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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | SANDIMMUN CONC(R) Intra-Venus VIAL 250 mg/5ml | 701890 | 59.16 | ||||
0 | SANDIMMUN NEORAL(R) ORAL CAPSUL 100 mg Box | 701891 | 551081530 | 16.95 | |||
0 | SANDIMMUN NEORAL(R) ORAL CAPSUL 25 mg Box | 701892 | 551081540 | 4.24 | |||
0 | SANDIMMUN NEORAL(R) ORAL CAPSUL 50 mg Box | 701893 | 551081845 | 7.63 | |||
0 | SANDIMMUN NEORAL(R) ORAL SYRUP 100 mg/ml(50ml) | 701894 | 551082510 | 872.65 | |||
0 | SANDIMMUN(R) Intra-Venus AMPOULE 50 mg/ml | 701895 | 551084510 | 161.95 | |||
0 | SANDOSTATIN(R) Intra-muscular INJECTION 20 mg LAR ( Long acting ) | 701896 | 541034278 | 5,326.70 | |||
0 | SANDOSTATIN(R) Intra-Venus AMPOULE 100 mcg/ml | 701897 | 541034277 | 40.69 | |||
0 | SAPOFEN JUNIOR(R) CHEWABLE SUSPENSION 100 | 701898 | 9.8 | ||||
mg/5ml | |||||||
0 | SAPOFEN(R) ORAL TABLET 200 mg | 701899 | 545021200 | 0.17 | |||
0 | SAPOFEN(R) ORAL TABLET 400 mg | 701900 | 545021200 | 0.5 |
SANDIMMUN CONC(R) Intra-Venus VIAL 250 mg/5ml
59.16
SANDIMMUN NEORAL(R) ORAL CAPSUL 100 mg Box
16.95
SANDIMMUN NEORAL(R) ORAL CAPSUL 25 mg Box
4.24
SANDIMMUN NEORAL(R) ORAL CAPSUL 50 mg Box
7.63
SANDIMMUN NEORAL(R) ORAL SYRUP 100 mg/ml(50ml)
872.65
SANDIMMUN(R) Intra-Venus AMPOULE 50 mg/ml
161.95
SANDOSTATIN(R) Intra-muscular INJECTION 20 mg LAR ( Long acting )
5,326.70
SANDOSTATIN(R) Intra-Venus AMPOULE 100 mcg/ml
40.69
SAPOFEN JUNIOR(R) CHEWABLE SUSPENSION 100
9.8
mg/5ml
SAPOFEN(R) ORAL TABLET 200 mg
0.17
SAPOFEN(R) ORAL TABLET 400 mg
0.5
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