INCOBOTULINUMTOXINA

incobotulinumtoxinA 100 units injection, 1 vial

INCOBOTULINUMTOXINA (15307P)

incobotulinumtoxinA 100 units injection, 1 vial
15307P
Body System:
Manner of administration:Injection
S100 Botulinum Toxin Program
Authority Required (STREAMLINED)

Restriction  5178

Indication: Moderate to severe spasticity of the upper limb

Restriction  8929

Indication: Moderate to severe spasticity of the upper limb
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: $1,319.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xeomin