CIPROFLOXACIN
Manner of administration:Oral
Restriction
Indication: Respiratory tract infection
Restriction
Indication: Bacterial gastroenteritis
Restriction
Indication: Infection
Restriction
Indication: Bone or joint infection
Restriction
Indication: Epididymo-orchitis
Restriction
Indication: Prostatitis
Restriction
Indication: Perichondritis of the pinna
Restriction
Indication: Gonorrhoea
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 1 | Max qty units: 14 | # of repeats: 0 | DPMQ: $17.68 | Max safety net: $19.16 | General Patient Charge: $21.95 |
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Manner of administration:Oral
Restriction
Indication: Respiratory tract infection
Restriction
Indication: Bacterial gastroenteritis
Restriction
Indication: Infection
Restriction
Indication: Bone or joint infection
Restriction
Indication: Epididymo-orchitis
Restriction
Indication: Prostatitis
Restriction
Indication: Perichondritis of the pinna
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 14 | # of repeats: 0 | DPMQ: $18.20 | Max safety net: $19.68 | General Patient Charge: $22.47 |
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Manner of administration:Oral
Restriction
Indication: Respiratory tract infection
Restriction
Indication: Bacterial gastroenteritis
Restriction
Indication: Infection
Restriction
Indication: Bone or joint infection
Restriction
Indication: Epididymo-orchitis
Restriction
Indication: Prostatitis
Restriction
Indication: Perichondritis of the pinna
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 14 | # of repeats: 0 | DPMQ: $19.18 | Max safety net: $20.66 | General Patient Charge: $23.45 |
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Body System:
Manner of administration:Application To The Eye
Restriction
Indication: Bacterial keratitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $44.02 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $53.52 | Max safety net: $25.00 | General Patient Charge: $34.50 | ||
Body System:
Manner of administration:Application To The Ear
Restriction
Indication: Chronic suppurative otitis media
Restriction
Indication: Chronic suppurative otitis media
Restriction
Indication: Chronic suppurative otitis media
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: 1 | DPMQ: $40.22 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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| Ciloxan | |||||
Body System:
Manner of administration:Application To The Eye
Restriction
Indication: Bacterial keratitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $44.02 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $53.52 | Max safety net: $25.00 | General Patient Charge: $34.50 | ||