HUMAN MENOPAUSAL GONADOTROPHIN
human menopausal gonadotrophin 600 units injection [1 vial] (&) inert substance diluent
[1 mL syringe], 1 pack
Manner of administration:Injection
Restriction (Streamlined authority code: 5027)
Indication: Assisted Reproductive Technology
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 3 | # of repeats: 0 | DPMQ: $756.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Menopur 600 | |||||
human menopausal gonadotrophin 1200 units injection [1 vial] (&) inert substance diluent
[2 x 1 mL syringes], 1 pack
Manner of administration:Injection
Restriction (Streamlined authority code: 5027)
Indication: 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: 0 | DPMQ: $1,966.44 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Menopur 1200 | |||||