| Code | Short Description | Long Description |
| 93463 | PHARMACY AGENT ADMIN | |
| 63601 | TPA (STROKE) FULL DOSE PER PHARMACY | |
| 78708 | KIDNEY FUNCTION W/PHARMACY | 78708 KIDNEY IMG VASC SGL W DRUGS |
| C9275 | PHARMACY | |
| J3490 | MIXTURE FEE - PHARMACY | |
| S9430 | PHARMACY COMP/ DISP SERV. LOW | |
| S9430 | PHARMACY COMP/ DISP SERV. |