Description - DE Medical Assistance Program

J9240 MEDROXYPROGESTERONE ACETATE, 100 MG O $0.00
J9245 INJ MELPHALAN HYDROCHL 50 MG 5 $0.00
J9250 METHOTREXATE SODIUM INJ 5 $0.00
J9260 METHOTREXATE SODIUM INJ 3 $1.72
J9261 NELARABINE INJECTION 3 $103.30
J9263 OXALIPLATIN 3 $5.08
J9264 PACLITAXEL PROTEIN BOUND 3 $9.38
J9265 PACLITAXEL INJECTION 3 $9.44
J9266 PEGASPARGASE INJECTION 5 $0.00
J9268 PENTOSTATIN INJECTION 5 $0.00
J9270 PLICAMYCIN (MITHRAMYCIN) INJ 5 $0.00
J9280 MITOMYCIN 5 MG INJ 3 $15.64
J9290 MITOMYCIN 20 MG INJ 5 $0.00
J9291 MITOMYCIN 40 MG INJ 5 $0.00
J9293 MITOXANTRONE HYDROCHL / 5 MG 5 $0.00
J9295 POLYESTRADIOL PHOSPHATE 40 MG O $0.00
J9300 GEMTUZUMAB OZOGAMICIN INJ 5 $0.00
J9303 PANITUMUMAB INJECTION 3 $87.08
J9305 PEMETREXED INJECTION 3 $50.66
J9310 RITUXIMAB INJECTION 3 $567.99
J9320 STREPTOZOCIN INJECTION 5 $0.00
J9328 TEMOZOLOMIDE INJECTION 3 $4.84
J9330 TEMSIROLIMUS INJECTION 3 $49.22
J9340 THIOTEPA INJECTION 5 $0.00
J9350 TOPOTECAN INJECTION 3 $1,081.56
J9355 TRASTUZUMAB INJECTION 3 $64.18
J9357 VALRUBICIN INJECTION 5 $0.00
J9360 VINBLASTINE SULFATE INJ 3 $3.69
J9370 VINCRISTINE SULFATE 1 MG INJ 3 $5.68
J9375 VINCRISTINE SULFATE 2 MG INJ 3 $11.36
J9380 VINCRISTINE SULFATE 5 MG INJ 5 $0.00
J9390 VINORELBINE TARTRATE INJ 3 $19.64
J9395 INJECTION, FULVESTRANT 3 $82.36
J9600 PORFIMER SODIUM INJECTION 5 $0.00
J9999 CHEMOTHERAPY DRUG 5 $0.00
K0001 STANDARD WHEELCHAIR 3 $532.70
K0002 STND HEMI (LOW SEAT) WHLCHR 5 $0.00
K0003 LIGHTWEIGHT WHEELCHAIR 3 $0.00
K0004 HIGH STRENGTH LTWT WHLCHR 3 $1.00
K0005 ULTRALIGHTWEIGHT WHEELCHAIR 3 $1,839.61
K0006 HEAVY DUTY WHEELCHAIR 3 $0.00
K0007 EXTRA HEAVY DUTY WHEELCHAIR 5 $0.00
K0008 CSTM MANUAL WHEELCHAIR/BASE 9 $0.00
K0009 OTHER MANUAL WHEELCHAIR/BASE 5 $0.00
K0010 STND WT FRAME POWER WHLCHR 5 $0.00
K0011 STND WT PWR WHLCHR W CONTROL 5 $0.00
K0012 LTWT PORTBL POWER WHLCHR 5 $0.00
K0013 CUSTOM POWER WHLCHR BASE 9 $0.00
K0014 OTHER POWER WHLCHR BASE 5 $0.00