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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | VISACROM(R) EYE DROPS 4% | 702230 | 550013250 | 14.95 | |||
0 | VISANNE ORAL TABLET 2 MG Box | 702231 | 547015199 | 8.52 | |||
0 | VISCOTEARS OPTH(R) EYE GEL 2 mg/g | 702232 | 17.4 | ||||
0 | VISIPAQUE Intra-Venus INJECTION 320 MG I/ML 50 Vial | 702233 | 551154774 | 134.3 | |||
0 | TUSSILAR(R) ORAL TABLET 15 mg | 702139 | 0.26 | ||||
0 | TYGACIL Intra-Venus INJECTION 50 MG(NON- FORMULARY) | 702140 | 540011301 | 215.13 | |||
0 | TYLENOL FORTE(R) ORAL TABLET 500 mg | 702141 | 545021100 | 0.38 | |||
0 | TYLENOL(R) ORAL DROPS 100 mg/ml | 702142 | 545022110 | 6.25 | |||
0 | TYLENOL(R) RECTAL SUPPOSITORY 100 mg | 702143 | 545023115 | 1.02 | |||
0 | TYLENOL(R) RECTAL SUPPOSITORY 200 mg | 702144 | 545023115 | 1.14 | |||
0 | TYLENOL(R) RECTAL SUPPOSITORY 350 mg | 702145 | 545023115 | 1.3 | |||
0 | TYPHM VI(R) Intra-muscular VACCINE 0.5ml/dose Injection | 702146 | 542014160 | 32.05 |
VISACROM(R) EYE DROPS 4%
14.95
VISANNE ORAL TABLET 2 MG Box
8.52
VISCOTEARS OPTH(R) EYE GEL 2 mg/g
17.4
VISIPAQUE Intra-Venus INJECTION 320 MG I/ML 50 Vial
134.3
TUSSILAR(R) ORAL TABLET 15 mg
0.26
TYGACIL Intra-Venus INJECTION 50 MG(NON- FORMULARY)
215.13
TYLENOL FORTE(R) ORAL TABLET 500 mg
0.38
TYLENOL(R) ORAL DROPS 100 mg/ml
6.25
TYLENOL(R) RECTAL SUPPOSITORY 100 mg
1.02
TYLENOL(R) RECTAL SUPPOSITORY 200 mg
1.14
TYLENOL(R) RECTAL SUPPOSITORY 350 mg
1.3
TYPHM VI(R) Intra-muscular VACCINE 0.5ml/dose Injection
32.05
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