BLINATUMOMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11115BMP | BLINATUMOMAB Injection (PI, CMI)
|
784 mcg | 2 | $78480.39 | $31.60 | $31.60 |
BLINATUMOMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11116CMP | BLINATUMOMAB Injection (PI, CMI)
|
651 mcg | 0 | $67287.75 | $31.60 | $31.60 |
BLINATUMOMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11117DMP | BLINATUMOMAB Injection (PI, CMI)
|
784 mcg | 2 | $77355.46 | $31.60 | $31.60 |
BLINATUMOMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11118EMP | BLINATUMOMAB Injection (PI, CMI)
|
651 mcg | 0 | $66317.34 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner