CEMIPLIMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13135HMP | CEMIPLIMAB Injection (PI, CMI)
|
350 mg | 2 | $7523.97 | $30.00 | $30.00 |
CEMIPLIMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13153GMP | CEMIPLIMAB Injection (PI, CMI)
|
350 mg | 7 | $7523.97 | $30.00 | $30.00 |
CEMIPLIMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13160PMP | CEMIPLIMAB Injection (PI, CMI)
|
350 mg | 6 | $7523.97 | $30.00 | $30.00 |
CEMIPLIMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13162RMP | CEMIPLIMAB Injection (PI, CMI)
|
350 mg | 6 | $7523.97 | $30.00 | $30.00 |
- Legend
- MPMedical Practitioner