| Source HCPCS Code |
|
Target NDC Code |
J1575
INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN
|
⇄
|
00944-2510-02
HYQVIA (PF,LATEX-FREE) 160 U/ML-10%
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
26.25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
J1575
INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN
|
⇄
|
00944-2511-02
HYQVIA (PF,LATEX-FREE) 160 U/ML-10%
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
52.5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
J1575
INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN
|
⇄
|
00944-2512-02
HYQVIA (PF,LATEX-FREE) 160 U/ML-10%
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
105 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
J1575
INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN
|
⇄
|
00944-2513-02
HYQVIA (PF,LATEX-FREE) 160 U/ML-10%
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
210 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
J1575
INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN
|
⇄
|
00944-2514-02
HYQVIA (PF,LATEX-FREE) 160 U/ML-10%
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
315 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
SC |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2715-25
HYQVIA IG CMPNT 2.5 GM/25 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
26.25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2716-05
HYQVIA IG CMPNT 5 GM/50 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
52.5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2717-10
HYQVIA IG CMPNT 10 GM/100 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
105 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2718-20
HYQVIA IG CMPNT 20 GM/200 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
210 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2719-30
HYQVIA IG CMPNT 30 GM/300 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
315 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2720-03
HYQVIA HY CMPNT 200 UNIT/1.25
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
26.25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2721-03
HYQVIA HY CMPNT 400 UNIT/2.5
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
52.5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2722-03
HYQVIA HY CMPNT 800 UNIT/5 ML
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
105 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2723-03
HYQVIA HY CMPNT 1,600 UNIT/10
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
210 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
|
⇄
|
00944-2724-03
HYQVIA HY CMPNT 2,400 UNIT/15
|
| Detail Information |
| Relationship Start Date |
01/01/2016 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
315 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J1575
Hyqvia 100mg immuneglobulin
|
⇄
|
00944-2510-02
Hyqvia
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J1575
Hyqvia 100mg immuneglobulin
|
⇄
|
00944-2511-02
Hyqvia
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J1575
Hyqvia 100mg immuneglobulin
|
⇄
|
00944-2512-02
Hyqvia
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J1575
Hyqvia 100mg immuneglobulin
|
⇄
|
00944-2513-02
Hyqvia
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J1575
Hyqvia 100mg immuneglobulin
|
⇄
|
00944-2514-02
Hyqvia
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|