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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
VOTREX(R) Intra-Venus AMPOULE
702257
3.26
0
VOTREX(R) ORAL TABLET 25 mg
702258
545021250
0.31
0
VOTREX(R) ORAL TABLET 50 mg
702259
545021250
0.51
0
VOTREX(R) RECTAL SUPPOSITORY 100 mg
702260
1.58
0
VOTREX(R) RECTAL SUPPOSITORY 50 mg
702261
0.79
0
WARFARIN SODIUM(R) ORAL TABLET 1 mg
702262
543021230
0.41
0
WARFARIN SODIUM(R) ORAL TABLET 3 mg
702263
543021230
0.56
0
WARFARIN SODIUM(R) ORAL TABLET 5 mg
702264
543021230
0.94
0
WAXSOL EAR DROPS 0.5 % ( WAX REMOVAL ) 1
702265
550028532
6.05
0
WINEX(R) CHEWABLE SUSPENSION 100 mg/5ml
702266
40.35
0
WINEX(R) ORAL CAPSUL 200 mg
702267
6.21
0
WINEX(R) ORAL CAPSUL 400 mg
702268
11.33
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