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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
67457-0649-10	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM 10 GM-5 GM	IV
67457-0657-25	J1805	INJECTION, ESMOLOL HYDROCHLORIDE, 10 MG	ESMOLOL HCL (PF) 2500 MG/250 ML	IV
67457-0658-10	J1805	INJECTION, ESMOLOL HYDROCHLORIDE, 10 MG	ESMOLOL HCL (PF) 2000 MG/100 ML	IV
67457-0662-05	J9351	INJECTION, TOPOTECAN, 0.1 MG	TOPOTECAN (SDV) 1 MG/1 ML	IV
67457-0675-02	J0630	INJECTION, CALCITONIN SALMON, UP TO 400 UNITS	MIACALCIN 200 IU/1 ML	IJ
67457-0705-75	J3370	INJECTION, VANCOMYCIN HCL, 500 MG	VANCOMYCIN HCL (LYOPHILIZED) 750 MG	IV
67457-0705-75	J3371	INJECTION, VANCOMYCIN HCL (MYLAN) NOT THERAPEUTICALLY EQUIVALENT TO J3370, 500 MG	VANCOMYCIN HCL (LYOPHILIZED) 750 MG	IV
67457-0781-08	J9171	INJECTION, DOCETAXEL, 1 MG	DOCETAXEL (MDV,PF,LATEX-FREE) 20 MG/1 ML	IV
67457-0790-05	J1953	INJECTION, LEVETIRACETAM, 10 MG	LEVETIRACETAM (SDV) 100 MG/1 ML	IV
67457-0794-10	J3489	INJECTION, ZOLEDRONIC ACID, 1 MG	ZOLEDRONIC ACID (SINGLE USE,PF) 5 MG/100 ML	IV
67457-0813-50	J0878	INJECTION, DAPTOMYCIN, 1 MG	DAPTOMYCIN (SDV,PF,LYOPHILIZED) 500 MG	IV
67457-0822-99	J3370	INJECTION, VANCOMYCIN HCL, 500 MG	VANCOMYCIN HCL (LYOPHILIZED) 250 MG	IV

HCPCS Code	Description	Billing Unit	SA Type
A6455	Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to 5 in.	Per Yard	N
A6456	Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to 3 in. and less than 5 in.	Per Yard	N
A6457	Tubular dressing with or without elastic, any width	Per Linear Yard	N
A6460	Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing	Each	Y
A6461	Synthetic resorbable wound dressing, sterile, pad size mor than 16 sq. in. but less than or equal to 48 sq. in, without adhesive border, each dressing	Each	Y
E1399	Clamp, Cannula	Each	Y
A4452	Tape, waterproof, per 18 square inches	1 unit = 18 sq inches	N
A4461	Surgical dressing holder, non-reusable, each	Each	N
A4463	Surgical dressing holder, reusable, each	Each	N
A6010	Collagen based wound filler, dry form, per gram of collagen	Gram	N
A6011	Collagen based wound filler, gel/paste, per gram of collagen	Gram	N
A6021	Collagen dressing, sterile, pad size 16 sq. in. or less, each	Each	N