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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
STREPTAS(R) Intra-Venus VIAL 250000 International-Unit
701995
543044250
163.4
0
STREPTAS(R) Intra-Venus VIAL 750000 International-Unit
701996
543044260
249.45
0
SENSIPAR ORAL TABLET 60 MG
701918
547084803
61.13
0
SEPTAZOLE(R) ORAL TABLET 480 mg
701919
0.45
0
SEPTRIN Intra-muscular AMPOULE 960 mg/3ml
701920
11.03
0
SEPTRIN Intra-Venus AMPOULE 480 mg/5ml
701921
540074850
11.03
0
SEPTRIN ORAL TABLET 480 mg 20 ????
701922
0.91
0
SEPTRIN DOUBLE STRENGTH(R) ORAL TABLET 960 mg
701923
0.91
0
SEPTRIN PAED(R) ORAL TABLET 120 mg
701924
0.4
0
SERETIDE DISKUS ORAL INHALER 500 MCG ( DISKUS )
701925
549016056
245.25
Box
0
SERETIDE EVOHALER(R) Diskus Inhaler 250 mcg + 50
701926
549016045
185.95
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