Description - DE Medical Assistance Program

J1452 INTRAOCULAR FOMIVIRSEN NA 5 $0.00
J1453 FOSAPREPITANT INJECTION 3 $1.57
J1455 FOSCARNET SODIUM INJECTION 3 $10.10
J1457 GALLIUM NITRATE INJECTION 3 $1.60
J1458 GALSULFASE INJECTION 3 $334.47
J1459 INJ IVIG PRIVIGEN 500 MG 3 $35.14
J1460 GAMMA GLOBULIN 1 CC INJ 5 $0.00
J1470 GAMMA GLOBULIN 2 CC INJ 5 $0.00
J1480 GAMMA GLOBULIN 3 CC INJ 5 $0.00
J1490 GAMMA GLOBULIN 4 CC INJ 5 $0.00
J1500 GAMMA GLOBULIN 5 CC INJ 5 $0.00
J1510 GAMMA GLOBULIN 6 CC INJ 5 $0.00
J1520 GAMMA GLOBULIN 7 CC INJ 5 $0.00
J1530 GAMMA GLOBULIN 8 CC INJ 5 $0.00
J1540 GAMMA GLOBULIN 9 CC INJ 5 $0.00
J1550 GAMMA GLOBULIN 10 CC INJ 5 $0.00
J1560 GAMMA GLOBULIN > 10 CC INJ 5 $0.00
J1561 GAMUNEX INJECTION 3 $37.62
J1562 VIVAGLOBIN, INJ 3 $7.18
J1563 IV IMMUNE GLOBULIN O $0.00
J1564 IMMUNE GLOBULIN 10 MG O $0.00
J1565 RSV-IVIG O $0.00
J1566 IMMUNE GLOBULIN, POWDER 3 $30.48
J1567 IMMUNE GLOBULIN, LIQUID O $0.00
J1568 OCTAGAM INJECTION 3 $37.71
J1569 GAMMAGARD LIQUID INJECTION 3 $38.53
J1570 GANCICLOVIR SODIUM INJECTION 3 $46.56
J1571 HEPAGAM B IM INJECTION 3 $50.22
J1572 FLEBOGAMMA INJECTION 3 $37.12
J1573 HEPAGAM B INTRAVENOUS, INJ 3 $50.22
J1580 GARAMYCIN GENTAMICIN INJ 3 $0.87
J1590 GATIFLOXACIN INJECTION 5 $0.00
J1595 INJECTION GLATIRAMER ACETATE 3 $85.65
J1600 GOLD SODIUM THIOMALEATE INJ 5 $0.00
J1610 GLUCAGON HYDROCHLORIDE/1 MG 5 $0.00
J1620 GONADORELIN HYDROCH/ 100 MCG 5 $0.00
J1625 INJECTION, GRANISETRON HYDROCHLORID O $0.00
J1626 GRANISETRON HCL INJECTION 3 $0.35
J1630 HALOPERIDOL INJECTION 5 $0.00
J1631 HALOPERIDOL DECANOATE INJ 3 $2.68
J1640 HEMIN, 1 MG 3 $8.07
J1642 INJ HEPARIN SODIUM PER 10 U 3 $0.12
J1644 INJ HEPARIN SODIUM PER 1000U 3 $0.06
J1645 DALTEPARIN SODIUM 5 $0.00
J1650 INJ ENOXAPARIN SODIUM 3 $6.47
J1652 FONDAPARINUX SODIUM 5 $0.00
J1655 TINZAPARIN SODIUM INJECTION 3 $2.65
J1660 INJECTION, HISTAMINE, UP TO 2.75 MG O $0.00
J1670 TETANUS IMMUNE GLOBULIN INJ 5 $0.00