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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | KERLONE FC(R) ORAL TABLET 20 mg | 701122 | 1.43 | ||||
0 | KESELAN MG(R) ORAL TABLET 1.5 mg | 701123 | 545031600 | 0.4 | |||
0 | KETRAX(R) ORAL TABLET 40 mg ( non formulary ) 30 Box | 701124 | 540032582 | 0.87 | |||
0 | KIDIPRIN(R) CHEWABLE TABLET 100 mg | 701125 | 0.13 | ||||
0 | INDICARDIN(R) ORAL TABLET 10 mg | 701035 | 544051201 | 0.1 | |||
0 | INDICARDIN(R) ORAL TABLET 40 mg | 701036 | 544051205 | 0.22 | |||
0 | INDOCID(R) ORAL CAPSUL 25 mg | 701037 | 545021225 | 0.47 | |||
0 | INDOCID(R) ORAL CAPSUL 75 mg | 701038 | 545021225 | 0.47 | |||
0 | INDOCID(R) RECTAL SUPPOSITORY 100 mg | 701039 | 545023230 | 1.12 | |||
0 | INDOGESIC(R) ORAL CAPSUL 25 mg | 701040 | 545021225 | 0.12 | |||
0 | INDOMETHACIN(R) Intra-Venus INJECTION 1 MG 5 | 701041 | 545021230 | 27.79 | |||
Ampule |
KERLONE FC(R) ORAL TABLET 20 mg
1.43
KESELAN MG(R) ORAL TABLET 1.5 mg
0.4
KETRAX(R) ORAL TABLET 40 mg ( non formulary ) 30 Box
0.87
KIDIPRIN(R) CHEWABLE TABLET 100 mg
0.13
INDICARDIN(R) ORAL TABLET 10 mg
0.1
INDICARDIN(R) ORAL TABLET 40 mg
0.22
INDOCID(R) ORAL CAPSUL 25 mg
0.47
INDOCID(R) ORAL CAPSUL 75 mg
0.47
INDOCID(R) RECTAL SUPPOSITORY 100 mg
1.12
INDOGESIC(R) ORAL CAPSUL 25 mg
0.12
INDOMETHACIN(R) Intra-Venus INJECTION 1 MG 5
27.79
Ampule
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