PROPYLENE GLYCOL
Body System:
Manner of administration:Application To The Eye
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: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $17.16 | Max safety net: $18.70 | General Patient Charge: $21.49 |
| Available brands | |||||
| Systane Balance | |||||
Body System:
Manner of administration:Application To The Eye
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: $19.96 | Max safety net: $21.50 | General Patient Charge: $24.29 |
| Available brands | |||||
| Systane Balance | |||||