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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
51079-0721-20	J7517	MYCOPHENOLATE MOFETIL, ORAL, 250 MG	MYCOPHENOLATE MOFETIL (10 X 10,HARD GELATIN) 250 MG	PO
51079-0817-20	J7507	TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG	TACROLIMUS (10X10,HARD GELATIN) 0.5 MG	PO
51079-0818-20	J7507	TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG	TACROLIMUS (10X10,HARD GELATIN) 1 MG	PO
51224-0012-10	J2760	INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG	PHENTOLAMINE MESYLATE (LYOPHILIZED) 5 MG	IJ
51224-0012-20	J2760	INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG	PHENTOLAMINE MESYLATE (LYOPHILIZED) 5 MG	IJ
51224-0013-10	J1953	INJECTION, LEVETIRACETAM, 10 MG	LEVETIRACETAM (10X5ML,SINGLE-USE) 100 MG/1 ML	IV
51224-0013-25	J1953	INJECTION, LEVETIRACETAM, 10 MG	LEVETIRACETAM (SINGLE-USE) 100 MG/1 ML	IV
51224-0022-06	Q0144	AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM	AZITHROMYCIN (1X6, USP,FILM-COATED) 250 MG	PO
51224-0022-18	Q0144	AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM	AZITHROMYCIN (3X6,FILM-COATED) 250 MG	PO
38779-0101-09	J3350	INJECTION, UREA, UP TO 40 GM	UREA (U.S.P)	NA
38779-0104-03	J1230	INJECTION, METHADONE HCL, UP TO 10 MG	METHADONE HCL (U.S.P.)	NA
38779-0104-04	J1230	INJECTION, METHADONE HCL, UP TO 10 MG	METHADONE HCL (U.S.P.)	NA

HCPCS Code	Description	Billing Unit	SA Type
A7005	Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable	Each	N
A7006	Administration set, with small volume filter pneumatic nebulizer	Each	N
A7007	Large voume nebulizer, disposable, unfilled, used with aerosol compressor	Each	N
A7008	Large volume nebulizer, disposable, Prefilled, used with aerosol compressor	Each	N