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 | $639.44 | $25.00 | $25.00 |
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 | $735.71 | $25.00 | $25.00 |
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 | $617.13 | $25.00 | $25.00 |
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 | $759.69 | $25.00 | $25.00 |
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 | $735.71 | $25.00 | $25.00 |
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 | $617.13 | $25.00 | $25.00 |
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 | $759.69 | $25.00 | $25.00 |
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 | $639.44 | $25.00 | $25.00 |
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 | $413.47 | $25.00 | $25.00 |
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 | $296.47 | $25.00 | $25.00 |
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 | $735.71 | $25.00 | $25.00 |
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 | $617.13 | $25.00 | $25.00 |
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 | $432.94 | $25.00 | $25.00 |
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 | $314.30 | $25.00 | $25.00 |
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 | $759.69 | $25.00 | $25.00 |
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 | $639.44 | $25.00 | $25.00 |
- Legend
- MPMedical Practitioner




