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 |
$16.05 |
$17.36 |
$20.65 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
5 |
$19.90 |
$17.36 |
$24.50 |
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 |
$16.05 |
$17.36 |
$20.65 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
5 |
$19.90 |
$17.36 |
$24.50 |
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 unit doses
(PI,
CMI)
|
3 |
3 |
5 |
$37.04 |
$30.00 |
$30.00 |
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 unit doses
(PI,
CMI)
|
3 |
3 |
5 |
$37.04 |
$30.00 |
$30.00 |
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 |
$16.05 |
$17.36 |
$20.65 |
Available brands |
Poly-Tearsa |
Tears Naturalea * Additional charge for this brand is
$3.85B
|
1 |
1 |
11 |
$19.90 |
$17.36 |
$24.50 |
space
- Legend
- BBrand premium applies
- aBrand equivalent a
- MPMedical Practitioner
- NPNurse Practitioner
- OPOptometrist