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 | $845.38 | $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 | $706.93 | $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 | $845.38 | $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 | $706.93 | $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 | $467.00 | $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 | $328.55 | $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 | $845.38 | $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 | $706.93 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner