BACLOFEN
baclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule
BACLOFEN (6284R)
6284R
Manner of administration:Injection
Restriction 9488
Indication: Severe chronic spasticity
Restriction 9637
Indication: Severe chronic spasticity
Restriction 9489
Indication: Severe chronic spasticity
Restriction 9524
Indication: Severe chronic spasticity
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 10 | Max qty units: 10 | # of repeats: 0 | DPMQ: $802.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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