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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
LATYCIN(R) EYE/EAR OINTMENT 1%
701161
550013060
2.6
0
LAXOCODYL(R) ORAL TABLET 5 mg 200 Box
701162
546061515
0.15
0
LAXOCODYL(R) RECTAL SUPPOSITORY 10 mg 10 Box
701163
546063510
0.52
0
LAXOCODYL(R) RECTAL SUPPOSITORY 5 MG 30 Box
701164
546065562
0.31
0
LAXOCYDYL RECTAL SUPPOSITORY 10 mg
701165
0.52
0
LAXOLYNE(R) RECTAL SUPPOSITORY 900 mg 10 Box
701166
546065550
0.27
0
LEDCLAIR Intra-Venus INJECTION 200 mg/ml Ampule
701167
551054370
2.51
0
LEFOX Intra-Venus INFUSION 500 mg ( 5 mg / ml ) 1
701168
540011324
88
0
LEFOX COATED ORAL TABLET 750 MG 1 Tab
701169
540011331
14.39
0
LEPONEX(R) ORAL TABLET 100 mg 50 Box
701170
545031539
3.12
0
LEPONEX(R) ORAL TABLET 25 mg 50 Box
701171
545031538
1.01
0
LERGICOL(R) ORAL TABLET 4 mg
701172
549041450
0.09
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