| Název | Doplněk názvu | Síla | Léková forma | Balení | Expedice | Max. doplatek |
|---|---|---|---|---|---|---|
| Mantomed | 10mg tbl flm 56 | 10 mg | potahovaná tableta | 56 | na recept | 153,07 Kč |
| Mantomed | 10mg tbl flm 60 | 10 mg | potahovaná tableta | 60 | na recept | 1071,16 Kč |
| Mantomed | 20mg tbl flm 56 | 20 mg | potahovaná tableta | 56 | na recept | 724,98 Kč |
| Mantomed | 20mg tbl flm 60 | 20 mg | potahovaná tableta | 60 | na recept | 2568,67 Kč |
| Mantomed | 10mg tbl flm 70 | 10 mg | potahovaná tableta | 70 | na recept | 1188,78 Kč |
| Mantomed | 20mg tbl flm 70 | 20 mg | potahovaná tableta | 70 | na recept | 2908,02 Kč |