fee schedule 2009 new - DE Medical Assistance Program

J0290 6 AMPICILLIN 500 MG INJ 0.00
J0295 6 AMPICILLIN SODIUM PER 1.5 GM 0.00
J0300 5 AMOBARBITAL 125 MG INJ 0.00
J0330 6 SUCCINYCHOLINE CHLORIDE INJ 0.00
J0340 O NANDROLON PHENPROPIONATE INJ 0.00
J0348 6 ANIDULAFUNGIN INJECTION 0.00
J0350 5 INJECTION ANISTREPLASE 30 U 0.00
J0360 5 HYDRALAZINE HCL INJECTION 0.00
J0364 6 APOMORPHINE HYDROCHLORIDE 0.00
J0365 5 APROTONIN, 10,000 KIU 0.00
J0380 5 INJ METARAMINOL BITARTRATE 0.00
J0390 5 CHLOROQUINE INJECTION 0.00
J0395 5 ARBUTAMINE HCL INJECTION 0.00
J0400 6 INJECTION, ARIPIPRAZOLE, INTRAMUSC 0.00
J0456 6 AZITHROMYCIN 0.00
J0460 6 ATROPINE SULFATE INJECTION 0.00
J0470 5 DIMECAPROL INJECTION 0.00
J0475 6 BACLOFEN 10 MG INJECTION 0.00
J0480 5 BASILIXIMAB 0.00
J0500 5 DICYCLOMINE INJECTION 0.00
J0510 O BENZQUINAMIDE INJECTION 0.00
J0515 5 INJ BENZTROPINE MESYLATE 0.00
J0520 5 BETHANECHOL CHLORIDE INJECT 0.00
J0530 5 PENICILLIN G BENZATHINE INJ 0.00
J0540 5 PENICILLIN G BENZATHINE INJ 0.00
J0550 5 PENICILLIN G BENZATHINE INJ 0.00
J0560 5 PENICILLIN G BENZATHINE INJ 0.00
J0570 3 PENICILLIN G BENZATHINE INJ 13.60
J0580 5 PENICILLIN G BENZATHINE INJ 0.00
J0583 6 BIVALIRUDIN 0.00
J0585 6 BOTULINUM TOXIN A PER UNIT 0.00
J0587 6 BOTULINUM TOXIN TYPE B 0.00
J0590 O ETHYLNOREPINEPHRINE HCL INJ 0.00
J0592 5 BUPRENORPHINE HYDROCHLORIDE 0.00
J0594 6 BUSULFAN INJECTION 0.00
J0595 6 BUTORPHANOL TARTRATE 1 MG 0.00
J0600 5 EDETATE CALCIUM DISODIUM INJ 0.00
J0610 6 CALCIUM GLUCONATE INJECTION 0.00
J0620 5 CALCIUM GLYCER & LACT/10 ML 0.00
J0630 5 CALCITONIN SALMON INJECTION 0.00
J0635 O CALCITRIOL INJECTION 0.00
J0636 5 INJ CALCITRIOL PER 0.1 MCG 0.00
J0637 5 CASPOFUNGIN ACETATE 0.00
J0640 3 LEUCOVORIN CALCIUM INJECTION 1.95
J0641 6 LEVOLEUCOVORIN INJECTION 0.00
J0670 3 INJ MEPIVACAINE HCL/10 ML 1.82
J0680 O INJECTION, DESLANOSIDE, UP TO 0.4 M 0.00
J0690 6 CEFAZOLIN SODIUM INJECTION 0.00
J0692 6 CEFEPIME HCL FOR INJECTION 0.00
J0694 6 CEFOXITIN SODIUM INJECTION 0.00