fee schedule 2009 new - DE Medical Assistance Program

S0135 5 PEGFILGRASTIM INJECTION 6MG 0.00
S0136 9 CLOZAPINE, 25 MG 0.00
S0137 9 DIDANOSINE, 25 MG 0.00
S0138 9 FINASTERIDE, 5 MG 0.00
S0139 9 MINOXIDIL, 10 MG 0.00
S0140 9 SAQUINAVIR, 200 MG 0.00
S0141 O ZALCITABINE, 0.375 MG 0.00
S0142 9 COLISTIMETHATE INH SOL MG 0.00
S0143 O AZTREONAM, INH SOL GRAM 0.00
S0145 5 PEG INTERFERON ALFA-2A/180 0.00
S0146 5 PEG INTERFERON ALFA-2B/10 0.00
S0147 O ALGLUCOSIDASE ALFA 20 MG 0.00
S0155 5 EPOPROSTENOL DILUTANT 0.00
S0156 5 EXEMESTANE, 25 MG 0.00
S0157 9 BECAPLERMIN GEL 1%, 0.5 GM 0.00
S0158 O INJECTION LARONIDASE 0.00
S0159 O INJECTION AGALSIDASE 0.00
S0160 9 DEXTROAMPHETAMINE 0.00
S0161 5 CALCITROL 0.00
S0162 5 INJECTION EFALIZUMAB 0.00
S0163 O INJECTION RISPERIDONELA 0.00
S0164 5 INJECTION PANTOPRAZOLE 0.00
S0165 O INJECTION ABARELIX 0.00
S0166 9 INJ OLANZAPINE 2.5MG 0.00
S0167 O INJ APOMORPHINE HCL 1MG 0.00
S0168 O INJ AZACITIDINE 100 MG 0.00
S0170 9 ANASTROZOLE 1 MG 0.00
S0171 5 BUMETANIDE 0.5 MG 0.00
S0172 9 CHLORAMBUCIL 2 MG 0.00
S0173 O DEXAMETHASONE 4 MG 0.00
S0174 9 DOLASETRON 50 MG 0.00
S0175 9 FLUTAMIDE 125 MG 0.00
S0176 9 HYDROXYUREA 500 MG 0.00
S0177 9 LEVAMISOLE 50 MG 0.00
S0178 9 LOMUSTINE 10 MG 0.00
S0179 9 MEGESTROL 20 MG 0.00
S0180 O ETONOGESTREL IMPLANT SYSTEM 0.00
S0181 9 ONDANSETRON 4 MG 0.00
S0182 9 PROCARBAZINE 5 MG 0.00
S0183 9 PROCHLORPERAZINE 5 MG 0.00
S0187 9 TAMOXIFEN 10 MG 0.00
S0189 9 TESTOSTERONE PELLET 75 MG 0.00
S0190 5 MIFEPRISTONE, ORAL, 200 MG 0.00
S0191 5 MISOPROSTOL, ORAL, 200 MCG 0.00
S0194 9 VITAMIN SUPPL 100 CAPS 0.00
S0195 5 PNEUMOCOCCAL CONJUGATE VAC 0.00
S0196 9 POLY-L-LACTIC ACID 1ML FACE 0.00
S0197 9 PRENATAL VITAMINS 30 DAY 0.00
S0198 O INJ PEGAPTANIB 0.3 MG 0.00
S0199 9 MEDICALLY INDUCED ABORTION BY ORAL 0.00