Description - DE Medical Assistance Program

J9070 CYCLOPHOSPHAMIDE 100 MG INJ 5 $0.00
J9080 CYCLOPHOSPHAMIDE 200 MG INJ 5 $0.00
J9090 CYCLOPHOSPHAMIDE 500 MG INJ 3 $21.69
J9091 CYCLOPHOSPHAMIDE 1.0 GRM INJ 3 $43.39
J9092 CYCLOPHOSPHAMIDE 2.0 GRM INJ 5 $0.00
J9093 CYCLOPHOSPHAMIDE LYOPHILIZED 3 $5.16
J9094 CYCLOPHOSPHAMIDE LYOPHILIZED 3 $4.45
J9095 CYCLOPHOSPHAMIDE LYOPHILIZED 3 $11.13
J9096 CYCLOPHOSPHAMIDE LYOPHILIZED 3 $22.26
J9097 CYCLOPHOSPHAMIDE LYOPHILIZED 5 $0.00
J9098 CYTARABINE LIPOSOME INJ 6 $0.00
J9100 CYTARABINE HCL 100 MG INJ 3 $1.80
J9110 CYTARABINE HCL 500 MG INJ 3 $3.86
J9120 DACTINOMYCIN INJECTION 5 $0.00
J9130 DACARBAZINE 100 MG INJ 3 $4.14
J9140 DACARBAZINE 200 MG INJ 3 $8.11
J9150 DAUNORUBICIN INJECTION 3 $16.26
J9151 DAUNORUBICIN CITRATE INJ 5 $0.00
J9155 DEGARELIX INJECTION 3 $2.28
J9160 DENILEUKIN DIFTITOX INJ 5 $0.00
J9165 DIETHYLSTILBESTROL INJECTION 5 $0.00
J9170 DOCETAXEL INJECTION O $0.00
J9171 DOCETAXEL INJECTION 3 $17.62
J9175 ELLIOTTS B SOLUTION PER ML 3 $4.02
J9178 INJ, EPIRUBICIN HCL, 2 MG 6 $0.00
J9180 EPIRUBICIN HCL INJECTION O $0.00
J9181 ETOPOSIDE INJECTION 3 $0.45
J9182 ETOPOSIDE 100 MG INJ O $0.00
J9185 FLUDARABINE PHOSPHATE INJ 3 $151.12
J9190 FLUOROURACIL INJECTION 3 $1.60
J9200 FLOXURIDINE INJECTION 5 $0.00
J9201 GEMCITABINE HCL INJECTION 3 $144.88
J9202 GOSERELIN ACETATE IMPLANT 3 $203.86
J9206 IRINOTECAN INJECTION 3 $6.94
J9207 IXABEPILONE INJECTION 3 $63.37
J9208 IFOSFOMIDE INJECTION 5 $0.00
J9209 MESNA INJECTION 5 $0.00
J9211 IDARUBICIN HCL INJECTION 5 $0.00
J9212 INTERFERON ALFACON-1 INJ 5 $0.00
J9213 INTERFERON ALFA-2A INJ 5 $0.00
J9214 INTERFERON ALFA-2B INJ 3 $14.71
J9215 INTERFERON ALFA-N3 INJ 5 $0.00
J9216 INTERFERON GAMMA 1-B INJ 5 $0.00
J9217 LEUPROLIDE ACETATE SUSPNSION 3 $515.00
J9218 LEUPROLIDE ACETATE INJECITON 5 $0.00
J9219 LEUPROLIDE ACETATE IMPLANT 5 $0.00
J9225 VANTAS IMPLANT 3 $1,462.69
J9226 SUPPRELIN LA IMPLANT 6 $0.00
J9230 MECHLORETHAMINE HCL INJ 3 $152.79