| Servico | TABELA CEMED - MEDICAMENTO | DELLER 50MG COM VER LIB PROL CT BL AL PLAST PVDC X 60 + CX + 8 X 307,81 17 = 2.043,84 DIOVAM 320MG COM VER CT BL AL AL X 28 + CX + 7 X 85,79 17 = 498,40 DIOVANHCT 320/12,5MG COM VER CT BL AL AL X 28 + CX + 7 X 89,20 17 = 518,21 DONAREN 50MG COM VER CT BL AL PLAS TRANS X 60 + CX + 6 X 76,27 17 = 378,80 EFEXOR XR 150MG CAP DURA LIB PROL CT BL AL PLAS TRANS X 30 + CX + 12 X 429,19 17 = 4.274,64 ELIQUIS 5MG COM VER CT BL AL PLAS TRANS X 60 + CX + 12 X 240,12 17 = 2.391,48 FORXIGA 10MG COM VER CT BL ALAL X30 + CX + 10 X 134,50 17 = 1.116,30 KEPPRA 250MG COM VER CT BL AL PLAS PVCTRNS X 60 + CX + 20 X 485,24 17 = 8.054,80 KEPPRA 750MG COM VER CT BL AL PLAS PVC TRANS X 60 + CX + 20 X 116,91 17 = 1.940,60 LAMICTAL 50MG COM CT BL AL PLAS TRANS X30 + CX + 13 X 207,15 - 17 = 2.235,09 LAMITOR CCD 100MG COM SUS CT BL AL/AL X60 + CX + 12 X 688,87 17 = 6.861,12 LEPONEX 100MG COM CT BL AL PLAS PVC TRANS X 30 + CX + 08 X 258,94 17 = 1.719,36 LEXAPRO 10MG COM VER CT BL AL PLAS TRANSX 60 + CX + 07 X 486,25 17 = 2.825,06 LYRICA 75MG CAP DURA CT BL AL PLAS PVC TRANS X 30 + CX + 08 X 134,48 17 = 892,88 NATRILIX 1,5MGCOM VER CT BL AL PLAWS INCX 30 + CX +9 X 34,45 17 = 256,59 PONDERA 25MG COM VER CT BL AL PLAS TRANS X 20 + CX + 7 X 86,62 17 = 503,23 PRADAXA 150MG CAP DURA CT BL AL AL X 60 + CX + 9 X 237,54 17 = 1.774,35 QUEROPAX 25MG COM VER CT BL AL PLASTOPC X 30 + CX + 8 X 133,16 17 = 884,16 SEROQUEL XR 50MG COM VER LIB PROL CT BLAL PLAS PVC OPC X30 + CX + 10 X 247,06 17 = 2.050,50 STANGLIT 15MG COM CT FR PLAS OPC X 60 + CX + 9 X 121,07 17 = 904,32 STILNOX 12,5MG CO LIB PROL CT BL AL PLASTRANS X 30 + CX + 9 X 87,92 17 = 656,73 SULPAM MG CAP GEL DURA CT BL AL PLAS PVCTRANS X 20 + CX + 12 X 25,15 17 = 250,44 TEGRETOL 400MG COM LIB PROL CT BL PLAS PVDC TRANS X 60 + CX + 12 X 134,03 17 = 1.334,88 TRILEPTAL 300MGCOM VER CT BL AL AL PLAS TRANS X 60 + CX + 10 X 143,59 17 = 1.191,70 VIMPAT 200MG COM VER CT AL PLAST TRANSX 56 + CX + 10 X 847,42 17 = 7.033,50 ZYPREXA 10MG COM VER CT BL AL AL X 30 + CX + 10 X 1033,72 17 = 8.579,80 | 1,0000 | R$ 73.699,74 | R$ 61.170,78 |