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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | LANSOMID(R) ORAL CAPSUL 30 mg | 701149 | 546031236 | 3.5 | |||
0 | LANTUS SUBCUTANEOUS INJECTION 100 Unit/Ml (10ML) 1 | 701150 | 547064594 | 220.1 | |||
0 | LANTUS SOLOSTAR SUBCUTANEOUS CARTRIDGE(PEN) 100 Unit/Ml (3ML) 5 | 701151 | 547064600 | 59.29 | |||
0 | LARGACTIL(R) ORAL TABLET 25 mg 50 Box | 701152 | 545031500 | 0.93 | |||
0 | LARIAM(R) ORAL TABLET 250 mg Box | 701153 | 540031575 | 4.67 | |||
0 | LASIX IM/IV/SC AMPOULE 10 mg/ml (25 ml amp) | 701154 | 544074490 | 2.76 | |||
0 | LASIX ORAL SYRUP 5 mg/5ml | 701155 | 544072495 | 22.85 | |||
0 | LASIX ORAL TABLET 500 mg | 701156 | 544071480 | 1.18 | |||
0 | LASIX(R) ORAL SYRUP 100 ml | 701157 | 22.85 | ||||
0 | LASIX(R) Intra-Venus AMPOULE 250 mg | 701158 | 544074490 | 25.29 | |||
0 | LASIX(R) ORAL TABLET 40 mg | 701159 | 544071475 | 1.18 | |||
0 | LASTET(R) Intra-Venus AMPOULE 100 mg/5ml Ampule | 701160 | 541054417 | 29.31 |
LANSOMID(R) ORAL CAPSUL 30 mg
3.5
LANTUS SUBCUTANEOUS INJECTION 100 Unit/Ml (10ML) 1
220.1
LANTUS SOLOSTAR SUBCUTANEOUS CARTRIDGE(PEN) 100 Unit/Ml (3ML) 5
59.29
LARGACTIL(R) ORAL TABLET 25 mg 50 Box
0.93
LARIAM(R) ORAL TABLET 250 mg Box
4.67
LASIX IM/IV/SC AMPOULE 10 mg/ml (25 ml amp)
2.76
LASIX ORAL SYRUP 5 mg/5ml
22.85
LASIX ORAL TABLET 500 mg
1.18
LASIX(R) ORAL SYRUP 100 ml
22.85
LASIX(R) Intra-Venus AMPOULE 250 mg
25.29
LASIX(R) ORAL TABLET 40 mg
1.18
LASTET(R) Intra-Venus AMPOULE 100 mg/5ml Ampule
29.31
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