FOLLITROPIN ALFA
follitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge
FOLLITROPIN ALFA (12779N)
12779N
Manner of administration:Injection
Restriction 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: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $188.64 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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