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 | $6838.60 | $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 | $6838.60 | $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 | $6978.73 | $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 | $6978.73 | $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 | $6978.73 | $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 | $6978.73 | $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 | $6838.60 | $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 | $6838.60 | $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 | $6838.60 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner




