得克萨斯大学MD安德森中心供应收费表实际患者供价取决于供方类型并因患者而异所有定价都可修改自2019年12月开始定价,Disclaimer:Site仅供信息目的使用,不归并或代理实战服务Med Anderson提供此信息时,即用辅助基础向用户提供与医疗护理无关的潜在特性总体判断,而不警告获取信息时的认知性、完整性或使用性信息无关 北考虑金融或医疗咨询MDDERSON不保护信息 提供到此 weblite集合信息严格地算法 和驱动安卓无法保证 服务改编为教程 和他们的科5因 教程决策, 强制编译编译,辅助测试或服务 和个体需求IN ADDITION, ESTIMATES MAY CHANGE BASED ON YOUR CONTRACTED INSURANCE BENEFITS, INSURANCE POLICY EXCLUSIONS, MAXIMUM BENEFITS, PENDING FINANCIAL ASSISTANCE, OR PENDING STATE/FEDERAL PROGRAM OR OTHER AID.",,,, List ID,CPT Code,Supply Category,Description,Unit Charge 1,A4206,Needles,"Syringe with needle, sterile, 1 cc or less, each",$34 2,A4209,Needles,"Syringe with needle, sterile 5 cc or greater, each ",$25-$41 3,A4210,Needles,"Needle-free injection device, each",$3 4,A4211,Other Supplies,Supplies for self-administered injections,$3-$78 5,A4212,Needles,Non-coring needle or stylet with or without catheter,$24-$138 6,A4213,Needles,"Syringe, sterile, 20 cc or greater, each ",$27-$40 7,A4215,Needles,"Needle, sterile, any size, each ",$3-$839 8,A4221,Catheter,"Supplies for maintenance of non-insulin drug infusion catheter, per week ",$22 9,A4222,Other Supplies,"Infusion supplies for external drug infusion pump, per cassette or bag",$18-$22 10,A4253,Blood Glucose Supplies,"Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips",$37-$178 11,A4256,Other Supplies,"Normal, low and high calibrator solution / chips ",$21 12,A4259,Other Supplies,"Lancets, per box of 100 ",$36-$40 13,A4270,Disposables,"Disposable endoscope sheath, each",$319 14,A4301,Implantables/ Stents/ Pacemakers,"Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) ",$105-$270 15,A4310,Skin Substitutes,Insertion tray without drainage bag and without catheter (accessories only) ,$9-$25 16,A4311,Catheter,"Incontinence insertion tray, without drainage bag, with catheter",$7-$235 17,A4314,Catheter,"Incontinence insertion tray, with drainage bag, with catheter",$38-$80 18,A4315,Skin Substitutes,"Insertion tray with drainage bag with indwelling catheter, foley type, 2-way, all silicone ",$25-$327 19,A4322,Other Supplies,"Irrigation syringe, bulb or piston, each ",$3 20,A4326,Catheter,"Male external catheter with integral collection chamber, any type, each ",$3-$13 21,A4330,Other Supplies,"Perianal fecal collection pouch with adhesive, each ",$12-$525 22,A4331,Tubing,"Extension Drainage Tubing, any type, any length, each",$3-$38 23,A4333,Catheter,"Urinary catheter anchoring device, each",$3-$12 24,A4335,Other Supplies,Incontinence supply!3-338 25,A4338,Catheter直线线端,有或非涂层,每个 "3-6530A4352Cathetercoude(curved)小技巧,有或无涂层, 每人"14 31,A4353,Catheter34A4358,Catheter"eriary排水袋、leg或abdomen,固态4x4或等效3,37A464,Ostomy自备物9,A4388,Ostomy自备物9,A4388,Ostomy自备物4sleeve, each ",$3-$8 46,A4400,Other Supplies,Ostomy irrigation set ,$33 47,A4407,Ostomy Supplies,"Ostomy skin barrier, with flange, with built-in convexity, 4 x 4 inches or smaller, each",$11-$63 48,A4409,Ostomy Supplies,"Ostomy skin barrier, with flange, without built-in convexity, 4 x 4 inches or smaller, each ",$3-$41 49,A4414,Ostomy Supplies,"Ostomy skin barrier, with flange, without built-in convexity, 4 x 4 inches or smaller, each",$3-$38 50,A4415,Ostomy Supplies,"Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each",$43 51,A4416,Ostomy Supplies,"Ostomy pouch, closed, with barrier attached, with filter, each",$3 52,A4421,Ostomy Supplies,"Ostomy supplies, miscellaneous",$3-$51 53,A4425,Ostomy Supplies,"Ostomy pouch, drainable with filter, each",$53 54,A4432,Ostomy Supplies,"Ostomy pouch, urinary, for use on barrier with non-locking flange, with faucet-type tap with valve, each ",$36 55,A4450,Other Supplies,"Tape, non-waterproof, per 18 sq in",$3-$53 56,A4452,Other Supplies,"Tape, waterproof, per 18 sq in",$18 57,A4461,Dressings/Foams,"Surgical dressing holder, non-reusable, each ",$3-$7 58,A4463,Dressings/Foams,"Surgical dressing holder, reusable, each",$32-$141 59,A4465,Orthotic and Prosthetic Devices,Non-elastic binder for extremity,$23-$24 60,A4481,Tracheostomy Supplies,"Tracheostoma filter, any type, any size, each ",$131 61,A4490,Compression Stockings and Boots,"Surgical stockings above knee length, each",$9-$19 62,A4495,Compression Stockings and Boots,"Surgical stockings thigh length, each",$11-$107 63,A4500,Compression Stockings and Boots,"Surgical stockings below knee length, each",$9 64,A4520,Other Supplies,"Incontinence garment, any type, each",$3-$22 65,A4550,Skin Substitutes,Surgical trays,$14-$4425 66,A4554,Disposables,"Disposable underpads, all sizes ",$3-$31 67,A4556,Other Supplies,"Electrodes, (e.g., apnea monitor), per pair ",$31 68,A4562,Other Supplies,"Pessary, non rubber, any type",$97-$138 69,A4565,Orthotic and Prosthetic Devices,Slings ,$35-$60 70,A4570,Orthotic and Prosthetic Devices,Splint ,$16-$131 71,A4615,Other Supplies,"Cannula, nasal",$3-$52 72,A4623,Tracheostomy Supplies,"Tracheostomy, inner cannula",$11-$34 73,A4624,Catheter,"Tracheal suction catheter, each",$3-$12 74,A4625,Tracheostomy Supplies,Tracheostomy care kit for new tracheostomy,$7 75,A4648,Radiology Supplies,"Tissue Market, implantable, any type, each",$50-$1900 76,A4649,Skin Substitutes,Surgical supplies,$3-$13425 77,A5061,Ostomy Supplies,"Ostomy pouch, drainable,with barrier attached, each",$3-$29 78,A5062,Ostomy Supplies,"Ostomy pouch, drainable!无屏障(1块),各 " 4179A5063骨架服饰,Ostomy邮袋可排水屏障用法兰治2块系统 每人 2480A5071骨架用品带屏障(1块) 3-13881A5072OstomyService无屏障(1块),每人 " 16 82,A5093,骨架用品,骨架附属品convex insert ,$13-$15 83,A5102,Other Supplies,"Bedside drainage bottle with or without tubing, rigid or expandable, each",$288 84,A5120,Dressings/Foams,"Skin barrier, wipes or swabs, each",$35-$59 85,A5126,Dressings/Foams,"Disk or foam pad, adhesive or non-adhesive",$38 86,A6022,Dressings/Foams,"Wound Care Collagen dressing, sterile, size 16 sq in to 48 sq in, each ",$36-$65 87,A6025,Wound Care Supplies,"Gel sheet for dermal or epidermal application, each ",$56-$120 88,A6154,Wound Care Supplies,"Wound Care pouch, each",$23-$485 89,A6196,Dressings/Foams,"Wound Care Alginate or other fiber gelling dressing, sterile, pad size 16 sq in or less, each ",$8-$384 90,A6197,Dressings/Foams,"Wound Care Alginate or other fiber gelling dressing, sterile, pad size 16 sq in to 48 sq in, each ",$26-$139 91,A6198,Dressings/Foams,"Wound Care Alginate or other fiber gelling dressing, sterile, pad size more than 48 sq in, each ",$19-$38 92,A6199,Dressings/Foams,"Wound Care Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches",$16-$32 93,A6203,Dressings/Foams,Composite Dressings,$3-$15 94,A6204,Dressings/Foams,"Wound Care Composite dressing, sterile, pad size 16 sq in to 48 sq in, with any size adhesive, each ",$3-$18 95,A6205,Dressings/Foams,"Wound Care Composite dressing, sterile, pad size more than 48 sq in, with adhesive, each",$3-$53 96,A6206,Wound Care Supplies,"Wound Care Contact layer, sterile, 16 sq in or less, each",$17-$138 97,A6207,Wound Care Supplies,"Contact layer, sterile, 16 sq in to 48 sq in, each",$32-$137 98,A6208,Wound Care Supplies,"Wound Care Contact layer, sterile, more than 48 sq in, each ",$61-$192 99,A6209,Dressings/Foams,Foam Dressings,$9-$46 100,A6210,Dressings/Foams,"Wound Care Foam Dressing, sterile, pad size 16 sq in to 48 sq in, without adhesive, each ",$18-$71 101,A6211,Dressings/Foams,"Wound Care Foam Dressing, wound cover without adhesive borders, pad size more than 48 sq in, each dressing",$46-$90 102,A6212,Dressings/Foams,"Wound Care Foam Dressing, wound cover with adhesive borders, pad size less than 16 sq in, each dressing",$10-$138 103,A6213,Dressings/Foams,"Wound Care Foam Dressing, wound cover, pad more than 16 sq in to 48 sq in, with adhesive borders, each",$15-$24 104,A6214,Dressings/Foams,"Wound Care Foam Dressing, wound cover with adhesive borders, pad size more than 48 sq in, each dressing",$22-$38 105,A6215,Dressings/Foams,Wound Care Dressing Polymem WIC 3X12IN,$87 106,A6216,Wound Care Supplies,"Wound Care Gauze, non-impregnated, non-sterile, pad size 16 sq.插进.3-13107A6223Dress/Fams3108A6229DGLSFSLSLAYHYDORLAYLEGETYLEGETYLEGETYLEGETYLETYLETYSqLETYLETETYLETYLETYLETYLETSGETYLETYLETYSGLETYLETYLETYLETYLETYLETYLETYLETYLETYLETYLETYSLETYLAYLETYLETYLETYLAYLETYSGLETYLETYLAYLETYLYLEGYLAFYGLEFYDYLAFYDYLEGYLEGYLAQLAQLAQLAQLAQLAQYLAQLAQLAQLSLAQLAQLSQLSY16F532AQYLSEGYLSADYLSADYLSYQLYLYLSGYQLAQLAQLAQLAQLAQLAQLAQLSYQLSYLSY插进.or less, without adhesive, each ",$6 113,A6243,Dressings/Foams,"Hydrogel dressing, wound cover, sterile, pad size 16 sq in to 48 sq in, without adhesive, each ",$21 114,A6248,Dressings/Foams,"Hydrogel dressing, wound filler, gel, per fluid ounce",$20 115,A6250,Wound Care Supplies,Wound Care Supplies,$15-$1432 116,A6252,Dressings/Foams,"Wound Care Specialty absorptive dressing, sterile, pad size 16 sq in to 48 sq in, without adhesive, each",$9-$644 117,A6253,Dressings/Foams,"Wound Care Specialty absorptive dressing, sterile, pad size more than 48 sq in, without adhesive, each ",$9-$131 118,A6257,Wound Care Supplies,Wound Care Tranparent Film,$3-$38 119,A6258,Wound Care Supplies,"Transparent film, sterile, 16 sq in to 48 sq in, each ",$3 120,A6259,Wound Care Supplies,"Wound Care Transparent film, sterile, more than 48 sq in, each",$3 121,A6260,Wound Care Supplies,"Wound Care cleansers, any type, any size ",$16-$49 122,A6262,Wound Care Supplies,"Wound Care filler, dry form, per gram",$7 123,A6402,Dressings/Foams,"Wound Care Gauze Dressing, sterile, pad size 16 sq.插进.or less, without adhesive border, each",$3-$38 124,A6403,Wound Care Supplies,"Wound Care Gauze, non-impregnated, sterile, pad size 16 sq in to 48 sq in, without adhesive, each ",$3 125,A6407,Other Supplies,"Packing strips, non-impregnated, sterile, up to 2 in width, per linear yard ",$110-$144 126,A6442,Wound Care Supplies,"Wound Care bandages, non-elastic, non-sterile, width less than 3 in, per yard",$21-$27 127,A6533,Compression Stockings and Boots,"Gradient compression burn stocking, thigh length, 18-30 mmhg, each",$28-$138 128,A6535,Compression Stockings and Boots,"Gradient compression stocking, thigh length, 40-50 mmhg, each ",$107 129,A6549,Compression Stockings and Boots,Gradient compression burn stocking/sleeve,$62-$180 130,A6550,Wound Care Supplies,"Wound Care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories",$100-$257 131,A7000,Disposables,"Canister, disposable, used with suction pump, each ",$107 132,A7002,Tubing,"Tubing, used with suction pump, each",$64 133,A7040,Other Supplies,One way chest drain valve ,$83-$86 134,A7041,Other Supplies,Water seal drainage container and tubing for use with implanted chest tube ,$138 135,A7048,Tubing,"Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each ",$464-$861 136,A7502,Other Supplies,"Replacement diaphragm/faceplate for tracheostoma valve, each",$148 137,A7503,Tracheostomy Supplies,"Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each ",$102-$116 138,A7504,Tracheostomy Supplies,"Filter for use in a tracheostoma heat and moisture exchange system, each ",$115-$158 139,A7505,Tracheostomy Supplies,"Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each ",$22 140,A7506,Dressings/Foams,"Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, each",$40-$146 141,A7507,Tracheostomy Supplies,"Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each ",$160-$188 142,A7508,Tracheostomy Supplies,"Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each ",$185 143,A7520,Tracheostomy Supplies,"Tracheostomy/laryngectomy tube, non-cuffed, each",$11-$522 144,A7521,Tracheostomy Supplies,"Tracheostomy/laryngectomy tube, cuffed, each ",$3-$341 145,A7523,Tracheostomy Supplies,"Tracheostomy shower protector, each ",$74 146,A7524,Tracheostomy Supplies,"Tracheostoma stent/stud/button, each ",$18-$239 147,A7526,Tracheostomy Supplies,"Tracheostomy tube collar/holder, each",$13-$17 148,A7527,Tracheostomy Supplies,"Tracheostomy/laryngectomy tube plug/stop, each ",$38-$130 149,A9270,Dressings/Foams,Non-covered item or service ,$3-$9 150,A9272,Wound Care Supplies,Prevena Incision Mgmt Peel & Place Kit ,$875 151,A9284,Other Supplies,"Spirometer, non-electronic",$9 152,A9300,Other Supplies,Exercise equipment,$7-$88 153,A9900,Medical Equipment,"Miscellaneous DME supply, accessory, and/or service component of another hcpcs code",$75 154,B4035,Feeding Supplies,"Enteral feeding supply kit!pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape ",$7-$9 155,B4081,Tubing,Nasogastric tubing with stylet,$65-$75 156,B4082,Tubing,Nasogastric tubing without stylet,$52 157,B4087,Tubing,"Gastrostomy/jejunostomy tube, standard, each",$52-$639 158,B4088,Tubing,"Gastrostomy/jejunostomy tube, low-profile, each ",$61-$646 159,B9998,Other Supplies,Noc for enteral supplies,$3-$96 160,BLANK,Misc Supplies,General supplies,$10-$9158 161,BLANK,Misc Supplies,Non-sterile supplies,$8-$464 162,BLANK,Misc Supplies,Other implants,$171-$14886 163,BLANK,Misc Supplies,Sterile supplies,$3-$7811 164,BLANK,Misc Supplies,Take home supplies,$3-$273 165,BLANK,Misc Supplies,Non-prescription pharmacy supplies,$7-$46 166,C1713,Screws,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),$40-$13850 167,C1715,Needles,Brachytherapy needle,$25 168,C1721,Implantables/ Stents/ Pacemakers,"Cardioverter-defibrillator, dual chamber",$40000-$47716 169,C1722,Implantables/ Stents/ Pacemakers,"Cardioverter-defibrillator, single chamber ",$32000-$44086 170,C1725,Catheter,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) ",$70-$1732 171,C1726,Catheter,"Catheter, balloon dilatation, non-vascular",$56-$3930 172,C1728,Catheter,"Catheter, brachytherapy seed administration",$25-$5570 173,C1729,Catheter,"Catheter, drainage",$29-$10792 174,C1730,Catheter,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes) ",$338-$875 175,C1750,Catheter,"Catheter, hemodialysis/peritoneal, long-term",$212-$660 176,C1751,Catheter,"Infusion catheter, inserted peripherally, central or midline (other than hemodialysis)",$7-$5400 177,C1752,Catheter,"Catheter, hemodialysis/peritoneal, short-term",$147-$870 178,C1753,Catheter,"Catheter, intravascular ultrasound","$1,450" 179,C1755,Catheter,"Catheter, intraspinal",$41-$1344 180,C1757,Catheter,"Catheter, thrombectomy/embolectomy",$99-$6800 181,C1758,Catheter,"Catheter, ureteral ",$3-$101 182,C1759,Catheter,"Catheter, intracardiac echocardiography ","$6,364" 183,C1760,Implantables/ Stents/ Pacemakers,"Closure device, vascular (implantable/insertable)",$138-$1970 184,C1762,Implantables/ Stents/ Pacemakers,Avance Nerve Graft or Achilles Tendon Tissue,$4211-$11800 185,C1763,Implantables/ Stents/ Pacemakers,"Connective tissue, non-human (includes synthetic) ",$1600-$6320 186,C1764,Implantables/ Stents/ Pacemakers,"Event recorder, cardiac (implantable) ",$10500-$10590 187,C1765,Dressings/Foams,Adhesion barrier,$514 188,C1766,Introducer/ sheath,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away ",$83-$101 189,C1767,Generator,"Generator, neurostimulator, non-rechargeable ",$19240-$27590 190,C1768,Other Supplies,"Graft, vascular",$848-$26963 191,C1769,Other Supplies,Guide Wire,$23-$1300 192,C1770,Other Supplies,"Imaging coil, magnetic resonance (insertable) ",$196-$301 193,C1771,Catheter,"Repair device, urinary, incontinence, with sling graft",$1890-$10500 194,C1773,Other Supplies,"Retrieval device, insertable (used to retrieve fractured medical devices) ",$19-$1340 195,C1776,Implantables/ Stents/ Pacemakers,Joint device (implantable) ,$252-$17473 196,C1777,Cardiac/ Stents/ Pacemaker,"Lead, cardioverter-defibrillator, endocardial single coil ",$1000-$9719 197,C1778,Implantables/ Stents/ Pacemakers,"Lead, neurostimulator (implantable) ",$1000-$11900 198,C1780,Implantables/ Stents/ Pacemakers,"Lens, intraocular (new technology) ",$170-$318 199,C1781,Implantables/ Stents/ Pacemakers,Mesh (implantable) ,$454-$5900 200,C1785,Cardiac/ Stents/ Pacemaker,"Pacemaker, dual chamber, rate-responsive",$7900-$17453 201,C1786,Cardiac/ Stents/ Pacemaker,"Pacemaker, single chamber, rate-responsive ",$2739-$21500 202,C1787,Other Supplies,"Patient programmer, neurostimulator ",$1697-$1877 203,C1788,Implantables/ Stents/ Pacemakers,"Port, indwelling (implantable)",$364-$1030 204,C1789,Implantables/ Stents/ Pacemakers,"Prosthesis, breast (implantable)",$83-$4000 205,C1813,Implantables/ Stents/ Pacemakers,"Prosthesis, penile, inflatable",$1905-$11355 206,C1815,Implantables/ Stents/ Pacemakers,"Prosthesis, urinary sphincter",$4300-$20600 207,C1820,Generator,"Generator, neurostimulator, with rechargeable battery and charging system ","$31,850" 208,C1874,Cardiac/ Stents/ Pacemaker,"Stent, coated/covered, with delivery system ",$110-$31930 209,C1876,Cardiac/ Stents/ Pacemaker,"Stent, non-coated/non-covered, with delivery system ",$1000-$5175 210,C1877,Cardiac/ Stents/ Pacemaker,"Stent, non-coated/non-covered, without delivery system","$11,000" 211,C1878,Implantables/ Stents/ Pacemakers,"Material for vocal cord medialization, synthetic (implantable)","$1,150" 212,C1880,Implantables/ Stents/ Pacemakers,Vena cava filter ,$895-$2543 213,C1881,Dialysis Supplies,Dialysis access system,$175-$670 214,C1882,Implantables/ Stents/ Pacemakers,"Cardioverter-defibrillator, other than single or dual chamber ",$41000-$65146 215,C1883,Cardiac/ Stents/ Pacemaker,"Adapter/extension, pacing lead or neurostimulator lead",$860-$4878 216,C1886,Catheter,"Catheter, extravascular tissue ablation, any modality (insertable) ","$4,940" 217,C1887,Catheter,"Catheter, guiding",$23-$1638 218,C1888,Catheter,"Catheter, ablation, non-cardiac, endovascular (implantable)",$338-$3990 219,C1889,Catheter,Tri-ex Triple LMN extraction balloon,$370 220,C1892,Introducer/ sheath,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away ",$38-$235 221,C1893,Introducer/ sheath,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away ",$42-$1530 222,C1894,Introducer/ sheath,"Introducer/shealth, other than guiding, other than intracardiac electrophysiological, non-laser ",$9-$990 223,C1895,Cardiac/ Stents/ Pacemaker,"Lead, cardioverter-defibrillator, endocardial dual coil ",$7800-$10528 224,C1897,Cardiac/ Stents/ Pacemaker,"Lead, neurostimulator test kit",$80-$2724 225,C1898,Cardiac/ Stents/ Pacemaker,"Lead, pacemaker, other than transvenous vdd single pass",$923-$2000 226,C1900,Cardiac/ Stents/ Pacemaker,"Lead, left ventricular coronary venous system",$4364-$10380 227,C2613,Implantables/ Stents/ Pacemakers,Lung biopsy plug with delivery system,$495 228,C2616,Radiology Supplies,"Brachytherapy source, non-stranded, yttrium-90, per source","$33,000" 229,C2617,Cardiac/ Stents/ Pacemaker,"Stent, non-coronary, temporary, without delivery system ",$37-$550 230,C2618,Needles,"Probe/needle, cryoablation",$578-$8250 231,C2621,Cardiac/ Stents/ Pacemaker,"Pacemaker, other than single or dual chamber ",$16012-$25513 232,C2623,Catheter,"Catheter, transluminal angioplasty, drug-coated, non-laser",$2095-$5998 233,C2624,Implantables/ Stents/ Pacemakers,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components","$36,000" 234,C2625,Cardiac/ Stents/ Pacemaker,"Stent, non-coronary, temporary, with delivery system",$230-$1395 235,C2627,Catheter,"Catheter, suprapubic/cystoscopic ",$72-$374 236,C2628,Catheter,"Catheter, occlusion",$147-$878 237,C2634,Radiology Supplies,"Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source",$101-$280 238,C2638,Radiology Supplies,"Brachytherapy source, stranded, iodine-125, per source",$66 239,C2640,Radiology Supplies,"Brachytherapy source, stranded, palladium-103, per source",$110 240,C2698,Radiology Supplies,"Brachytherapy source, stranded, not otherwise specified, per source",$716 241,C2699,Radiology Supplies,"Brachytherapy source, non-stranded, not otherwise specified, per source ","$2,645" 242,G0429,Other Supplies,Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome,$621 243,J3590,Implantables/ Stents/ Pacemakers,Renuva allograft adipose matrix ,$1040-2060 244,K0746,Dressings/Foams,"Wound Care Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 sq in ",$28 245,L0120,Orthotic and Prosthetic Devices,"Cervical, flexible, non-adjustable, prefabricated, foam collar",$35-$81 246,L0172,Orthotic and Prosthetic Devices,"Cervical, collar, semi-rigid thermoplastic foam, 2-piece, prefabricated",$87-$88 247,L1830,Orthotic and Prosthetic Devices,"Knee orthosis, immobilizer, canvas longitudinal, prefabricated",$75-$97 248,L1930,Orthotic and Prosthetic Devices,"Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment",$66 249,L3260,Orthotic and Prosthetic Devices,"Surgical boot/shoe, each ",$21-$30 250,L3265,Orthotic and Prosthetic Devices,"Orthopedic footwear, Plastazote sandal, each ",$21 251,L3720,Orthotic and Prosthetic Devices,"Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated ",$20 252,L4350,Orthotic and Prosthetic Devices,"Ankle control orthosis, stirrup style, rigid, includes any type interface, prefabricated",$52 253,L4386,Orthotic and Prosthetic Devices,"Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated ",$27 254,L4398,Orthotic and Prosthetic Devices,"Foot drop splint, recumbent positioning device, prefabricated",$187-$247 255,L6310,Orthotic and Prosthetic Devices,"Shoulder disarticulation, passive restoration",$38 256,L7900,Orthotic and Prosthetic Devices,Male vacuum erection system ,$495 257,L8000,Orthotic and Prosthetic Devices,"Breast prosthesis, mastectomy bra",$71-$261 258,L8030,Orthotic and Prosthetic Devices,"Breast prosthesis, silicone or equal, without integral adhesive",$97-$700 259,L8500,Orthotic and Prosthetic Devices,"Artificial larynx, any type ",$91-$875 260,L8501,Tracheostomy Supplies,Tracheostomy speaking valve ,$22-$797 261,L8509,Orthotic and Prosthetic Devices,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",$138-$885 262,L8511,Other Supplies,"Insert for indwelling tracheoesophageal prosthesis, replacement only, each",$74-$138 263,L8512,Other Supplies,"Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 ",$53 264,L8513,Dressings/Foams,"Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each",$27-$87 265,L8600,Orthotic and Prosthetic Devices,"Implantable breast prosthesis, silicone or equal ",$950-$4000 266,L8603,Orthotic and Prosthetic Devices,"Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies ",$596-$990 267,L8610,Orthotic and Prosthetic Devices,Ocular implant,$34-$1790 268,L8612,Orthotic and Prosthetic Devices,Aqueous shunt,$122-$7900 269,L8680,Orthotic and Prosthetic Devices,"Implantable neurostimulator electrode, each",$230-$15278 270,L8686,Orthotic and Prosthetic Devices,"Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension ","$21,504" 271,L8691,Other Supplies,"Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each ",$4950-$5400 272,L8699,Orthotic and Prosthetic Devices,"Prosthetic implant, not otherwise specified",$13-$19656 273,L9900,Orthotic and Prosthetic Devices,"Orthotic and prosthetic supply, accessory, and/or service component",$112-$1400 274,Q4051,Orthotic and Prosthetic Devices,"Splint supplies, miscellaneous ",$77-$86 275,Q4100,Skin Substitutes,"Skin substitute, not otherwise specified",$1536-$2701 276,Q9967,Radiology Supplies,"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml",$94-$212 277,V2628,Hearing aids and supplies,Fabrication and fitting of ocular conformer,$38 278,V2790,Other Supplies,"Amniotic membrane for surgical reconstruction, per procedure",$1540-$1898 279,V5180,Hearing aids and supplies,"Hearing aid, cros, behind the ear ",$875-$3564 280,V5221,Hearing aids and supplies,Cros Binaural bte/bte level 1-3 ,$3050-$3650 281,V5254,Hearing aids and supplies,"Hearing aid, digital, monaural",$85-$3000 282,V5257,Hearing aids and supplies,"Hearing aid, digital, monaural",$1200-$2450 283,V5258,Hearing aids and supplies,"Hearing aid, digital, binaural",$3600-$6000 284,V5261,Hearing aids and supplies,"Hearing aid, digital, binaural, bte",$1200-$4900 285,V5266,Hearing aids and supplies,Battery for use in hearing device,$8