INOTUZUMAB OZOGAMICIN
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11668DMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
|
2820 mcg | 4 | $40010.22 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11673JMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
|
3384 mcg | 2 | $53302.99 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11680RMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
|
2820 mcg | 4 | $39416.34 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
|
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11696NMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
|
3384 mcg | 2 | $52525.58 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner