Description - DE Medical Assistance Program

J7321 HYALGAN/SUPARTZ INJ PER DOSE 3 $92.28
J7322 SYNVISC INJ PER DOSE O $0.00
J7323 EUFLEXXA INJ PER DOSE 3 $107.08
J7324 ORTHOVISC INJ PER DOSE 3 $176.05
J7325 SYNVISC OR SYNVISC-ONE 3 $11.74
J7330 CULTURED CHONDROCYTES IMPLNT 9 $0.00
J7340 METABOLIC ACTIVE D/E TISSUE O $0.00
J7341 NON-HUMAN, METABOLIC TISSUE O $0.00
J7342 METABOLICALLY ACTIVE TISSUE O $0.00
J7343 NONMETABOLIC ACT D/E TISSUE O $0.00
J7344 NONMETABOLIC ACTIVE TISSUE O $0.00
J7345 NON-HUMAN, NON-METAB TISSUE O $0.00
J7346 INJECTABLE HUMAN TISSUE O $0.00
J7347 INTEGRA MATRIX TISSUE O $0.00
J7348 TISSUEMEND TISSUE O $0.00
J7349 PRIMATRIX TISSUE O $0.00
J7350 INJECTABLE HUMAN TISSUE O $0.00
J7500 AZATHIOPRINE ORAL 50MG 9 $0.00
J7501 AZATHIOPRINE PARENTERAL 5 $0.00
J7502 CYCLOSPORINE ORAL 100 MG 9 $0.00
J7503 CYCLOSPORINE PARENTERAL O $0.00
J7504 LYMPHOCYTE IMMUNE GLOBULIN 5 $0.00
J7505 MONOCLONAL ANTIBODIES 5 $0.00
J7506 PREDNISONE ORAL 9 $0.00
J7507 TACROLIMUS ORAL PER 1 MG 9 $0.00
J7508 TACROLIMUS ORAL PER 5 MG O $0.00
J7509 METHYLPREDNISOLONE ORAL 9 $0.00
J7510 PREDNISOLONE ORAL PER 5 MG 9 $0.00
J7511 ANTITHYMOCYTE GLOBULN RABBIT 5 $0.00
J7513 DACLIZUMAB, PARENTERAL 5 $0.00
J7515 CYCLOSPORINE ORAL 25 MG 9 $0.00
J7516 CYCLOSPORIN PARENTERAL 250MG 5 $0.00
J7517 MYCOPHENOLATE MOFETIL ORAL 9 $0.00
J7518 MYCOPHENOLIC ACID 9 $0.00
J7520 SIROLIMUS, ORAL 9 $0.00
J7525 TACROLIMUS INJECTION 5 $0.00
J7599 IMMUNOSUPPRESSIVE DRUG NOC 5 $0.00
J7602 ALBUTEROL INH NON-COMP CON O $0.00
J7603 ALBUTEROL INH NON-COMP U D O $0.00
J7604 ACETYLCYSTEINE COMP UNIT 9 $0.00
J7605 ARFORMOTEROL NON-COMP UNIT 9 $0.00
J7606 FORMOTEROL FUMARATE, INH 9 $0.00
J7607 LEVALBUTEROL COMP CON 9 $0.00
J7608 ACETYLCYSTEINE NON-COMP UNIT 9 $0.00
J7609 ALBUTEROL COMP UNIT 9 $0.00
J7610 ALBUTEROL COMP CON 9 $0.00
J7611 ALBUTEROL NON-COMP CON O $0.00
J7612 LEVALBUTEROL NON-COMP CON O $0.00
J7613 ALBUTEROL NON-COMP UNIT O $0.00