| Servico | TABELA CEMED - MEDICAMENTO | ALPRAZOLAM 1 MG C/30 + CX + 38,92 X 50 = 1.946,00 70 = 584,00 ALPRAZOLAM 2 MG C/30 + CX + 68,44 X 100 = 6.844 70 = 2.053,00 BROMAZEPM 3 MG C/30 + CX + 22,92 X 30 = 687,60 70 = 206,40 BROMAZEPM 6 MG C/30 + CX + 38,43 X 30 = 1.152,90 70 = 345,90 CLONAZEPAM 2 MG C/30 + CX + 14,10 X 100 = 1.410,00 70 = 423,00 CLONAZEPAM 2,5MG/ML 20ML + FR + 15,60 X 100 = 1.560,00 - 70 = 468,00 DIAZEPAM 10 MG C/30 + CX + 19,08 X 50 = 954,00 -70 = 286,00 DIPIRONA 500MG/ML 20ML + FR + 14,61 X 200 = 2.922,00 70 = 876,00 DULOXETINA 30 MG C/30 + CX + 155,33 X 30 = 4.659,90 70 = 1.398,00 DULOXETINA 60 MG C/30 + CX + 244,08 X 30 = 7.322,40 70 = 2.196,60 ESCITALOPRAM 10 MG C/30 + CX + 88,82 X 40 = 3.552,80 70 = 1.066,00 ESCITALOPRAM 20 MG + CX + 177,41 X 40 = 7.096,40 70 = 2.128,80 FLUOXETINA 20 MG C/70 + CX + 73,57 X 50 = 3.678,50 -70 = 1.103,50 LAMOTRIGINA 50 MG C/30 + CX + 159,81 X 50 = 7.990,50 70 = 2.397,00 PREGABALINA 150 MG C/30 + CX + 159,16 X 30 = 4.774,80 70 = 1.432,50 PREGABALINA 75 MG C/30 + CX + 103,78 X 50 = 5.189,00 -70 = 1.556,50 SERTRALINA 25 MG C/30 + CX + 90,67 X 30 = 2.720,10 70 = 816,00 SERTRALINA 50 MG C/30 + CX + 72,39 X 100 = 7.239,00 70 = 2.172,00 TOPIRAMATO 50 MG C/60 + CX + 133,34 X 50 = 6.667,00 70 = 2.000,00 VENLAFAXINA 75 MG C/30 + CX + 149,27 X 50 = 7.463,50 70 = 2.239,00 VENLAFAXINA 150 MG C/30 + CX + 221,92 X 50 = 11.096,00 70 = 3.329,00 LEVETIRACETAM 500 MG C/30 + CX + 98,93 X 50 = 4.946,50 70 = 1.484,00 QUETIAPINA 100 MG C/30 + CX + 147,51 X 100 = 17.451,00 70 = 4.425,00 QUETIAPINA 25 MG C/30 + CX + 77,02 X 100= 7.702,00 70 = 2.311,00 QUETIAPINA 50MG C/30 + CX + 199,77 X 30 = 5.993,10 70 = 1.797,90 RISPERIDONA 1 MG C/30 + CX + 55,36 X 200 = 11.072,00 70 = 3.322,00 RISPERIDONA 2 MG C/30 + CX + 66,65 X 200 = 13.330,00 70 = 4.000,00 TRAZODONA 100 MG C/30 + CX + 58,85 X 50 = 2.942,50 70 = 883,00 TRAZODONA 150MG C/30 + CX + 58,85 X 20 = 1.177,00 70 = 353,20 TRAZODONA 50 MG C/60 + CX + 88,27 X 50 = 4.413,50 70 = 1.324,00 | 1,0000 | R$ 163.257,67 | R$ 48.977,30 |