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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
16714-0644-10	J3490	UNCLASSIFIED DRUGS	DOXYCYCLINE (SDV,PF,LATEX-FREE) 100 MG	IV
16714-0671-01	Q0162	ONDANSETRON 1 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	ONDANSETRON (USP,1X60ML,STRAWBERRY) 4 MG/5ML	PO
16714-0690-10	J2704	INJECTION, PROPOFOL, 10 MG	PROPOFOL (PF,LATEX-FREE) 10 MG/1 ML	IV
16714-0699-01	J3370	INJECTION, VANCOMYCIN HCL, 500 MG	VANCOMYCIN HCL (PHARMACY BULK,PF) 10 GM	IV
16714-0705-01	J8999	PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS	IMATINIB MESYLATE (FILM COATED) 400 MG	PO
16714-0725-01	J9206	INJECTION, IRINOTECAN, 20 MG	IRINOTECAN HYDROCHLORIDE (SDV,PF,LATEX-FREE) 20 MG/1 ML	IV
16714-0726-01	J9206	INJECTION, IRINOTECAN, 20 MG	IRINOTECAN HYDROCHLORIDE (SDV,PF,LATEX-FREE) 20 MG/1 ML	IV
16729-0474-05	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE (LATEX-FREE) 0.2 MG/1 ML	IJ
16729-0486-01	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE (USP,UNCOATED) 2.5 MG	PO
16729-0493-03	J0330	INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG	SUCCINYLCHOLINE CHLORIDE (1X10ML;MDV,LATEX-FREE) 20 MG/1 ML	IJ
16729-0493-45	J0330	INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG	SUCCINYLCHOLINE CHLORIDE (10X10ML;MDV,LATEX-FREE) 20 MG/1 ML	IJ
16729-0500-08	J1940	INJECTION, FUROSEMIDE, UP TO 20 MG	FUROSEMIDE (25X2ML;SDV;USP,PF) 10 MG/1 ML	IJ

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