ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11277MMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11284XMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 5 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11297NMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11309FMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 5 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11792PMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 5 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11801DMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11802EMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11807KMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 5 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11926QMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 3 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11927RMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 3 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11928TMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 4 | $6973.74 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11929WMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 4 | $6835.99 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11930XMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9534.92 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11931YMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 3 | $9534.92 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11940KMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 3 | $9710.45 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11957HMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9710.45 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner