Description - DE Medical Assistance Program

J3570 LAETRILE AMYGDALIN VIT B17 9 $0.00
J3590 UNCLASSIFIED BIOLOGICS 5 $0.00
J6015 TYPHUS O $0.00
J7010 VIAL OF ALLERGY VACCINE, SINGLE DOS O $0.00
J7020 VIAL OF ALLERGY VACCINE, MULTIPLE D O $0.00
J7030 NORMAL SALINE SOLUTION INFUS 3 $0.46
J7040 NORMAL SALINE SOLUTION INFUS 3 $0.56
J7042 5% DEXTROSE/NORMAL SALINE 3 $0.34
J7050 NORMAL SALINE SOLUTION INFUS 3 $0.28
J7051 STERILE SALINE/WATER O $0.00
J7060 5% DEXTROSE/WATER 3 $1.13
J7070 D5W INFUSION 5 $0.00
J7080 INFUSION, ALBUMISOL 5%, 500 ML VIAL O $0.00
J7090 INFUSION, ALBUMISOL 25%, 50 ML VIAL O $0.00
J7100 DEXTRAN 40 INFUSION 5 $0.00
J7110 DEXTRAN 75 INFUSION 5 $0.00
J7120 RINGERS LACTATE INFUSION 3 $6.14
J7130 HYPERTONIC SALINE SOLUTION 5 $0.00
J7140 PRESCRIPTION DRUG, ORAL, DISPENSED 9 $0.00
J7150 PRESCRIPTION DRUG, ORAL CHEMOTHERAP 9 $0.00
J7185 XYNTHA INJ 3 $1.02
J7186 ANTIHEMOPHILIC VIII/VWF COMP 3 $0.67
J7187 HUMATE-P, INJ 3 $0.67
J7188 INJ VONWILLEBRAND FACTOR IU O $0.00
J7189 FACTOR VIIA 3 $1.30
J7190 FACTOR VIII 5 $0.00
J7191 FACTOR VIII (PORCINE) 5 $0.00
J7192 FACTOR VIII RECOMBINANT NOS 5 $0.00
J7193 FACTOR IX NON-RECOMBINANT 3 $0.77
J7194 FACTOR IX COMPLEX 5 $0.00
J7195 FACTOR IX RECOMBINANT 5 $0.00
J7196 OTHR HEMOPHILIA CLOT FACTORS O $0.00
J7197 ANTITHROMBIN III INJECTION 3 $2.32
J7198 ANTI-INHIBITOR 3 $1.03
J7199 HEMOPHILIA CLOT FACTOR NOC 5 $0.00
J7300 INTRAUT COPPER CONTRACEPTIVE 9 $0.00
J7302 LEVONORGESTREL IU CONTRACEPT 3 $703.05
J7303 CONTRACEPTIVE VAGINAL RING 9 $0.00
J7304 CONTRACEPTIVE HORMONE PATCH 9 $0.00
J7306 LEVONORGESTREL IMPLANT SYS 9 $0.00
J7307 ETONOGESTREL IMPLANT SYSTEM 3 $610.76
J7308 AMINOLEVULINIC ACID HCL TOP 9 $0.00
J7310 GANCICLOVIR LONG ACT IMPLANT 9 $0.00
J7311 FLUOCINOLONE ACETONIDE IMPLT 9 $0.00
J7315 SODIUM HYALURONATE INJECTION O $0.00
J7316 SODIUM HYALURONATE INJECTION O $0.00
J7317 SODIUM HYALURONATE INJECTION O $0.00
J7319 SODIUM HYALURONATE INJECTION O $0.00
J7320 HYLAN G-F 20 INJECTION O $0.00