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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
72572-0226-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE (25X1ML;USP;SDV) 0.2 MG/1 ML	IJ
72572-0250-25	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (USP) 1000 U/1 ML	IJ
72572-0255-25	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (USP) 5000 U/1 ML	IJ
72572-0265-25	J0360	INJECTION, HYDRALAZINE HCL, UP TO 20 MG	HYDRALAZINE HCL (25X1ML;SDV;USP) 20 MG/1 ML	IJ
72572-0350-01	J1920	INJECTION, LABETALOL HYDROCHLORIDE, 5 MG	LABETALOL HCL (MDV) 5 MG/1 ML	IV
72572-0354-01	J1885	INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG	KETOROLAC TROMETHAMINE (SDV) 15 MG/1 ML	IJ
72572-0354-10	J1885	INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG	KETOROLAC TROMETHAMINE (10X1ML,SDV) 15 MG/1 ML	IJ
72572-0355-01	J1885	INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG	KETOROLAC TROMETHAMINE (SDV) 30 MG/1 ML	IJ
72572-0355-25	J1885	INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG	KETOROLAC TROMETHAMINE (25X1ML;SDV) 30 MG/1 ML	IJ
72572-0360-01	J1953	INJECTION, LEVETIRACETAM, 10 MG	LEVETIRACETAM (SDV) 100 MG/1 ML	IV
72603-0108-01	J3301	INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG	TRIAMCINOLONE ACETONIDE (LATEX-FREE) 40 MG/1 ML	IJ
72603-0128-10	J3490	UNCLASSIFIED DRUGS	PANTOPRAZOLE SODIUM (SDV,PF,LATEX-FREE) 40 MG	IV

HCPCS Code	Description	Billing Unit	SA Type
E2202	Manual Wheelchair Accessory, Nonstandard Seat Frame Width, 24-27 Inches	Each	N
E2202 RR	Manual Wheelchair Accessory, Nonstandard Seat Frame Width, 24-27 Inches	Day	N
E2203	Manual Wheelchair Accessory, Nonstandard Seat Frame Depth, 20 To Less Than 22 Inches	Each	N
E2203 RR	Manual Wheelchair Accessory, Nonstandard Seat Frame Depth, 20 To Less Than 22 Inches	Day	N
E2204	Manual Wheelchair Accessory, Nonstandard Seat Frame Depth, 22 To 25 Inches	Each	N
E2204 RR	Manual Wheelchair Accessory, Nonstandard Seat Frame Depth, 22 To 25 Inches	Day	N
E2292	Seat, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Each	Y
E2292 RR	Seat, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Day	Y
E2294	Seat, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Each	Y
E2294 RR	Seat, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Day	Y
E2340	Power Wheelchair Accessory, Nonstandard Seat Frame Width, 20-23 Inches	Each	Y
E2340 RR	Power Wheelchair Accessory, Nonstandard Seat Frame Width, 20-23 Inches	Day	Y