| Název | Doplněk názvu | Síla | Léková forma | Balení | Expedice | Max. doplatek |
|---|---|---|---|---|---|---|
| Mantomed | 10mg tbl flm 56 | 10 mg | potahovaná tableta | 56 | na recept | 969,60 Kč |
| Mantomed | 20mg tbl flm 56 | 20 mg | potahovaná tableta | 56 | na recept | 2358,13 Kč |
| Mantomed | 10mg tbl flm 60 | 10 mg | potahovaná tableta | 60 | na recept | 157,35 Kč |
| Mantomed | 10mg tbl flm 70 | 10 mg | potahovaná tableta | 70 | na recept | 1188,78 Kč |
| Mantomed | 20mg tbl flm 60 | 20 mg | potahovaná tableta | 60 | na recept | 768,07 Kč |
| Mantomed | 20mg tbl flm 70 | 20 mg | potahovaná tableta | 70 | na recept | 2908,02 Kč |