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 | $686.45 | $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 | $831.87 | $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 | $663.48 | $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 | $857.19 | $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 | $831.87 | $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 | $663.48 | $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 | $857.19 | $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 | $686.45 | $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 | $461.55 | $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 | $315.04 | $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 | $831.87 | $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 | $663.48 | $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 | $481.69 | $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 | $333.13 | $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 | $857.19 | $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 | $686.45 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner




