|
1pc ost pch drain hgh output
|
HCPCS A4435 |
$2.97 |
$8.40
|
$23.73 |
52 |
|
1 pc ost pouch w filter
|
HCPCS A5056 |
$3.00 |
$6.72
|
$16.37 |
54 |
|
1 pc ost pou w built-in conv
|
HCPCS A5057 |
$2.00 |
$11.05
|
$49.50 |
58 |
|
Absorpt drg >16<=48 in w/bdr
|
HCPCS A6255 |
$0.60 |
$5.99
|
$67.00 |
50 |
|
Absorpt drg >16 <=48 without bdr
|
HCPCS A6252 |
$0.77 |
$6.40
|
$74.26 |
74 |
|
Absorpt drg <=16 sq in w/bdr
|
HCPCS A6254 |
$1.20 |
$13.80
|
$95.50 |
70 |
|
Absorpt drg <=16 sq in without b
|
HCPCS A6251 |
$1.80 |
$5.60
|
$19.40 |
65 |
|
Absorpt drg > 48 sq in without b
|
HCPCS A6253 |
$1.54 |
$7.76
|
$22.41 |
50 |
|
Acetaminophen 120 mg rectal suppository
|
HCPCS A9270 |
$14.58 |
$146.76
|
$2,440.80 |
79 |
|
Adhesive, liquid or equal
|
HCPCS A4364 |
$3.92 |
$14.40
|
$48.10 |
62 |
|
Alginate dressing <=16 sq in
|
HCPCS A6196 |
$1.82 |
$16.56
|
$105.00 |
177 |
|
Alginate drsg >16 <=48 sq in
|
HCPCS A6197 |
$3.99 |
$43.72
|
$366.00 |
265 |
|
Alginate drsg wound filler
|
HCPCS A6199 |
$1.26 |
$15.79
|
$156.00 |
193 |
|
Als 1
|
HCPCS A0426 |
$132.40 |
$853.44
|
$3,506.36 |
88 |
|
Als1-emergency
|
HCPCS A0427 |
$457.49 |
$1,103.37
|
$3,680.90 |
106 |
|
Als 2
|
HCPCS A0433 |
$561.60 |
$1,288.56
|
$4,793.44 |
96 |
|
Bag urine leg fbrc strap 32oz flipflo anti-reflux valve
|
HCPCS A4358 |
$2.00 |
$16.00
|
$102.00 |
132 |
|
Bard marquee Ultrasound biopsy device
|
HCPCS A4649 |
$85.47 |
$1,686.67
|
$16,169.40 |
248 |
|
Barrier film 1.0ml wipe
|
HCPCS A5120 |
$0.91 |
$17.66
|
$106.54 |
35 |
|
Barrier film 28ml spray no stng cavilon
|
HCPCS A4369 |
$4.77 |
$19.50
|
$169.00 |
58 |
|
Barrier skin flat ctf 2.75in
|
HCPCS A4408 |
$0.44 |
$0.44
|
$1.74 |
13 |
|
Barrier skin flextend 2.25in floating flang new image
|
HCPCS A4409 |
$0.26 |
$2.60
|
$24.77 |
74 |
|
Barrier skin flxtnd ctf 3.5in flt flang 4in w/tape cut to ft
|
HCPCS A4414 |
$0.80 |
$3.30
|
$24.00 |
58 |
|
Barrier skn ft cx ff red 2.25 ctf new image w/tape
|
HCPCS A4407 |
$0.44 |
$8.45
|
$73.30 |
56 |
|
Bedside drainage bag
|
HCPCS A4357 |
$1.24 |
$19.10
|
$158.50 |
70 |
|
Belt ostomy lg 34-65in
|
HCPCS A4367 |
$0.49 |
$5.18
|
$22.10 |
52 |
|
Bladder irrigation tubing
|
HCPCS A4355 |
$2.80 |
$12.32
|
$65.40 |
30 |
|
Bln ureth 5ml 28f 2wy ltx st
|
HCPCS A4338 |
$1.82 |
$34.40
|
$312.66 |
163 |
|
Bls-emergency
|
HCPCS A0429 |
$123.16 |
$892.32
|
$3,289.60 |
84 |
|
Cannula nasal
|
HCPCS A4615 |
$1.44 |
$5.70
|
$40.80 |
20 |
|
Cassette provox xtraflow hme
|
HCPCS A7507 |
$2.67 |
$2.67
|
$10.69 |
17 |
|
Cath council tip 16fr 5cc
|
HCPCS A4344 |
$3.75 |
$40.96
|
$280.00 |
203 |
|
Cath entrl fd nutri 5fr 40cm
|
HCPCS B4082 |
$2.28 |
$18.40
|
$171.00 |
78 |
|
Catheter w/bag 3-way
|
HCPCS A4313 |
$30.97 |
$128.70
|
$128.70 |
13 |
|
Catheter without bag 2-way latex
|
HCPCS A4311 |
$4.55 |
$82.80
|
$149.52 |
68 |
|
Cath ext adhere actv m 28mm
|
HCPCS A4349 |
$0.59 |
$1.81
|
$3.96 |
47 |
|
Cath follower heyman 20f
|
HCPCS A4352 |
$5.85 |
$128.00
|
$361.20 |
40 |
|
Cath impl vasc access portal
|
HCPCS A4300 |
$39.00 |
$156.85
|
$2,068.20 |
112 |
|
Cath indw foley 3 way
|
HCPCS A4346 |
$12.18 |
$41.20
|
$181.20 |
159 |
|
Cath infuse micro 150cm rapidtransit
|
HCPCS A4351 |
$1.08 |
$13.23
|
$130.80 |
115 |
|
Cath insertion tray w/bag
|
HCPCS A4354 |
$3.18 |
$33.56
|
$88.80 |
52 |
|
Cath pezzer 34fr drain bardex propor head mushrm ltx
|
HCPCS A4340 |
$4.04 |
$64.06
|
$453.00 |
157 |
|
Cath soaker 5in 400mlx4ml/hr on-q silvr dual 2ml site
|
HCPCS A4306 |
$64.52 |
$381.36
|
$1,709.70 |
110 |
|
Cath suction replogle 8fr neonatal esophageal
|
HCPCS A4624 |
$0.60 |
$3.92
|
$54.83 |
51 |
|
Cath w/drainage 2-way latex
|
HCPCS A4314 |
$3.60 |
$71.20
|
$587.40 |
170 |
|
Cath w/drainage 2-way silcne
|
HCPCS A4315 |
$4.80 |
$38.22
|
$440.40 |
88 |
|
Cath without bag 2-way silicone
|
HCPCS A4312 |
$7.80 |
$68.50
|
$252.82 |
39 |
|
Choline c-11
|
HCPCS A9515 |
$2,062.94 |
$2,062.94
|
$5,777.00 |
25 |
|
Clsd ostomy pouch w/flange
|
HCPCS A5054 |
$3.53 |
$3.53
|
$17.00 |
6 |
|
Clsd ostomy pouch without barr
|
HCPCS A5052 |
$1.33 |
$1.33
|
$12.75 |
29 |
|
Collagen based wound filler
|
HCPCS A6010 |
$227.50 |
$1,794.78
|
$10,094.50 |
188 |
|
Collagen dressing <=16 sq in
|
HCPCS A6021 |
$5.11 |
$42.50
|
$234.00 |
171 |
|
Collagen drsg>16<=48 sq in
|
HCPCS A6022 |
$5.20 |
$25.75
|
$116.64 |
99 |
|
Collagen dsg wound filler
|
HCPCS A6024 |
$12.16 |
$12.16
|
$12.16 |
4 |
|
Collagen gel/paste wound fil
|
HCPCS A6011 |
$4.49 |
$9.65
|
$88.39 |
26 |
|
Composite drsg >16<=48 sq in
|
HCPCS A6204 |
$3.00 |
$42.60
|
$336.05 |
76 |
|
Composite drsg <= 16 sq in
|
HCPCS A6203 |
$0.78 |
$6.62
|
$37.60 |
79 |
|
Compression stocking bk18-30
|
HCPCS A6530 |
$29.40 |
$62.88
|
$398.64 |
59 |
|
Conform band n/s w>=3"<5"/yd
|
HCPCS A6443 |
$0.55 |
$1.04
|
$15.84 |
51 |
|
Conform band s w>=3" <5"/yd
|
HCPCS A6446 |
$0.75 |
$1.04
|
$2.35 |
24 |
|
Conform band s w >=5"/yd
|
HCPCS A6447 |
$1.30 |
$1.84
|
$16.37 |
11 |
|
Contact layer >16<= 48 sq in
|
HCPCS A6207 |
$1.82 |
$36.17
|
$285.36 |
110 |
|
Copper cu 64 dotatate diag
|
HCPCS A9592 |
$301.65 |
$2,820.66
|
$13,490.90 |
270 |
|
Cr-51 sodium chromate
|
HCPCS A9553 |
$41.00 |
$688.80
|
$4,440.15 |
73 |
|
Deodorant ostmy adapt lube 8ml
|
HCPCS A4394 |
$0.10 |
$1.98
|
$8.00 |
33 |
|
Diabetic custom molded shoe
|
HCPCS A5501 |
$144.06 |
$269.36
|
$375.08 |
33 |
|
Diabetic shoe with wedge
|
HCPCS A5504 |
$63.19 |
$63.19
|
$63.19 |
4 |
|
Diabetic shoe w/off set heel
|
HCPCS A5506 |
$63.19 |
$63.19
|
$63.19 |
4 |
|
Diabetic shoe w/roller/rockr
|
HCPCS A5503 |
$63.19 |
$63.19
|
$63.19 |
4 |
|
Diab shoe for density insert
|
HCPCS A5500 |
$48.30 |
$147.56
|
$178.40 |
45 |
|
Diab shoe w/metatarsal bar
|
HCPCS A5505 |
$63.19 |
$63.19
|
$63.19 |
4 |
|
Drainable plastic pch w fcpl
|
HCPCS A4375 |
$3.00 |
$33.77
|
$171.00 |
8 |
|
Drain chst dry seal exp thorastat
|
HCPCS A7041 |
$27.36 |
$119.43
|
$336.85 |
128 |
|
Drain ostomy pouch w/flange
|
HCPCS A5063 |
$1.08 |
$8.80
|
$81.00 |
74 |
|
Drsg sht 5.625x4.625in std
|
HCPCS A6025 |
$7.28 |
$123.24
|
$639.00 |
93 |
|
Drsg surg adh 11x11 3/4 occl drap wnd 28x30
|
HCPCS A6259 |
$1.90 |
$19.10
|
$42.00 |
35 |
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
HCPCS A2008 |
$44.80 |
$94.94
|
$525.00 |
70 |
|
Drsg wound/burn 18x10cm suprathel resorb cost per sq cm
|
HCPCS A2012 |
$0.15 |
$1.00
|
$16.74 |
85 |
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
HCPCS A2007 |
$32.80 |
$376.50
|
$4,072.20 |
145 |
|
Electrodes, pair
|
HCPCS A4556 |
$1.80 |
$15.12
|
$23.89 |
24 |
|
Extension drainage tubing
|
HCPCS A4331 |
$6.25 |
$27.60
|
$188.00 |
29 |
|
F-18 fdg pet diag
|
HCPCS A9552 |
$32.20 |
$551.72
|
$5,435.40 |
542 |
|
F-18 florbetapir less than or equal to 10 mci
|
HCPCS A9586 |
$353.40 |
$5,224.83
|
$45,941.00 |
284 |
|
F-18 fluciclovine per mci
|
HCPCS A9588 |
$117.40 |
$1,042.30
|
$12,882.69 |
268 |
|
F-18 sodium fluoride
|
HCPCS A9580 |
$94.80 |
$492.56
|
$4,485.47 |
240 |
|
Fem urinary collect pouch
|
HCPCS A4328 |
$3.60 |
$3.60
|
$20.47 |
9 |
|
Flortaucipir inj 1 millicuri
|
HCPCS A9601 |
$464.00 |
$3,710.00
|
$12,985.00 |
47 |
|
Flotufolastat f18 diag 1 mci
|
HCPCS A9608 |
$270.90 |
$2,091.04
|
$19,503.33 |
207 |
|
Fluorodopa f-18 diag per mci
|
HCPCS A9602 |
$498.62 |
$4,070.21
|
$5,870.49 |
58 |
|
Fluoroestradiol f 18
|
HCPCS A9591 |
$301.20 |
$1,591.20
|
$14,790.48 |
221 |
|
Flurpiridaz f18, diag, 1 mci
|
HCPCS A9611 |
$530.00 |
$1,033.50
|
$1,578.90 |
36 |
|
Foam drg >16<=48 sq in w/bdr
|
HCPCS A6213 |
$4.32 |
$58.10
|
$437.40 |
162 |
|
Foam drg >16<=48 sq in without b
|
HCPCS A6210 |
$4.95 |
$39.00
|
$171.60 |
160 |
|
Foam drg <=16 sq in w/border
|
HCPCS A6212 |
$2.80 |
$16.25
|
$167.05 |
219 |
|
Foam drg > 48 sq in w/border
|
HCPCS A6214 |
$6.50 |
$23.63
|
$74.58 |
59 |
|
Foam drg > 48 sq in without brdr
|
HCPCS A6211 |
$8.22 |
$33.49
|
$253.80 |
120 |
|
Foam drsg <=16 sq in without bdr
|
HCPCS A6209 |
$4.20 |
$21.74
|
$209.85 |
172 |
|
Foam/fabric leg strap
|
HCPCS A5114 |
$9.10 |
$14.96
|
$14.96 |
5 |
|
Ga-67 gallium 0.1 mci
|
HCPCS A9556 |
$7.72 |
$121.73
|
$1,469.22 |
411 |
|
Ga-68 gallium 68 dotatate
|
HCPCS A9587 |
$21.00 |
$140.35
|
$2,100.00 |
247 |