CHORIOGONADOTROPIN ALFA
choriogonadotropin alfa 250 microgram/0.5 mL injection, 0.5 mL syringe
CHORIOGONADOTROPIN ALFA (14640M)
14640M
Manner of administration:Injection
Restriction
Indication: Infertility indications other than that of Assisted Reproductive Technology
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $518.16 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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