INCOBOTULINUMTOXINA
Manner of administration:Injection
Restriction (Streamlined authority code: 5360)
Indication: Blepharospasm
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: 0 | DPMQ: $1,319.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 5222)
Indication: Spasmodic torticollis
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: 0 | DPMQ: $1,319.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 9547)
Indication: Moderate to severe spasticity of the upper limb following an acute event
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: 0 | DPMQ: $1,319.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 18047)
Indication: Chronic sialorrhea
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: $339.29 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 18059)
Indication: Chronic sialorrhea
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: $339.29 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 5178)
Indication: Moderate to severe spasticity of the upper limb
Restriction (Streamlined authority code: 8929)
Indication: Moderate to severe spasticity of the upper limb
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: 0 | DPMQ: $1,319.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||
Manner of administration:Injection
Restriction (Streamlined authority code: 5359)
Indication: Dynamic equinus foot deformity
Restriction (Streamlined authority code: 8822)
Indication: Dynamic equinus foot deformity
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: 0 | DPMQ: $1,319.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Xeomin | |||||