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 | $6837.50 | $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 | $6837.50 | $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 | $6976.63 | $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 | $6976.63 | $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 | $6976.63 | $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 | $6976.63 | $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 | $6837.50 | $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 | $6837.50 | $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 | $6837.50 | $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 | $6976.63 | $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 | $6976.63 | $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 | $6837.50 | $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 | $9536.43 | $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 | $9536.43 | $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 | $9713.34 | $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 | $9713.34 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12076NMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 3 | $9713.34 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12078QMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 3 | $9536.43 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12097QMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9536.43 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12098RMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9713.34 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12155RMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 8 | $6976.63 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12159YMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9713.34 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12167JMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 3 | $6976.63 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12168KMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 8 | $6837.50 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12171NMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 3 | $6837.50 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12174RMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9536.43 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13170EMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9713.34 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13172GMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6976.63 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13173HMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1680 mg | 5 | $9536.43 | $31.60 | $31.60 |
ATEZOLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
13174JMP | ATEZOLIZUMAB Injection (PI, CMI)
|
1200 mg | 7 | $6837.50 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner