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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
23155-0790-41	J9050	INJECTION, CARMUSTINE, 100 MG	CARMUSTINE NOVAPLUS (W/DILUENT,LYOPHILIZED) 100 MG	IV
23155-0799-01	Q0175	PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	PERPHENAZINE (USP,FILM COATED) 2 MG	PO
25021-0184-87	J1450	INJECTION FLUCONAZOLE, 200 MG	FLUCONAZOLE (10X200ML,PF,LATEX-FREE) 400 MG/200 ML	IV
25021-0185-10	J1570	INJECTION, GANCICLOVIR SODIUM, 500 MG	GANCICLOVIR (PF) 50 MG/1 ML	IV
25021-0185-11	J1570	INJECTION, GANCICLOVIR SODIUM, 500 MG	GANCICLOVIR (SDV,PF,LATEX-FREE) 50 MG/1 ML	IV
25021-0186-20	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM (USP, SDV,PF,LATEX-FREE) 1 GM-0.5 GM	IJ
25021-0187-30	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM (USP, SDV,PF,LATEX-FREE) 2 GM-1 GM	IJ
25021-0188-99	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM (PHARMACY BULK,USP,PF) 10 GM-5 GM	IV
25021-0190-10	J2248	INJECTION, MICAFUNGIN SODIUM, 1 MG	MICAFUNGIN SODIUM (PF,LATEX-FREE) 50 MG	IV
25021-0190-11	J2248	INJECTION, MICAFUNGIN SODIUM, 1 MG	MICAFUNGIN SODIUM (1X10,SDV,PF,LATEX-FREE) 50 MG	IV
25021-0191-10	J2248	INJECTION, MICAFUNGIN SODIUM, 1 MG	MICAFUNGIN SODIUM (PF,LATEX-FREE) 100 MG	IV
25021-0191-11	J2248	INJECTION, MICAFUNGIN SODIUM, 1 MG	MICAFUNGIN SODIUM (1X10,SDV,PF,LATEX-FREE) 100 MG	IV

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