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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
65219-0566-20	J9280	INJECTION, MITOMYCIN, 5 MG	MITOMYCIN (SDV,PF,LATEX-FREE) 20 MG	IV
65219-0568-00	J9280	INJECTION, MITOMYCIN, 5 MG	MITOMYCIN (PF,LATEX-FREE) 40 MG	IV
65219-0570-04	J3490	UNCLASSIFIED DRUGS	BUMETANIDE (10X4ML;SDV,LATEX-FREE) 0.25 MG/1 ML	IJ
65219-0572-10	J3490	UNCLASSIFIED DRUGS	BUMETANIDE (10X10ML;MDV,LATEX-FREE) 0.25 MG/1 ML	IJ
65219-0800-10	J2704	INJECTION, PROPOFOL, 10 MG	DIPRIVAN (10X20ML;USP;RFID) 10 MG/1 ML	IV
65250-0003-01	J3304	INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE-FREE, EXTENDED-RELEASE, MICROSPHERE FORMULATION, 1 MG	ZILRETTA (W/DILUENT) 32 MG	IJ
65293-0001-01	J0583	INJECTION, BIVALIRUDIN, 1 MG	ANGIOMAX (VIAL,GLASS) 250 MG	IV
65483-0590-10	J7500	AZATHIOPRINE, ORAL, 50 MG	IMURAN 50 MG	PO
65649-0231-41	J7500	AZATHIOPRINE, ORAL, 50 MG	AZASAN 75 MG	PO
65649-0241-41	J7500	AZATHIOPRINE, ORAL, 50 MG	AZASAN 100 MG	PO
65757-0401-03	J1944	INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG	ARISTADA 441 MG/1.6 ML	IM
65757-0402-03	J1944	INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG	ARISTADA 662 MG/2.4 ML	IM

HCPCS Code	Description	Billing Unit	SA Type
A7028	Oral cushion for comination oral/nasal mask, replacement only, each	Each	N
A7029	Nasal pillows for comination oral/nasal mask, replacement only, each	Each	N
A7030	Full face mask used with positive airway pressure device, eahc	Each	N
A7031	Face mask interface, replacement for full face mask, each	Each	N
A7032	Replacement cushion for nasal application device, each	Each	N
A7033	Replacement Pillows for nasal application device	Pair	N
A7034	Nasal interface (mask or cannula type) used w/positive airway pressure device, w/or w/out head strap	Each	N
A7035	Headgear used with positive airway pressure device	Each	N
A7036	Chinstrap used with positive airway pressure device	Each	N
A7037	Tubing used with positive airway pressure device	Each	N
A7038	Filter, disposable, used with positive airway pressure device	Each	N
A7039	Filter, non disposable, used with positive airway pressure device	Each	N