DEXTRAN-70 + HYPROMELLOSE
Code & Prescriber
|
Medicinal Product Pack
(Name, form & strength and pack size)
|
Max qty packs |
Max qty units |
No. of repeats |
DPMQ |
Max Safety Net |
General Patient Charge |
1509KMPNP |
DEXTRAN-70 + HYPROMELLOSE dextran-70 0.1% + hypromellose 0.3% eye drops, 15 mL
(PI,
CMI)
|
1 |
1 |
5 |
$16.90 |
$18.30 |
$21.75 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
5 |
$20.75 |
$18.30 |
$25.60 |
space
DEXTRAN-70 + HYPROMELLOSE
Code & Prescriber
|
Medicinal Product Pack
(Name, form & strength and pack size)
|
Max qty packs |
Max qty units |
No. of repeats |
DPMQ |
Max Safety Net |
General Patient Charge |
5520MOP |
DEXTRAN-70 + HYPROMELLOSE dextran-70 0.1% + hypromellose 0.3% eye drops, 15 mL
(PI,
CMI)
|
1 |
1 |
5 |
$16.90 |
$18.30 |
$21.75 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
5 |
$20.75 |
$18.30 |
$25.60 |
space
DEXTRAN-70 + HYPROMELLOSE
Code & Prescriber
|
Medicinal Product Pack
(Name, form & strength and pack size)
|
Max qty packs |
Max qty units |
No. of repeats |
DPMQ |
Max Safety Net |
General Patient Charge |
5521NOP |
DEXTRAN-70 + HYPROMELLOSE dextran-70 0.1% + hypromellose 0.3% eye drops, 28 x 0.4 mL ampoules
(PI,
CMI)
|
3 |
3 |
5 |
$30.06 |
$31.46 |
$31.60 |
Available brands |
Bion Tears |
space
DEXTRAN-70 + HYPROMELLOSE
Code & Prescriber
|
Medicinal Product Pack
(Name, form & strength and pack size)
|
Max qty packs |
Max qty units |
No. of repeats |
DPMQ |
Max Safety Net |
General Patient Charge |
8299TMPNP |
DEXTRAN-70 + HYPROMELLOSE dextran-70 0.1% + hypromellose 0.3% eye drops, 28 x 0.4 mL ampoules
(PI,
CMI)
|
3 |
3 |
5 |
$30.06 |
$31.46 |
$31.60 |
Available brands |
Bion Tears |
space
DEXTRAN-70 + HYPROMELLOSE
Code & Prescriber
|
Medicinal Product Pack
(Name, form & strength and pack size)
|
Max qty packs |
Max qty units |
No. of repeats |
DPMQ |
Max Safety Net |
General Patient Charge |
9216CMP |
DEXTRAN-70 + HYPROMELLOSE dextran-70 0.1% + hypromellose 0.3% eye drops, 15 mL
(PI,
CMI)
|
1 |
1 |
11 |
$16.90 |
$18.30 |
$21.75 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
11 |
$20.75 |
$18.30 |
$25.60 |
space
- Legend
- BBrand premium applies
- aBrand equivalent a
- MPMedical Practitioner
- NPNurse Practitioner
- OPOptometrist