fee schedule 2009 new - DE Medical Assistance Program

C9001 9 LINEZOLID INJ, 200MG 0.00
C9002 9 TENECTEPLASE, 50MG/VIAL 0.00
C9003 O PALIVIZUMAB, PER 50 MG 0.00
C9004 9 GEMTUZUMAB OZOGAMICIN INJ,5M 0.00
C9005 9 RETEPLASE INJ, HALF-KIT,18.8 0.00
C9006 9 TACROLIMUS INJ, PER 5 MG 0.00
C9007 O BACLOFEN INTRATHECAL KIT-1AM 0.00
C9008 O BACLOFEN REFILL KIT-500MCG 0.00
C9009 O BACLOFEN REFILL KIT-2000MCG 0.00
C9010 O BACLOFEN REFILL KIT--4000MCG 0.00
C9011 9 CAFFEINE CITRATE, INJ, 1ML 0.00
C9013 O CO 57 COBALTOUS CHLORIDE 0.00
C9019 9 CASPOFUNGIN ACETATE, 5 MG 0.00
C9020 9 SIROLIMUS TABLET, 1 MG 0.00
C9100 9 IODINATED I-131 ALBUMIN 0.00
C9102 O 51 NA CHROMATE, 50MCI 0.00
C9103 O NA IOTHALAMATE I-125, 10 UCI 0.00
C9104 9 ANTI-THYMOCYTE GLOBULIN,25MG 0.00
C9105 O HEP B IMM GLOB, PER 1 ML 0.00
C9106 9 SIROLIMUS 1MG/ML 0.00
C9107 9 TINZAPARIN SODIUM, 2ML VIAL 0.00
C9108 9 THYROTROPIN ALFA, 1.1 MG 0.00
C9109 O TIROFIBAN HCL, 6.25 MG 0.00
C9110 9 ALEMTUZUMAB, PER 10MG/ML 0.00
C9111 O INJ, BIVALIRUDIN, 250MG VIAL 0.00
C9112 O PERFLUTREN LIPID MICRO, 2ML 0.00
C9113 9 INJ PANTOPRAZOLE SODIUM, VIA 0.00
C9114 9 NESIRITIDE, PER 1.5 MG VIAL 0.00
C9115 9 INJ, ZOLEDRONIC ACID, 2 MG 0.00
C9116 O ERTAPENEM SODIUM, PER 1 GM 0.00
C9119 O INJECTION, PEGFILGRASTIM 0.00
C9120 O INJECTION, FULVESTRANT 0.00
C9121 9 INJECTION, ARGATROBAN 0.00
C9123 O TRANSCYTE, PER 247 SQ CM 0.00
C9124 O INJECTION, DAPTOMYCIN 0.00
C9125 O INJECTION, RISPERIDONE 0.00
C9126 O INJECTION, NATALIZUMAB 0.00
C9200 O ORCEL, PER 36 CM2 0.00
C9201 O DERMAGRAFT, PER 37.5 SQ CM 0.00
C9202 O OCTAFLUOROPROPANE 0.00
C9203 O PERFLEXANE LIPID MICRO 0.00
C9205 O OXALIPLATIN 0.00
C9206 O INTEGRA, PER CM2 0.00
C9207 O INJECTION, BORTEZOMIB 0.00
C9208 O INJECTION, AGALSIDASE BETA 0.00
C9209 O INJECTION, LARONIDASE 0.00
C9210 O INJECTION, PALONOSETRON HCL 0.00
C9211 O INJ, ALEFACEPT, IV 0.00
C9212 O INJ, ALEFACEPT, IM 0.00
C9213 O INJECTION, PEMETREXED 0.00