IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11628BMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 3 | $16125.09 | $31.60 | $31.60 |
IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11644WMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 3 | $16395.22 | $31.60 | $31.60 |
IPILIMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12304NMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 4 | $16395.22 | $31.60 | $31.60 |
IPILIMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12322MMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 4 | $16125.09 | $31.60 | $31.60 |
IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12583GMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 3 | $16125.09 | $31.60 | $31.60 |
IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12601FMP | IPILIMUMAB Injection (PI, CMI)
|
120 mg | 3 | $16395.22 | $31.60 | $31.60 |
IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
2638WMP | IPILIMUMAB Injection (PI, CMI)
|
360 mg | 3 | $43492.42 | $31.60 | $31.60 |
IPILIMUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
2641BMP | IPILIMUMAB Injection (PI, CMI)
|
360 mg | 3 | $42848.19 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner