| Source HCPCS Code |
|
Target NDC Code |
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8100-01
ESPEROCT 1,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8101-11
ESPEROCT 1,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8150-01
ESPEROCT 1,500 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8151-11
ESPEROCT 1,500 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8200-01
ESPEROCT 2,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8201-11
ESPEROCT 2,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8300-01
ESPEROCT 3,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8301-11
ESPEROCT 3,000 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8500-01
ESPEROCT 500 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
|
⇄
|
00169-8501-11
ESPEROCT 500 UNIT VIAL
|
| Detail Information |
| Relationship Start Date |
07/01/2020 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
F2 |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
AHF |
|
|
|
J7204
Inj recombin esperoct per iu
|
⇄
|
00169-8100-01
Esperoct
|
| 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 |
|
|
|
|
J7204
Inj recombin esperoct per iu
|
⇄
|
00169-8150-01
Esperoct
|
| 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 |
|
|
|
|
J7204
Inj recombin esperoct per iu
|
⇄
|
00169-8200-01
Esperoct
|
| 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 |
|
|
|
|
J7204
Inj recombin esperoct per iu
|
⇄
|
00169-8300-01
Esperoct
|
| 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 |
|
|
|
|
J7204
Inj recombin esperoct per iu
|
⇄
|
00169-8500-01
Esperoct
|
| 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 |
|
|
|
|