| Source HCPCS Code |
|
Target NDC Code |
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1011-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
00069-1109-01
PANZYGA 10% (2.5 G/25 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1109-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
00069-1224-01
PANZYGA 10% (5 G/50 ML) VIA
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1224-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
00069-1312-01
PANZYGA 10% (10 G/100 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1312-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
00069-1415-01
PANZYGA 10% (20 G/200 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1415-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
00069-1558-01
PANZYGA 10% (30 G/300 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
00069-1558-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
INJECTION, IMMUNE GLOBULIN (PANZYGA), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
|
⇄
|
68982-0822-02
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-03
PANZYGA 10% (5 G/50 ML) VIA
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-04
PANZYGA 10% (10 G/100 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-05
PANZYGA 10% (20 G/200 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-06
PANZYGA 10% (30 G/300 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-82
PANZYGA 10% (2.5 G/25 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-83
PANZYGA 10% (5 G/50 ML) VIA
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-84
PANZYGA 10% (10 G/100 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-85
PANZYGA 10% (20 G/200 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
|
⇄
|
68982-0822-86
PANZYGA 10% (30 G/300 ML) V
|
| Detail Information |
| Relationship Start Date |
07/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
68982-0822-02
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
68982-0822-03
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
68982-0822-04
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
68982-0822-05
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
68982-0822-06
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
00069-1109-02
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
00069-1224-02
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
00069-1312-02
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
00069-1415-02
PANZYGA
|
| 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 |
|
|
|
|
J1576
Inj, panzyga, 500 mg
|
⇄
|
00069-1558-02
PANZYGA
|
| 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 |
|
|
|
|