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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
OCTANATE(R) Intra-Venus VIAL 1000 International unit
701487
543054310
2,108.20
0
OCTANATE(R) Intra-Venus VIAL 250 international unit
701488
543054301
658.75
0
OCTEGAM(R) Intra-Venus VIAL 2-5 gm/ 50-100 ml
701489
542024310
2,062.50
0
OCUGESIC(R) EYE DROPS 0.1% 5 Drop
701490
545021256
13.3
0
OCULOSAN(R) EYE DROPS 0.05%
701491
12.05
0
OCUMOL(R) OPHTHALMIC DROPS 0.5% Box
701492
550013315
24.4
0
OEDEMAX(R) ORAL TABLET 40 mg
701493
544071475
1.18
0
OFTALMOLOSA CUSI DEICOL(R) TOPICAL OINTMENT 0.1%
701494
3.85
0
OFTALMOLOSA CUSI DEXAMETHASONE(R) TOPICAL OINTMENT 0.05%
701495
550013220
3.85
0
OFTALMOLOSA CUSI GENTAMYCIN(R) EYE OINTMENT
701496
7.35
0.50%
0
OFTALMOLOSA CUSI GENTAMYCIN(R) TOPICAL
701497
550013035
3.85
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