CARBOMER-980

carbomer-980 0.2% eye gel, 10 g

CARBOMER-980 (14385D)

carbomer-980 0.2% eye gel, 10 g
14385D
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: Severe dry eye syndrome
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: 5 DPMQ: $21.08 Max safety net: $22.62 General Patient Charge: $25.00
Available brands
Optifresh eye gel
PAA
Viscotears
*Additional charge for this brand is $7.26
 DPMQ: $28.34 Max safety net: $22.62 General Patient Charge: $32.26