BOTULINUM TOXIN TYPE A

botulinum toxin type A 100 units injection, 1 vial

BOTULINUM TOXIN TYPE A (12017L)

botulinum toxin type A 100 units injection, 1 vial
12017L
Body System:
Manner of administration:Injection
S100 Botulinum Toxin Program
Authority Required (STREAMLINED)

Restriction  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: $1,098.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Botox