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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
70655-0103-95	J2700	INJECTION, OXACILLIN SODIUM, UP TO 250 MG	OXACILLIN 10 GM	IV
70655-0109-95	J2700	INJECTION, OXACILLIN SODIUM, UP TO 250 MG	OXACILLIN 2 GM	IJ
70655-0143-06	J1450	INJECTION FLUCONAZOLE, 200 MG	FLUCONAZOLE NOVAPLUS (PF,LATEX-FREE) 200 MG/100 ML	IV
70655-0144-06	J1450	INJECTION FLUCONAZOLE, 200 MG	FLUCONAZOLE NOVAPLUS (PF,LATEX-FREE) 400 MG/200 ML	IV
70700-0167-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE (MDV,GLUTEN-FREE) 0.2 MG/1 ML	IJ
70700-0167-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE (MDV,GLUTEN-FREE) 0.2 MG/1 ML	IJ
70700-0169-22	J9206	INJECTION, IRINOTECAN, 20 MG	IRINOTECAN HYDROCHLORIDE (SDV;USP,PF,GLUTEN-FREE) 20 MG/1 ML	IV
70700-0170-22	J9206	INJECTION, IRINOTECAN, 20 MG	IRINOTECAN HYDROCHLORIDE (SDV;USP,PF,GLUTEN-FREE) 20 MG/1 ML	IV
70700-0171-23	J2710	INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG	NEOSTIGMINE METHYLSULFATE (LATEX-FREE) 0.5 MG/1 ML	IV
70700-0172-23	J2710	INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG	NEOSTIGMINE METHYLSULFATE (MDV,LATEX-FREE) 1 MG/1 ML	IV
70700-0173-22	J3260	INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG	TOBRAMYCIN (PF,LATEX-FREE) 1.2 GM	IV
70700-0173-86	J3260	INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG	TOBRAMYCIN (PF,LATEX-FREE) 1.2 GM	IV

HCPCS Code	Description	Billing Unit	SA Type
L2540	Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model	Each	Y
L2550	Addition to lower extremity, thigh/weight bearing, high roll cuff	Each	Y
L2570	Addition to lower extremity, pelvic control, hip joint, Clevis type, two position joint, each	Each	Y
L2580	Addition to lower extremity, pelvic control, pelvic sling	Each	Y
L2600	Addition to lower extremity, pelvic control, hip joint, Clevis type, or thrust bearing, free, each	Each	Y
L2610	Addition to lower extremity, pelvic control, hip joint, Clevis or thrust bearing, lock, each	Each	Y
L2620	Addition to lower extremity, pelvic control, hip joint, heavy-duty, each	Each	Y
L2622	Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each	Each	Y
L2624	Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each	Each	Y
L2627	Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables	Each	Y
L2628	Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables	Each	Y
L2630	Addition to lower extremity, pelvic control, band and belt, unilateral	Each	Y