fee schedule 2009 new - DE Medical Assistance Program

Q0513 9 DISP FEE INHAL DRUGS/30 DAYS 0.00
Q0514 9 DISP FEE INHAL DRUGS/90 DAYS 0.00
Q0515 5 SERMORELIN ACETATE INJECTION 0.00
Q1001 O NTIOL CATEGORY 1 0.00
Q1002 O NTIOL CATEGORY 2 0.00
Q1003 9 NTIOL CATEGORY 3 0.00
Q1004 9 NTIOL CATEGORY 4 0.00
Q1005 9 NTIOL CATEGORY 5 0.00
Q2001 O ORAL CABERGOLINE 0.5 MG 0.00
Q2002 O ELLIOTTS B SOLUTION PER ML 0.00
Q2003 O APROTININ, 10,000 KIU 0.00
Q2004 5 BLADDER CALCULI IRRIG SOL 0.00
Q2005 O CORTICORELIN OVINE TRIFLUTAT 0.00
Q2006 O DIGOXIN IMMUNE FAB (OVINE) 0.00
Q2007 O ETHANOLAMINE OLEATE 100 MG 0.00
Q2008 O FOMEPIZOLE, 15 MG 0.00
Q2009 5 FOSPHENYTOIN, 50 MG 0.00
Q2010 O GLATIRAMER ACETATE, PER DOSE 0.00
Q2011 O HEMIN, PER 1 MG 0.00
Q2012 O PEGADEMASE BOVINE, 25 IU 0.00
Q2013 O PENTASTARCH 10% SOLUTION 0.00
Q2014 O SERMORELIN ACETATE, 0.5 MG 0.00
Q2015 O SOMATREM, 5 MG 0.00
Q2016 O SOMATROPIN, 1 MG 0.00
Q2017 5 TENIPOSIDE, 50 MG 0.00
Q2018 O UROFOLLITROPIN, 75 IU 0.00
Q2019 O BASILIXIMAB 0.00
Q2020 O HISTRELIN ACETATE 0.00
Q2021 O LEPIRUDIN 0.00
Q2022 O VONWILLEBRANDFACTRCMPLXPERIU 0.00
Q3000 O RUBIDIUM RB 82 0.00
Q3001 5 BRACHYTHERAPY RADIOELEMENTS 0.00
Q3002 O GALLIUM GA 67 0.00
Q3003 O TECHNETIUM TC99M BICISATE 0.00
Q3004 O XENON XE 133 0.00
Q3005 O TECHNETIUM TC99M MERTIATIDE 0.00
Q3006 O TECHNETIUM TC99M GLUCEPATATE 0.00
Q3007 O SODIUM PHOSPHATE P32 0.00
Q3008 O INDIUM 111-IN PENTETREOTIDE 0.00
Q3009 O TECHNETIUM TC99M OXIDRONATE 0.00
Q3010 O TECHNETIUM TC99MLABELEDRBCS 0.00
Q3011 O CHROMIC PHOSPHATE P32 0.00
Q3012 O CYANOCOBALAMIN COBALT CO57 0.00
Q3014 9 TELEHEALTH FACILITY FEE 0.00
Q3017 9 ALS ASSESSMENT 0.00
Q3019 O ALS EMER TRANS NO ALS SERV 0.00
Q3020 O ALS NONEMER TRANS NO ALS SER 0.00
Q3021 5 PED HEPATITIS B VACCINE INJ 0.00
Q3022 5 HEPATITIS B VACCINE ADULT DS 0.00
Q3023 5 INJECTION HEPATITIS BVACCINE 0.00