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 | $9537.53 | $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 | $9537.53 | $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 | $9715.44 | $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 | $9715.44 | $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 | $9715.44 | $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 | $9537.53 | $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 | $9537.53 | $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 | $9715.44 | $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 | $9715.44 | $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 | $9537.53 | $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 | $9715.44 | $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 | $9537.53 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner




