THYROTROPIN ALFA

General Schedule
Restricted Benefit

Restriction

Indication: Ablation of thyroid remnant tissue
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: $1,562.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Thyrogen