CIPROFLOXACIN

CIPROFLOXACIN (1217C)

ciprofloxacin 0.3% eye drops, 5 mL
1217C
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required

Restriction

Indication: Bacterial keratitis
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: 0 DPMQ: $44.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
CiloQuin
Ciloxan
*Additional charge for this brand is $9.50
 DPMQ: $53.52 Max safety net: $25.00 General Patient Charge: $34.50

CIPROFLOXACIN (2480M)

ciprofloxacin 0.3% ear drops, 5 mL
2480M
Body System:
Manner of administration:Application To The Ear
General Schedule
Authority Required

Restriction

Indication: Chronic suppurative otitis media

Restriction

Indication: Chronic suppurative otitis media

Restriction

Indication: Chronic suppurative otitis media
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: 1 DPMQ: $40.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ciloxan

CIPROFLOXACIN (5564W)

ciprofloxacin 0.3% eye drops, 5 mL
5564W
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required

Restriction

Indication: Bacterial keratitis
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: 0 DPMQ: $44.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
CiloQuin
Ciloxan
*Additional charge for this brand is $9.50
 DPMQ: $53.52 Max safety net: $25.00 General Patient Charge: $34.50