TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10383LMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $685.01 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10391XMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $830.77 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10401KMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $662.38 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10402LMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $855.75 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10581XMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $830.77 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10588GMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $662.38 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10589HMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $855.75 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10597RMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $685.01 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
4632TMP | TRASTUZUMAB Injection (PI, CMI)
|
500 mg | 0 | $460.45 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
4639EMP | TRASTUZUMAB Injection (PI, CMI)
|
250 mg | 9 | $313.94 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
4650RMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $830.77 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
4703MMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $662.38 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
7264HMP | TRASTUZUMAB Injection (PI, CMI)
|
500 mg | 0 | $480.25 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
7265JMP | TRASTUZUMAB Injection (PI, CMI)
|
250 mg | 9 | $331.69 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
7266KMP | TRASTUZUMAB Injection (PI, CMI)
|
1000 mg | 0 | $855.75 | $31.60 | $31.60 |
TRASTUZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
7267LMP | TRASTUZUMAB Injection (PI, CMI)
|
750 mg | 3 | $685.01 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner