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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
54569-1818-02	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE 2.5 MG	PO
54569-1818-04	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE SODIUM 2.5 MG	PO
54569-1818-08	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE SODIUM 2.5 MG	PO
54569-1818-09	None	METHOTREXATE, 2.5 MG, ORAL	METHOTREXATE 2.5 MG	PO
54569-1827-01	J3301	INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG	KENALOG-10 (VIAL) 10 MG/ML	IJ
54569-1901-01	J1030	INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG	DEPO-MEDROL (M.D.V.) 40 MG/ML	IJ
54569-2318-00	J1815	INJECTION, INSULIN, PER 5 UNITS	HUMULIN N (VIAL) 100 U/ML	SC
54569-2319-00	J1815	INJECTION, INSULIN, PER 5 UNITS	HUMULIN R (VIAL) 100 U/ML	IJ
54569-2353-05	Q0177	HYDROXYZINE PAMOATE, 25 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	HYDROXYZINE PAMOATE 25 MG	PO
54569-2571-01	Q0177	HYDROXYZINE PAMOATE, 25 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	HYDROXYZINE PAMOATE 50 MG	PO
54569-2580-00	J1000	INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG	DEPO-ESTRADIOL 5 MG/ML	IM
54569-2646-00	J3355	INJECTION, UROFOLLITROPIN, 75 IU	METRODIN 75 IU	IM

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