| Servico | TABELA CEMED - MEDICAMENTO | STANGLIT 30MG COM CT FR PLAS OPC X60 + CX + 157,41 X 9 = 1416,69 3 = 1.374,21 TOPAMAX 50MG COM VER CT BL AL AL X60 + CX + 261,12 X 6 = 1.566,72 3 = 1.519,74 CYMBI 30MG CAP DURA LIB RETARD CT BL AL AL X60 + CX + 374,14 X 3 = 1.122,42 3 = 1.088,73 CARBOLITIUN 450MG COM LIB PROL CT BL AL PLAS PVC/PVDC TRANS X90 + CX + 126,74 X 6 = 760,44 3 = 737,64 CONDROFLEX 1,5+1,2G PO OR CT 30 SACH X 4,135G + CX + 191,11 X 4 = 764,44 3 = 741,52 CRESTOR 20MG COM VER CT BL AL/ALX30 + CX + 272,89 X 3= 818,67 3 = 794,10 PREBICTAL 150MG CAP DURA CT BL AL PLAS TRANS X28 + CX + 155,72 X 6 = 934,32 3 = 906,30 PREBICTAL 75MG CAP DURA CT BL AL PLAS TRANS X60 + CX + 206,26 X 6 = 1.237,56 3 = 1.200,42 CLEXANE 20MG SOL INJ CT 10 SER PRE-ENCHIDAS VC INC X0,2ML + CX + 251,64 X 4 = 1006.56 3 = 976,36 CLEXANE 40MG SOL INJ 6 SER PREENCHIDAS VD INC X0,4ML + CX + 293,25 X 6 = 1759,50 3 = 1.706,70 ARTICO 1,5G+1,2G PO SOL OR CT 30 SACHAL PAP POLIENT XO,5G + CX + 140,10 X 2 = 280,20 3 = 271,80 JOGGER 1500MG+1200 GRAN CT 30 ENVAL LAM X4G + CX + 161,62 X 4 = 646,48 3 = 627,08 EDISTRIDE 10MG COM VER CT BL AL AL X30 + CX + 131,08 X 3 = 393,24 3 = 381,45 SIGMATRIOL 0,25 MCG CAP MOLE CT FR VD + AMB X90 + CX + 311,17 X 10 = 3.111,70 3 = 3.018,30 CEDUR 400MG COM VER LIB PROL CT BL ALPLAST TRANS X30 + 112,88 X 3 = 338,64 3 = 328,47 CLEXANE 40MG SOL INJ CT 6 SER PRE -ENCHIDAS VD INC X0,4ML + CX + 293,25 X 10 = 2.932,50 3 = 2.844,50 CLEXANE 60MG SOL INJ CT 10 SER PRE -ENCHIDAS VD INC GRAD X 0,5ML + CX + 744,55 X 3 = 2.233,65 3 = 2.166,63 VERSA 100MG/ML SOL INJ CT 6 SER PREENCH VD TRANS X0,4ML + CX + 278,19 X 8 = 2.225,52 3 = 2.158,72 SAXENDA 5MG/ML SOL INJ CT X 3 CAR VD TRANS X3ML X 3 SIST APLIC PLAS + CX + 619,91 X 3 = 1.859,73 3 = 1.803,93 SELOZOK 50MG COM VER LIB PROL CT BL AL PLAS INC X60 + CX + 91,90 X 3 = 2.757,00 SELOZOK 100MG COM VER LIB PROL CT BLAL PLAS INC X60 + CX + 150,66 X 6 = 903,96 3 = 876,84 TAMARINE GEL CT FR PLAS OPC X250G + FR + 57,08 X 1 = 57,08 3 = 55,37 CITOBE 5000MCG+100MG+100MG COMVER CT BL AL AL X60 + CX + 109,86 X 2 = 219,72 3 = 213,12 BRONCHO-VAXOM 7,0MG PO LIOF CAPGEL DURA CT BL AL AL X30 + CX + 175,87 X 4 = 703,48 3 = 682,36 BENERVA 300MG COM VER CT BL AL PLAS PVC/PVDC TRANS X60 + CX + 40,70 X 1 = 40,70 3 39,48 AVAMYS 0,5MG/G SUS SPR NAS CT FR VD AMB X120 DOSES + CX + 43,54 X 3 = 130,62 3 = 126,69 CONCOR 10MG COM VER CT BL AL PLAS TRANS X28 + CX + 103,13 X 3 = 309,39 3 = 300,12 HIRUDOID 5MG/G GEL CT BG AL X40G + TB + 25,89 X 1 = 25,89 3 = 25,11 ACHEFLAN 5MG/G CREM DERM CT BG PLAS LAM X60G + TB + 64,46 X 1 = 64,46 3 = 62,53 DIOVAN HCT 320+12,5MG CM VER CT BL AL AL X28 + CX + 84,91 X 3 = 254,73 3 = 238,36 CLEXANE 40MG SOL INJ CT 6 SER PREENCHIDAS VD INC XO,4ML + CX + 293,25 X 10 = 2.932,50 3 = 2.844,50 LIPITOR 40MG COM VER CT BL AL/AL X30 + CX + 281,83 X 6 = 1.690,98 3 = 1.640,22 NORVASC 10MG COM CT BL AL PLAS PVC OPC X 60 + CX + 163,31 X 3 = 489,93 -3 = 475,23 TYLEX 500MG+30MG COM CT BL AL PLAS TRANS X36 + CX + 68,92 X 2 = 197,84 -3 = 133,70 NESINA MET 12,5+850MG COM VER CT BLAL AL X60 + CX + 178,91 X 4 = 715,64 3 = 694,16 DUTAM 0,5MG+0,4MG CAP DURA LIB PROL CT BL AL PLAS TRANS X90 CX + 282,63 X 6 = 1.695,78 3 = 1.644,90 DIATARCOM MR 60MG COM LIB PROL CT BL AL PLAST PVC TRANS X60 CX + 115,74 X 3 = 347,22 3 =336,81 TRAMAL 50MG CAP DURA CT BL AL PLAS PVC/PVDC CX + 48,84 X 6 = 293,04 3 = 284,22 FLUIMUCIL 600MG COM EFEV CT BL AL/AL X 16 CX + 42,77 X 2 = 85,57 3 =82,98 FORXIGA 10MG COM VER CT BL AL AL X30 CX + 131,10 X 3 = 393,30 3 = 393,30 ENTRESTO 60MG COM VER CT BL AL AL X28 CX + 118,50 X 3 = 355,50 3 =344,82 ENTRESTO 60MG COM VER CT BL AL AL X60 CX + 253,97 X 6 = 1.523,82 3 = 1.478,10 ARCOXIA 90 MG COM VER CT BL AL AL X14 CX + 92,78 X 4 = 371,12 3 =360,00 RUVA 20MG COM VER CT BL AL AL X30 CX 54,07 X 3 = 162, | 1,0000 | R$ 51.539,36 | R$ 49.993,18 |