INOTUZUMAB OZOGAMICIN
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Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
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11668DMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
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2820 mcg | 4 | $38019.19 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
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Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
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11673JMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
|
3384 mcg | 2 | $50647.32 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
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Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
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11680RMP | INOTUZUMAB OZOGAMICIN Injection (PI, CMI)
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2820 mcg | 4 | $37451.47 | $31.60 | $31.60 |
INOTUZUMAB OZOGAMICIN
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|
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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 | $49905.25 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner