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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
LEUCOVORIN CALCIUM(R) Intra-Venus VIAL 3 mg / ML
701173
543014075
21.22
0
LEUCOVORIN CALCIUM(R) Intra-Venus VIAL 50 MG
701174
543014080
21.22
0
ISOPTIN(R) ORAL TABLET 80 mg
701080
544031125
0.82
0
ISOPTIN(R) Intra-Venus INJECTION 5 mg/2ml
701081
544034130
3.35
0
ISOPTO CARPINE(R) EYE DROPS 1%
701082
8.95
0
ISOPTO CARPINE(R) EYE DROPS 2%
701083
550013320
8.95
0
ISOPTO CARPINE(R) EYE DROPS 3%
701084
4.05
0
ISOPTO CARPINE(R) EYE DROPS 4%
701085
8.95
0
ISOPTO FRIN(R) EYE DROPS 0.12%
701086
8.95
0
ISOPTOFENICOL(R) EYE DROPS 0.5%
701087
550013050
7.8
0
ISORDIL SUBLINGUAL TABLET 5 mg Tab
701088
544021070
0.16
0
ISORDIL(R) ORAL TABLET 10 mg 100 ????
701089
544021075
0.16
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