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 | $16122.48 | $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 | $16390.23 | $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 | $43487.43 | $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 | $42845.58 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner