DRESSING HYDROACTIVE DEBRIDEMENT

DRESSING HYDROACTIVE DEBRIDEMENT (12629Q)

dressing hydroactive debridement 5.5 cm dressing, 10
12629Q
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
HydroClean Plus 609606 DPMQ: $148.92 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (12636C)

dressing hydroactive debridement 4 cm dressing, 10
12636C
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
HydroClean Plus Cavity 609622 DPMQ: $93.71 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (12637D)

dressing hydroactive debridement 4 cm dressing, 10
12637D
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
HydroClean Plus 609602 DPMQ: $89.88 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (12660H)

dressing hydroactive debridement 7.5 cm x 7.5 cm dressing, 10
12660H
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
HydroClean Plus 609608 DPMQ: $197.97 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (4948K)

dressing hydroactive debridement 5.5 cm dressing, 10
4948K
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
TenderWet Active Cavity 609272 DPMQ: $86.98 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (4949L)

dressing hydroactive debridement 4 cm dressing, 10
4949L
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
TenderWet 24 Active 609210 DPMQ: $85.12 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROACTIVE DEBRIDEMENT (4950M)

dressing hydroactive debridement 7.5 cm x 7.5 cm dressing, 10
4950M
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
TenderWet 24 Active 609213 DPMQ: $112.72 Max safety net: $7.70 General Patient Charge: $7.70