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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
54569-5448-00	Q0144	AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM	ZITHROMAX TRI-PAK 500 MG	PO
54569-5589-00	Q0173	TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 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	TRIMETHOBENZAMIDE HCL 300 MG	PO
54569-5589-01	Q0173	TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 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	TRIMETHOBENZAMIDE HCL 300 MG	PO
54569-5605-00	J1815	INJECTION, INSULIN, PER 5 UNITS	LANTUS 100 U/ML	SC
54868-3826-08	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE SODIUM 2.5 MG	PO
54868-3826-09	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE SODIUM 2.5 MG	PO
54868-3873-00	J1800	INJECTION, PROPRANOLOL HCL, UP TO 1 MG	PROPRANOLOL (S.D.V.,10X1ML) 1 MG/ML	IV
54868-3905-00	A4217	STERILE WATER/SALINE, 500 ML	WATER FOR INJECTION	IV
59730-6503-01	J1556	INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG	BIVIGAM (LATEX-FREE) 100 MG/ML	IV
59746-0001-03	J7509	METHYLPREDNISOLONE ORAL, PER 4 MG	METHYLPREDNISOLONE 4 MG	PO
59746-0001-06	J7509	METHYLPREDNISOLONE ORAL, PER 4 MG	METHYLPREDNISOLONE 4 MG	PO
59746-0002-04	J7509	METHYLPREDNISOLONE ORAL, PER 4 MG	METHYLPREDNISOLONE (USP) 8 MG	PO

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