 | ||||
0 | Lyrica ORAL CAPSUL 150 mg | 701229 | 545051812 | 4.82 | |||
0 | Lyrica ORAL CAPSUL 300mg 30 | 701230 | 545051824 | 7.02 | |||
0 | Lyrica ORAL CAPSUL 75mg 30 | 701231 | 545051816 | 3.61 | |||
0 | LYSTHENON SICCUM(R) Intra-Venus VIAL 500 mg | 701232 | 12.71 | ||||
0 | M.M.R II(R) Intra-Venus VIAL | 701233 | 212.2 | ||||
0 | MAALOX ORAL SUSPENSION 180 mg | 701234 | 9.1 | ||||
0 | MAALOX PLUS(R) CHEWABLE SUSPENSION 450 mg/5ml | 701235 | 9.1 | ||||
0 | MAALOX PLUS(R) ORAL TABLET 200 mg | 701236 | 0.13 | ||||
0 | MAALOX(R) CHEWABLE SUSPENSION 425 mg/5ml | 701237 | 5.9 |
mg/2ml 1
LUPRON DEPOT(R) Intra-muscular INJECTION 7.5 mg/2ml 1
718.45
LUSTRAL(R) ORAL TABLET 50 mg
4.56
Lyrica ORAL CAPSUL 150 mg
4.82
Lyrica ORAL CAPSUL 300mg 30
7.02
Lyrica ORAL CAPSUL 75mg 30
3.61
LYSTHENON SICCUM(R) Intra-Venus VIAL 500 mg
12.71
M.M.R II(R) Intra-Venus VIAL
212.2
MAALOX ORAL SUSPENSION 180 mg
9.1
MAALOX PLUS(R) CHEWABLE SUSPENSION 450 mg/5ml
9.1
MAALOX PLUS(R) ORAL TABLET 200 mg
0.13
MAALOX(R) CHEWABLE SUSPENSION 425 mg/5ml
5.9
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