FOLLITROPIN ALFA
follitropin alfa 900 units (65.52 microgram)/1.44 mL injection, 1.44 mL pen device
FOLLITROPIN ALFA (6433N)
6433N
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: 5 | Max qty units: 5 | # of repeats: 0 | DPMQ: $1,686.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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