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 | $920.32 | $30.00 | $30.00 |
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 | $705.82 | $30.00 | $30.00 |
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 | $920.32 | $30.00 | $30.00 |
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 | $705.82 | $30.00 | $30.00 |
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 | $515.91 | $30.00 | $30.00 |
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 | $334.57 | $30.00 | $30.00 |
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 | $920.32 | $30.00 | $30.00 |
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 | $705.82 | $30.00 | $30.00 |
- Legend
- MPMedical Practitioner