Durable Medical Equipment, Prosthetics, Orthotics, and ... DME Fee... · Durable Medical Equipment,...

Durable Medical Equipment,

Prosthetics, Orthotics, and Supplies

PEIA January 2018 Fee Schedule

The absence or presents of a CPT Code does not determine coverage

HCPCS Mod Mod2 PEIA Fee Description

A4216 0.41 Sterile water/saline, 10 ml

A4217 3.00 Sterile water/saline, 500 ml

A4217 AU 3.00 Sterile water/saline, 500 ml

A4221 16.75 Supp non-insulin inf cath/wk

A4222 31.77 Infusion supplies with pump

A4224 16.75 Supply insulin inf cath/wk

A4225 2.24 Sup/ext insulin inf pump syr

A4233 NU 0.43 Alkalin batt for glucose mon

A4234 NU 2.01 J-cell batt for glucose mon

A4235 NU 0.85 Lithium batt for glucose mon

A4236 NU 0.99 Silvr oxide batt glucose mon

A4253 NU 7.07 Blood glucose/reagent strips

A4255 3.74 Glucose monitor platforms

A4256 2.87 Calibrator solution/chips

A4257 12.21 Replace lensshield cartridge

A4258 1.80 Lancet device each

A4259 1.21 Lancets per box

A4265 3.26 Paraffin

A4280 4.96 Brst prsths adhsv attchmnt

A4310 7.39 Insert tray w/o bag/cath

A4311 14.18 Catheter w/o bag 2-way latex

A4312 17.26 Cath w/o bag 2-way silicone

A4313 17.72 Catheter w/bag 3-way

A4314 24.19 Cath w/drainage 2-way latex

A4315 25.24 Cath w/drainage 2-way silcne

A4316 27.17 Cath w/drainage 3-way

A4320 4.56 Irrigation tray

A4321 0.00 Cath therapeutic irrig agent

A4322 2.78 Irrigation syringe

A4326 9.92 Male external catheter

A4327 40.43 Fem urinary collect dev cup

A4328 9.69 Fem urinary collect pouch

A4330 5.82 Stool collection pouch

A4331 3.04 Extension drainage tubing

A4332 0.11 Lube sterile packet

A4333 2.12 Urinary cath anchor device

A4334 4.71 Urinary cath leg strap

A4336 1.38 Urethral insert

A4338 11.73 Indwelling catheter latex

A4340 25.82 Indwelling catheter special

A4344 15.32 Cath indw foley 2 way silicn

A4346 18.73 Cath indw foley 3 way

A4349 1.93 Disposable male external cat

A4351 1.63 Straight tip urine catheter

A4352 5.23 Coude tip urinary catheter

A4353 6.69 Intermittent urinary cath

A4354 11.29 Cath insertion tray w/bag

A4355 8.41 Bladder irrigation tubing

A4356 43.65 Ext ureth clmp or compr dvc

A4357 9.29 Bedside drainage bag

A4358 6.34 Urinary leg or abdomen bag

A4360 0.47 Disposable ext urethral dev

A4361 17.57 Ostomy face plate

A4362 3.25 Solid skin barrier

A4363 2.27 Ostomy clamp, replacement

A4364 2.39 Adhesive, liquid or equal

A4366 1.24 Ostomy vent

A4367 7.04 Ostomy belt

A4368 0.24 Ostomy filter

A4369 2.32 Skin barrier liquid per oz

A4371 3.49 Skin barrier powder per oz

A4372 4.01 Skin barrier solid 4x4 equiv

A4373 6.00 Skin barrier with flange

A4375 16.43 Drainable plastic pch w fcpl

A4376 45.53 Drainable rubber pch w fcplt

A4377 4.11 Drainable plstic pch w/o fp

A4378 29.41 Drainable rubber pch w/o fp

A4379 14.37 Urinary plastic pouch w fcpl

A4380 35.71 Urinary rubber pouch w fcplt

A4381 4.43 Urinary plastic pouch w/o fp

A4382 23.55 Urinary hvy plstc pch w/o fp

A4383 26.97 Urinary rubber pouch w/o fp

A4384 9.20 Ostomy faceplt/silicone ring

A4385 4.88 Ost skn barrier sld ext wear

A4387 2.15 Ost clsd pouch w att st barr

A4388 4.17 Drainable pch w ex wear barr

A4389 5.95 Drainable pch w st wear barr

A4390 9.19 Drainable pch ex wear convex

A4391 6.77 Urinary pouch w ex wear barr

A4392 7.82 Urinary pouch w st wear barr

A4393 8.65 Urine pch w ex wear bar conv

A4394 2.47 Ostomy pouch liq deodorant

A4395 0.04 Ostomy pouch solid deodorant

A4396 38.73 Peristomal hernia supprt blt

A4397 4.58 Irrigation supply sleeve

A4398 13.23 Ostomy irrigation bag

A4399 9.97 Ostomy irrig cone/cath w brs

A4400 46.75 Ostomy irrigation set

A4402 1.53 Lubricant per ounce

A4404 1.48 Ostomy ring each

A4405 3.26 Nonpectin based ostomy paste

A4406 5.47 Pectin based ostomy paste

A4407 8.38 Ext wear ost skn barr <=4sq"

A4408 9.44 Ext wear ost skn barr >4sq"

A4409 5.95 Ost skn barr convex <=4 sq i

A4410 8.65 Ost skn barr extnd >4 sq

A4411 4.88 Ost skn barr extnd =4sq

A4412 2.58 Ost pouch drain high output

A4413 5.27 2 pc drainable ost pouch

A4414 4.71 Ost sknbar w/o conv<=4 sq in

A4415 5.73 Ost skn barr w/o conv >4 sqi

A4416 2.64 Ost pch clsd w barrier/filtr

A4417 3.56 Ost pch w bar/bltinconv/fltr

A4418 1.73 Ost pch clsd w/o bar w filtr

A4419 1.66 Ost pch for bar w flange/flt

A4420 0.00 Ost pch clsd for bar w lk fl

A4422 0.11 Ost pouch absorbent material

A4423 1.78 Ost pch for bar w lk fl/fltr

A4424 4.56 Ost pch drain w bar & filter

A4425 3.43 Ost pch drain for barrier fl

A4426 2.61 Ost pch drain 2 piece system

A4427 2.66 Ost pch drain/barr lk flng/f

A4428 6.23 Urine ost pouch w faucet/tap

A4429 7.89 Urine ost pouch w bltinconv

A4430 8.14 Ost urine pch w b/bltin conv

A4431 5.95 Ost pch urine w barrier/tapv

A4432 3.43 Os pch urine w bar/fange/tap

A4433 3.20 Urine ost pch bar w lock fln

A4434 3.60 Ost pch urine w lock flng/ft

A4435 5.52 1pc ost pch drain hgh output

A4450 AU 0.08 Non-waterproof tape

A4450 AV 0.08 Non-waterproof tape

A4450 AW 0.10 Non-waterproof tape

A4452 AU 0.34 Waterproof tape

A4452 AV 0.34 Waterproof tape

A4452 AW 0.37 Waterproof tape

A4455 1.37 Adhesive remover per ounce

A4456 0.23 Adhesive remover, wipes

A4461 3.15 Surgicl dress hold non-reuse

A4463 12.73 Surgical dress holder reuse

A4481 0.35 Tracheostoma filter

A4483 0.00 Moisture exchanger

A4556 9.88 Electrodes, pair

A4557 8.95 Lead wires, pair

A4558 5.22 Conductive gel or paste

A4559 0.09 Coupling gel or paste

A4561 19.08 Pessary rubber, any type

A4562 47.52 Pessary, non rubber,any type

A4565 7.36 Slings

A4595 8.79 Tens suppl 2 lead per month

A4602 NU 3.56 Replace lithium battery 1.5v

A4604 NU 32.77 Tubing with heating element

A4605 NU 15.69 Trach suction cath close sys

A4608 47.95 Transtracheal oxygen cath

A4614 22.75 Hand-held pefr meter

A4615 0.70 Cannula nasal

A4616 0.06 Tubing (oxygen) per foot

A4617 2.97 Mouth piece

A4618 NU 7.23 Breathing circuits

A4618 RR 0.84 Breathing circuits

A4618 UE 5.42 Breathing circuits

A4619 NU 1.66 Face tent

A4620 0.60 Variable concentration mask

A4623 5.32 Tracheostomy inner cannula

A4624 NU 2.52 Tracheal suction tube

A4625 6.62 Trach care kit for new trach

A4626 3.05 Tracheostomy cleaning brush

A4628 NU 3.58 Oropharyngeal suction cath

A4629 4.45 Tracheostomy care kit

A4630 NU 5.08 Repl bat t.e.n.s. own by pt

A4633 NU 39.25 Uvl replacement bulb

A4635 NU 4.90 Underarm crutch pad

A4635 RR 0.60 Underarm crutch pad

A4635 UE 3.26 Underarm crutch pad

A4636 NU 2.56 Handgrip for cane etc

A4636 RR 0.26 Handgrip for cane etc

A4636 UE 1.92 Handgrip for cane etc

A4637 NU 1.42 Repl tip cane/crutch/walker

A4637 RR 0.14 Repl tip cane/crutch/walker

A4637 UE 1.07 Repl tip cane/crutch/walker

A4638 NU 0.00 Repl batt pulse gen sys

A4638 RR 0.00 Repl batt pulse gen sys

A4638 UE 0.00 Repl batt pulse gen sys

A4639 RR 27.48 Infrared ht sys replcmnt pad

A4640 NU 42.03 Alternating pressure pad

A4640 RR 4.20 Alternating pressure pad

A4640 UE 31.53 Alternating pressure pad

A5051 1.98 Pouch clsd w barr attached

A5052 1.42 Clsd ostomy pouch w/o barr

A5053 1.66 Clsd ostomy pouch faceplate

A5054 1.72 Clsd ostomy pouch w/flange

A5055 1.27 Stoma cap

A5056 4.47 1 pc ost pouch w filter

A5057 9.19 1 pc ost pou w built-in conv

A5061 3.37 Pouch drainable w barrier at

A5062 2.00 Drnble ostomy pouch w/o barr

A5063 2.58 Drain ostomy pouch w/flange

A5071 5.75 Urinary pouch w/barrier

A5072 3.37 Urinary pouch w/o barrier

A5073 2.99 Urinary pouch on barr w/flng

A5081 3.17 Stoma plug or seal, any type

A5082 11.38 Continent stoma catheter

A5083 0.61 Stoma absorptive cover

A5093 1.59 Ostomy accessory convex inse

A5102 21.44 Bedside drain btl w/wo tube

A5105 39.01 Urinary suspensory

A5112 30.14 Urinary leg bag

A5113 3.83 Latex leg strap

A5114 7.28 Foam/fabric leg strap

A5120 AU 0.20 Skin barrier, wipe or swab

A5120 AV 0.21 Skin barrier, wipe or swab

A5121 6.83 Solid skin barrier 6x6

A5122 12.29 Solid skin barrier 8x8

A5126 1.07 Disk/foam pad +or- adhesive

A5131 12.89 Appliance cleaner

A5200 10.80 Percutaneous catheter anchor

A5500 60.83 Diab shoe for density insert

A5501 182.45 Diabetic custom molded shoe

A5503 29.98 Diabetic shoe w/roller/rockr

A5504 29.98 Diabetic shoe with wedge

A5505 29.98 Diab shoe w/metatarsal bar

A5506 29.98 Diabetic shoe w/off set heel

A5507 29.98 Modification diabetic shoe

A5512 24.81 Multi den insert direct form

A5513 37.03 Multi den insert custom mold

A6010 29.63 Collagen based wound filler

A6011 2.18 Collagen gel/paste wound fil

A6021 20.11 Collagen dressing <=16 sq in

A6022 20.11 Collagen drsg>16<=48 sq in

A6023 182.06 Collagen dressing >48 sq in

A6024 5.92 Collagen dsg wound filler

A6154 13.34 Wound pouch each

A6196 7.04 Alginate dressing <=16 sq in

A6197 15.73 Alginate drsg >16 <=48 sq in

A6199 5.06 Alginate drsg wound filler

A6203 3.22 Composite drsg <= 16 sq in

A6204 5.96 Composite drsg >16<=48 sq in

A6207 7.02 Contact layer >16<= 48 sq in

A6209 7.15 Foam drsg <=16 sq in w/o bdr

A6210 19.06 Foam drg >16<=48 sq in w/o b

A6211 28.10 Foam drg > 48 sq in w/o brdr

A6212 9.29 Foam drg <=16 sq in w/border

A6214 9.84 Foam drg > 48 sq in w/border

A6216 0.04 Non-sterile gauze<=16 sq in

A6217 0.00 Non-sterile gauze>16<=48 sq

A6219 0.92 Gauze <= 16 sq in w/border

A6220 2.47 Gauze >16 <=48 sq in w/bordr

A6222 2.04 Gauze <=16 in no w/sal w/o b

A6223 2.32 Gauze >16<=48 no w/sal w/o b

A6224 3.45 Gauze > 48 in no w/sal w/o b

A6229 3.45 Gauze >16<=48 sq in watr/sal

A6231 4.47 Hydrogel dsg<=16 sq in

A6232 6.56 Hydrogel dsg>16<=48 sq in

A6233 18.34 Hydrogel dressing >48 sq in

A6234 6.26 Hydrocolld drg <=16 w/o bdr

A6235 16.09 Hydrocolld drg >16<=48 w/o b

A6236 26.07 Hydrocolld drg > 48 in w/o b

A6237 7.57 Hydrocolld drg <=16 in w/bdr

A6238 21.81 Hydrocolld drg >16<=48 w/bdr

A6240 11.71 Hydrocolld drg filler paste

A6241 2.46 Hydrocolloid drg filler dry

A6242 5.80 Hydrogel drg <=16 in w/o bdr

A6243 11.79 Hydrogel drg >16<=48 w/o bdr

A6244 37.58 Hydrogel drg >48 in w/o bdr

A6245 6.95 Hydrogel drg <= 16 in w/bdr

A6246 9.50 Hydrogel drg >16<=48 in w/b

A6247 22.75 Hydrogel drg > 48 sq in w/b

A6248 15.55 Hydrogel drsg gel filler

A6251 1.90 Absorpt drg <=16 sq in w/o b

A6252 3.12 Absorpt drg >16 <=48 w/o bdr

A6253 6.06 Absorpt drg > 48 sq in w/o b

A6254 1.15 Absorpt drg <=16 sq in w/bdr

A6255 2.91 Absorpt drg >16<=48 in w/bdr

A6257 1.47 Transparent film <= 16 sq in

A6258 4.12 Transparent film >16<=48 in

A6259 10.46 Transparent film > 48 sq in

A6266 1.84 Impreg gauze no h20/sal/yard

A6402 0.11 Sterile gauze <= 16 sq in

A6403 0.41 Sterile gauze>16 <= 48 sq in

A6407 1.79 Packing strips, non-impreg

A6410 0.37 Sterile eye pad

A6411 0.00 Non-sterile eye pad

A6441 0.65 Pad band w>=3" <5"/yd

A6442 0.15 Conform band n/s w<3"/yd

A6443 0.26 Conform band n/s w>=3"<5"/yd

A6444 0.54 Conform band n/s w>=5"/yd

A6445 0.31 Conform band s w <3"/yd

A6446 0.38 Conform band s w>=3" <5"/yd

A6447 0.65 Conform band s w >=5"/yd

A6448 1.11 Lt compres band <3"/yd

A6449 1.67 Lt compres band >=3" <5"/yd

A6450 1.67 Lt compres band >=5"/yd

A6451 1.67 Mod compres band w>=3"<5"/yd

A6452 5.65 High compres band w>=3"<5"yd

A6453 0.60 Self-adher band w <3"/yd

A6454 0.75 Self-adher band w>=3" <5"/yd

A6455 1.33 Self-adher band >=5"/yd

A6456 1.22 Zinc paste band w >=3"<5"/yd

A6457 1.09 Tubular dressing

A6501 0.00 Compres burngarment bodysuit

A6502 0.00 Compres burngarment chinstrp

A6503 0.00 Compres burngarment facehood

A6504 0.00 Cmprsburngarment glove-wrist

A6505 0.00 Cmprsburngarment glove-elbow

A6506 0.00 Cmprsburngrmnt glove-axilla

A6507 0.00 Cmprs burngarment foot-knee

A6508 0.00 Cmprs burngarment foot-thigh

A6509 0.00 Compres burn garment jacket

A6510 0.00 Compres burn garment leotard

A6511 0.00 Compres burn garment panty

A6513 0.00 Compress burn mask face/neck

A6531 AW 41.39 Compression stocking bk30-40

A6532 AW 58.32 Compression stocking bk40-50

A6545 0.00 Grad comp non-elastic bk

A6545 AW 81.49 Grad comp non-elastic bk

A6550 20.81 Neg pres wound ther drsg set

A7000 NU 6.97 Disposable canister for pump

A7001 NU 31.65 Nondisposable pump canister

A7002 NU 3.66 Tubing used w suction pump

A7003 NU 1.25 Nebulizer administration set

A7004 NU 1.05 Disposable nebulizer sml vol

A7005 NU 9.97 Nondisposable nebulizer set

A7006 NU 6.35 Filtered nebulizer admin set

A7007 NU 2.77 Lg vol nebulizer disposable

A7008 NU 10.52 Disposable nebulizer prefill

A7009 NU 40.22 Nebulizer reservoir bottle

A7010 NU 13.40 Disposable corrugated tubing

A7012 NU 2.46 Nebulizer water collec devic

A7013 NU 0.48 Disposable compressor filter

A7014 NU 2.72 Compressor nondispos filter

A7015 NU 1.09 Aerosol mask used w nebulize

A7016 NU 6.94 Nebulizer dome & mouthpiece

A7017 NU 103.76 Nebulizer not used w oxygen

A7017 RR 10.38 Nebulizer not used w oxygen

A7017 UE 77.82 Nebulizer not used w oxygen

A7018 0.27 Water distilled w/nebulizer

A7020 NU 13.86 Interface, cough stim device

A7025 RR 41.62 Replace chest compress vest

A7026 NU 27.50 Replace chst cmprss sys hose

A7027 NU 102.01 Combination oral/nasal mask

A7028 NU 28.53 Repl oral cushion combo mask

A7029 NU 12.75 Repl nasal pillow comb mask

A7030 NU 73.38 Cpap full face mask

A7031 NU 28.46 Replacement facemask interfa

A7032 NU 15.96 Replacement nasal cushion

A7033 NU 12.85 Replacement nasal pillows

A7034 NU 46.30 Nasal application device

A7035 NU 15.20 Pos airway press headgear

A7036 NU 8.84 Pos airway press chinstrap

A7037 NU 9.81 Pos airway pressure tubing

A7038 NU 1.71 Pos airway pressure filter

A7039 NU 5.02 Filter, non disposable w pap

A7040 37.77 One way chest drain valve

A7041 70.98 Water seal drain container

A7044 NU 70.51 Pap oral interface

A7045 NU 9.71 Repl exhalation port for pap

A7045 RR 0.97 Repl exhalation port for pap

A7045 UE 7.28 Repl exhalation port for pap

A7046 NU 11.30 Repl water chamber, pap dev

A7047 NU 115.67 Resp suction oral interface

A7048 39.51 Vacuum drain bottle/tube kit

A7501 100.47 Tracheostoma valve w diaphra

A7502 47.76 Replacement diaphragm/fplate

A7503 10.85 Hmes filter holder or cap

A7504 0.65 Tracheostoma hmes filter

A7505 4.49 Hmes or trach valve housing

A7506 0.31 Hmes/trachvalve adhesivedisk

A7507 2.38 Integrated filter & holder

A7508 2.75 Housing & integrated adhesiv

A7509 1.35 Heat & moisture exchange sys

A7520 45.42 Trach/laryn tube non-cuffed

A7521 45.00 Trach/laryn tube cuffed

A7522 43.21 Trach/laryn tube stainless

A7524 74.06 Tracheostoma stent/stud/bttn

A7525 1.98 Tracheostomy mask

A7526 3.24 Tracheostomy tube collar

A7527 3.43 Trach/laryn tube plug/stop

A8000 NU 146.72 Soft protect helmet prefab

A8000 RR 14.67 Soft protect helmet prefab

A8000 UE 110.06 Soft protect helmet prefab

A8001 NU 146.72 Hard protect helmet prefab

A8001 RR 14.67 Hard protect helmet prefab

A8001 UE 110.06 Hard protect helmet prefab

A8002 NU 0.00 Soft protect helmet custom

A8002 RR 0.00 Soft protect helmet custom

A8002 UE 0.00 Soft protect helmet custom

A8003 NU 0.00 Hard protect helmet custom

A8003 RR 0.00 Hard protect helmet custom

A8003 UE 0.00 Hard protect helmet custom

A8004 NU 0.00 Repl soft interface, helmet

A8004 RR 0.00 Repl soft interface, helmet

A8004 UE 0.00 Repl soft interface, helmet

E0100 NU 18.68 Cane adjust/fixed with tip

E0100 RR 5.68 Cane adjust/fixed with tip

E0100 UE 15.08 Cane adjust/fixed with tip

E0105 NU 43.44 Cane adjust/fixed quad/3 pro

E0105 RR 8.48 Cane adjust/fixed quad/3 pro

E0105 UE 33.99 Cane adjust/fixed quad/3 pro

E0110 NU 63.10 Crutch forearm pair

E0110 RR 15.29 Crutch forearm pair

E0110 UE 47.30 Crutch forearm pair

E0111 NU 46.32 Crutch forearm each

E0111 RR 8.06 Crutch forearm each

E0111 UE 39.32 Crutch forearm each

E0112 NU 32.10 Crutch underarm pair wood

E0112 RR 9.51 Crutch underarm pair wood

E0112 UE 24.06 Crutch underarm pair wood

E0113 NU 17.19 Crutch underarm each wood

E0113 RR 4.92 Crutch underarm each wood

E0113 UE 12.89 Crutch underarm each wood

E0114 NU 38.38 Crutch underarm pair no wood

E0114 RR 8.19 Crutch underarm pair no wood

E0114 UE 34.14 Crutch underarm pair no wood

E0116 NU 22.57 Crutch underarm each no wood

E0116 RR 5.18 Crutch underarm each no wood

E0116 UE 16.98 Crutch underarm each no wood

E0117 RR 18.43 Underarm springassist crutch

E0130 NU 38.08 Walker rigid adjust/fixed ht

E0130 RR 3.81 Walker rigid adjust/fixed ht

E0130 UE 28.56 Walker rigid adjust/fixed ht

E0135 NU 38.25 Walker folding adjust/fixed

E0135 RR 3.83 Walker folding adjust/fixed

E0135 UE 28.69 Walker folding adjust/fixed

E0140 RR 23.91 Walker w trunk support

E0141 NU 40.42 Rigid wheeled walker adj/fix

E0141 RR 4.05 Rigid wheeled walker adj/fix

E0141 UE 30.31 Rigid wheeled walker adj/fix

E0143 NU 40.42 Walker folding wheeled w/o s

E0143 RR 4.05 Walker folding wheeled w/o s

E0143 UE 30.31 Walker folding wheeled w/o s

E0144 RR 22.17 Enclosed walker w rear seat

E0147 NU 327.20 Walker variable wheel resist

E0147 RR 32.72 Walker variable wheel resist

E0147 UE 245.40 Walker variable wheel resist

E0148 NU 69.90 Heavyduty walker no wheels

E0148 RR 6.99 Heavyduty walker no wheels

E0148 UE 52.42 Heavyduty walker no wheels

E0149 RR 10.41 Heavy duty wheeled walker

E0153 NU 56.43 Forearm crutch platform atta

E0153 RR 6.38 Forearm crutch platform atta

E0153 UE 42.31 Forearm crutch platform atta

E0154 NU 39.51 Walker platform attachment

E0154 RR 3.95 Walker platform attachment

E0154 UE 29.63 Walker platform attachment

E0155 NU 16.86 Walker wheel attachment,pair

E0155 RR 1.68 Walker wheel attachment,pair

E0155 UE 12.64 Walker wheel attachment,pair

E0156 NU 13.33 Walker seat attachment

E0156 RR 1.33 Walker seat attachment

E0156 UE 10.00 Walker seat attachment

E0157 NU 47.67 Walker crutch attachment

E0157 RR 4.77 Walker crutch attachment

E0157 UE 35.75 Walker crutch attachment

E0158 NU 17.88 Walker leg extenders set of4

E0158 RR 1.79 Walker leg extenders set of4

E0158 UE 13.41 Walker leg extenders set of4

E0159 NU 12.42 Brake for wheeled walker

E0159 RR 1.24 Brake for wheeled walker

E0159 UE 9.32 Brake for wheeled walker

E0160 NU 22.17 Sitz type bath or equipment

E0160 RR 2.22 Sitz type bath or equipment

E0160 UE 16.63 Sitz type bath or equipment

E0161 NU 20.77 Sitz bath/equipment w/faucet

E0161 RR 2.07 Sitz bath/equipment w/faucet

E0161 UE 15.57 Sitz bath/equipment w/faucet

E0162 NU 133.83 Sitz bath chair

E0162 RR 14.62 Sitz bath chair

E0162 UE 97.77 Sitz bath chair

E0163 NU 45.30 Commode chair with fixed arm

E0163 RR 4.53 Commode chair with fixed arm

E0163 UE 33.97 Commode chair with fixed arm

E0165 RR 10.43 Commode chair with detacharm

E0167 NU 8.38 Commode chair pail or pan

E0167 RR 0.84 Commode chair pail or pan

E0167 UE 6.29 Commode chair pail or pan

E0168 NU 99.90 Heavyduty/wide commode chair

E0168 RR 9.99 Heavyduty/wide commode chair

E0168 UE 74.93 Heavyduty/wide commode chair

E0170 RR 134.08 Commode chair electric

E0171 RR 24.64 Commode chair non-electric

E0175 NU 58.16 Commode chair foot rest

E0175 RR 5.81 Commode chair foot rest

E0175 UE 43.61 Commode chair foot rest

E0181 RR 13.12 Press pad alternating w/ pum

E0182 RR 16.28 Replace pump, alt press pad

E0184 NU 134.18 Dry pressure mattress

E0184 RR 13.42 Dry pressure mattress

E0184 UE 100.64 Dry pressure mattress

E0185 NU 143.28 Gel pressure mattress pad

E0185 RR 14.33 Gel pressure mattress pad

E0185 UE 107.46 Gel pressure mattress pad

E0186 RR 14.95 Air pressure mattress

E0187 RR 16.30 Water pressure mattress

E0188 NU 19.95 Synthetic sheepskin pad

E0188 RR 2.00 Synthetic sheepskin pad

E0188 UE 14.96 Synthetic sheepskin pad

E0189 NU 41.43 Lambswool sheepskin pad

E0189 RR 4.14 Lambswool sheepskin pad

E0189 UE 31.07 Lambswool sheepskin pad

E0191 NU 9.51 Protector heel or elbow

E0191 RR 0.99 Protector heel or elbow

E0191 UE 7.11 Protector heel or elbow

E0193 RR 574.05 Powered air flotation bed

E0194 RR 2717.94 Air fluidized bed

E0196 RR 25.03 Gel pressure mattress

E0197 RR 14.02 Air pressure pad for mattres

E0198 RR 21.20 Water pressure pad for mattr

E0199 NU 24.52 Dry pressure pad for mattres

E0199 RR 2.46 Dry pressure pad for mattres

E0199 UE 18.39 Dry pressure pad for mattres

E0200 NU 75.85 Heat lamp without stand

E0200 RR 10.29 Heat lamp without stand

E0200 UE 56.92 Heat lamp without stand

E0202 RR 59.90 Phototherapy light w/ photom

E0205 NU 185.66 Heat lamp with stand

E0205 RR 20.43 Heat lamp with stand

E0205 UE 139.24 Heat lamp with stand

E0210 NU 31.23 Electric heat pad standard

E0210 RR 2.94 Electric heat pad standard

E0210 UE 23.42 Electric heat pad standard

E0215 NU 67.78 Electric heat pad moist

E0215 RR 7.09 Electric heat pad moist

E0215 UE 50.84 Electric heat pad moist

E0217 NU 403.72 Water circ heat pad w pump

E0217 RR 44.95 Water circ heat pad w pump

E0217 UE 302.76 Water circ heat pad w pump

E0225 NU 316.04 Hydrocollator unit

E0225 RR 31.15 Hydrocollator unit

E0225 UE 237.02 Hydrocollator unit

E0235 RR 14.03 Paraffin bath unit portable

E0236 RR 35.97 Pump for water circulating p

E0239 NU 365.79 Hydrocollator unit portable

E0239 RR 36.58 Hydrocollator unit portable

E0239 UE 274.35 Hydrocollator unit portable

E0249 NU 81.00 Pad water circulating heat u

E0249 RR 8.90 Pad water circulating heat u

E0249 UE 60.75 Pad water circulating heat u

E0250 RR 51.08 Hosp bed fixed ht w/ mattres

E0251 RR 47.21 Hosp bed fixd ht w/o mattres

E0255 RR 51.73 Hospital bed var ht w/ mattr

E0256 RR 49.23 Hospital bed var ht w/o matt

E0260 RR 51.88 Hosp bed semi-electr w/ matt

E0261 RR 51.68 Hosp bed semi-electr w/o mat

E0265 RR 118.69 Hosp bed total electr w/ mat

E0266 RR 103.28 Hosp bed total elec w/o matt

E0271 NU 105.31 Mattress innerspring

E0271 RR 10.53 Mattress innerspring

E0271 UE 78.98 Mattress innerspring

E0272 NU 118.26 Mattress foam rubber

E0272 RR 11.82 Mattress foam rubber

E0272 UE 88.70 Mattress foam rubber

E0275 NU 11.31 Bed pan standard

E0275 RR 1.13 Bed pan standard

E0275 UE 8.49 Bed pan standard

E0276 NU 9.44 Bed pan fracture

E0276 RR 0.94 Bed pan fracture

E0276 UE 7.07 Bed pan fracture

E0277 RR 166.97 Powered pres-redu air mattrs

E0280 NU 25.34 Bed cradle

E0280 RR 2.53 Bed cradle

E0280 UE 19.01 Bed cradle

E0290 RR 46.86 Hosp bed fx ht w/o rails w/m

E0291 RR 35.67 Hosp bed fx ht w/o rail w/o

E0292 RR 49.65 Hosp bed var ht no sr w/matt

E0293 RR 45.26 Hosp bed var ht no sr no mat

E0294 RR 51.79 Hosp bed semi-elect w/ mattr

E0295 RR 51.68 Hosp bed semi-elect w/o matt

E0296 RR 92.61 Hosp bed total elect w/ matt

E0297 RR 81.73 Hosp bed total elect w/o mat

E0300 RR 206.36 Enclosed ped crib hosp grade

E0301 RR 139.34 Hd hosp bed, 350-600 lbs

E0302 RR 400.72 Ex hd hosp bed > 600 lbs

E0303 RR 141.99 Hosp bed hvy dty xtra wide

E0304 RR 416.25 Hosp bed xtra hvy dty x wide

E0305 RR 9.12 Rails bed side half length

E0310 NU 96.42 Rails bed side full length

E0310 RR 9.64 Rails bed side full length

E0310 UE 72.32 Rails bed side full length

E0316 RR 150.70 Bed safety enclosure

E0325 NU 7.31 Urinal male jug-type

E0325 RR 0.73 Urinal male jug-type

E0325 UE 5.44 Urinal male jug-type

E0326 NU 7.83 Urinal female jug-type

E0326 RR 0.78 Urinal female jug-type

E0326 UE 5.87 Urinal female jug-type

E0371 RR 166.97 Nonpower mattress overlay

E0372 RR 166.97 Powered air mattress overlay

E0373 RR 166.97 Nonpowered pressure mattress

E0424 RR 59.70 Stationary compressed gas 02

E0424 RR QF 59.70 Stationary compressed gas 02

E0431 RR 14.70 Portable gaseous 02


E0433 RR 31.82 Portable liquid oxygen sys


E0434 RR 14.70 Portable liquid 02


E0439 RR 59.70 Stationary liquid 02

E0439 RR QF 59.70 Stationary liquid 02

E0441 45.32 Stationary o2 contents, gas

E0442 45.32 Stationary o2 contents, liq

E0443 41.06 Portable 02 contents, gas

E0444 41.06 Portable 02 contents, liquid

E0462 RR 263.03 Rocking bed w/ or w/o side r

E0465 RR 913.16 Home vent invasive interface

E0466 RR 913.16 Home vent non-invasive inter

E0470 RR 88.91 Rad w/o backup non-inv intfc

E0471 RR 218.96 Rad w/backup non inv intrfc

E0472 RR 331.01 Rad w backup invasive intrfc

E0480 RR 38.56 Percussor elect/pneum home m

E0482 RR 397.49 Cough stimulating device

E0483 RR 1017.07 Chest compression gen system

E0484 NU 35.33 Non-elec oscillatory pep dvc

E0484 RR 3.53 Non-elec oscillatory pep dvc

E0484 UE 26.50 Non-elec oscillatory pep dvc

E0485 NU 0.00 Oral device/appliance prefab

E0485 RR 0.00 Oral device/appliance prefab

E0485 UE 0.00 Oral device/appliance prefab

E0486 NU 0.00 Oral device/appliance cusfab

E0486 RR 0.00 Oral device/appliance cusfab

E0486 UE 0.00 Oral device/appliance cusfab

E0500 RR 105.00 Ippb all types

E0550 RR 40.77 Humidif extens supple w ippb

E0560 NU 141.41 Humidifier supplemental w/ i

E0560 RR 16.57 Humidifier supplemental w/ i

E0560 UE 106.07 Humidifier supplemental w/ i

E0561 NU 61.22 Humidifier nonheated w pap

E0561 RR 6.12 Humidifier nonheated w pap

E0561 UE 45.92 Humidifier nonheated w pap

E0562 NU 115.38 Humidifier heated used w pap

E0562 RR 11.53 Humidifier heated used w pap

E0562 UE 86.54 Humidifier heated used w pap

E0565 RR 34.50 Compressor air power source

E0570 RR 4.89 Nebulizer with compression

E0572 RR 26.18 Aerosol compressor adjust pr

E0574 RR 37.42 Ultrasonic generator w svneb

E0575 RR 98.33 Nebulizer ultrasonic

E0580 NU 107.71 Nebulizer for use w/ regulat

E0580 RR 10.77 Nebulizer for use w/ regulat

E0580 UE 80.78 Nebulizer for use w/ regulat

E0585 RR 24.69 Nebulizer w/ compressor & he

E0600 RR 43.80 Suction pump portab hom modl

E0601 RR 34.48 Cont airway pressure device

E0602 NU 28.24 Manual breast pump

E0602 RR 2.84 Manual breast pump

E0602 UE 21.18 Manual breast pump

E0605 NU 23.94 Vaporizer room type

E0605 RR 2.94 Vaporizer room type

E0605 UE 17.95 Vaporizer room type

E0606 RR 21.96 Drainage board postural

E0607 NU 63.92 Blood glucose monitor home

E0607 RR 6.38 Blood glucose monitor home

E0607 UE 47.93 Blood glucose monitor home

E0610 NU 227.55 Pacemaker monitr audible/vis

E0610 RR 24.00 Pacemaker monitr audible/vis

E0610 UE 170.68 Pacemaker monitr audible/vis

E0615 NU 424.79 Pacemaker monitr digital/vis

E0615 RR 55.96 Pacemaker monitr digital/vis

E0615 UE 318.56 Pacemaker monitr digital/vis

E0617 RR 290.86 Automatic ext defibrillator

E0617 RR KF 322.95 Automatic ext defibrillator

E0618 RR 261.19 Apnea monitor

E0619 RR 0.00 Apnea monitor w recorder

E0620 RR 83.64 Cap bld skin piercing laser

E0621 NU 66.22 Patient lift sling or seat

E0621 RR 6.62 Patient lift sling or seat

E0621 UE 49.67 Patient lift sling or seat

E0627 NU 215.16 Seat lift mech, electric any

E0627 RR 21.51 Seat lift mech, electric any

E0627 UE 161.37 Seat lift mech, electric any

E0629 NU 214.19 Seat lift mech, non-electric

E0629 RR 21.42 Seat lift mech, non-electric

E0629 UE 160.64 Seat lift mech, non-electric

E0630 RR 49.16 Patient lift hydraulic

E0635 RR 96.19 Patient lift electric

E0636 RR 812.80 Pt support & positioning sys

E0639 RR 90.71 Moveable patient lift system

E0640 RR 90.71 Fixed patient lift system

E0650 NU 631.11 Pneuma compresor non-segment

E0650 RR 85.03 Pneuma compresor non-segment

E0650 UE 473.31 Pneuma compresor non-segment

E0651 NU 746.83 Pneum compressor segmental

E0651 RR 76.30 Pneum compressor segmental

E0651 UE 560.13 Pneum compressor segmental

E0652 NU 5012.59 Pneum compres w/cal pressure

E0652 RR 501.23 Pneum compres w/cal pressure

E0652 UE 3759.44 Pneum compres w/cal pressure

E0655 NU 103.26 Pneumatic appliance half arm

E0655 RR 12.14 Pneumatic appliance half arm

E0655 UE 77.54 Pneumatic appliance half arm

E0656 RR 55.28 Segmental pneumatic trunk

E0657 RR 51.93 Segmental pneumatic chest

E0660 NU 152.83 Pneumatic appliance full leg

E0660 RR 15.90 Pneumatic appliance full leg

E0660 UE 114.62 Pneumatic appliance full leg

E0665 NU 111.40 Pneumatic appliance full arm

E0665 RR 11.44 Pneumatic appliance full arm

E0665 UE 83.65 Pneumatic appliance full arm

E0666 NU 132.12 Pneumatic appliance half leg

E0666 RR 13.61 Pneumatic appliance half leg

E0666 UE 99.10 Pneumatic appliance half leg

E0667 NU 309.73 Seg pneumatic appl full leg

E0667 RR 30.99 Seg pneumatic appl full leg

E0667 UE 232.30 Seg pneumatic appl full leg

E0668 NU 359.32 Seg pneumatic appl full arm

E0668 RR 35.46 Seg pneumatic appl full arm

E0668 UE 269.50 Seg pneumatic appl full arm

E0669 NU 166.51 Seg pneumatic appli half leg

E0669 RR 16.65 Seg pneumatic appli half leg

E0669 UE 124.88 Seg pneumatic appli half leg

E0670 NU 1172.12 Seg pneum int legs/trunk

E0670 RR 117.15 Seg pneum int legs/trunk

E0670 UE 879.17 Seg pneum int legs/trunk

E0671 NU 397.36 Pressure pneum appl full leg

E0671 RR 39.75 Pressure pneum appl full leg

E0671 UE 298.00 Pressure pneum appl full leg

E0672 NU 308.74 Pressure pneum appl full arm

E0672 RR 30.89 Pressure pneum appl full arm

E0672 UE 231.57 Pressure pneum appl full arm

E0673 NU 256.55 Pressure pneum appl half leg

E0673 RR 25.66 Pressure pneum appl half leg

E0673 UE 192.44 Pressure pneum appl half leg

E0675 RR 367.89 Pneumatic compression device

E0691 NU 859.65 Uvl pnl 2 sq ft or less

E0691 RR 85.96 Uvl pnl 2 sq ft or less

E0691 UE 644.74 Uvl pnl 2 sq ft or less

E0692 NU 1079.49 Uvl sys panel 4 ft

E0692 RR 104.22 Uvl sys panel 4 ft

E0692 UE 809.61 Uvl sys panel 4 ft

E0693 NU 1330.70 Uvl sys panel 6 ft

E0693 RR 133.08 Uvl sys panel 6 ft

E0693 UE 998.03 Uvl sys panel 6 ft

E0694 NU 4235.50 Uvl md cabinet sys 6 ft

E0694 RR 423.55 Uvl md cabinet sys 6 ft

E0694 UE 3176.65 Uvl md cabinet sys 6 ft

E0705 NU 40.80 Transfer device

E0705 NU KU 44.83 Transfer device

E0705 RR 4.08 Transfer device

E0705 RR KU 4.56 Transfer device

E0705 UE 30.60 Transfer device

E0705 UE KU 32.83 Transfer device

E0720 NU 60.66 Tens two lead

E0730 NU 61.29 Tens four lead

E0731 NU 75.98 Conductive garment for tens/

E0740 RR 50.03 Non-implant pelv flr e-stim

E0744 RR 74.46 Neuromuscular stim for scoli

E0745 RR 85.64 Neuromuscular stim for shock

E0747 NU KF 3746.38 Elec osteogen stim not spine

E0747 RR KF 372.28 Elec osteogen stim not spine

E0747 UE KF 2783.50 Elec osteogen stim not spine

E0748 NU KF 3722.12 Elec osteogen stim spinal

E0748 RR KF 372.19 Elec osteogen stim spinal

E0748 UE KF 2791.59 Elec osteogen stim spinal

E0749 RR KF 231.23 Elec osteogen stim implanted

E0760 NU KF 3093.01 Osteogen ultrasound stimltor

E0760 RR KF 309.31 Osteogen ultrasound stimltor

E0760 UE KF 2319.74 Osteogen ultrasound stimltor

E0762 RR 89.41 Trans elec jt stim dev sys

E0764 RR KF 1058.71 Functional neuromuscularstim

E0765 NU 80.49 Nerve stimulator for tx n&v

E0765 RR 8.06 Nerve stimulator for tx n&v

E0765 UE 60.38 Nerve stimulator for tx n&v

E0776 NU 118.97 Iv pole

E0776 RR 11.90 Iv pole

E0776 UE 89.23 Iv pole

E0779 RR 15.44 Amb infusion pump mechanical

E0780 NU 9.82 Mech amb infusion pump <8hrs

E0781 RR 200.31 External ambulatory infus pu

E0782 NU KF 3875.60 Non-programble infusion pump

E0782 RR KF 387.55 Non-programble infusion pump

E0782 UE KF 2906.72 Non-programble infusion pump

E0783 NU KF 7832.15 Programmable infusion pump

E0783 RR KF 783.24 Programmable infusion pump

E0783 UE KF 5874.13 Programmable infusion pump

E0784 RR 361.18 Ext amb infusn pump insulin

E0785 KF 452.04 Replacement impl pump cathet

E0786 NU KF 7639.78 Implantable pump replacement

E0786 RR KF 763.96 Implantable pump replacement

E0786 UE KF 5729.84 Implantable pump replacement

E0791 RR 237.97 Parenteral infusion pump sta

E0840 NU 70.09 Tract frame attach headboard

E0840 RR 15.62 Tract frame attach headboard

E0840 UE 52.55 Tract frame attach headboard

E0849 RR 49.31 Cervical pneum trac equip

E0850 NU 100.50 Traction stand free standing

E0850 RR 13.80 Traction stand free standing

E0850 UE 75.38 Traction stand free standing

E0855 RR 47.29 Cervical traction equipment

E0856 RR 14.72 Cervic collar w air bladders

E0860 NU 35.59 Tract equip cervical tract

E0860 RR 6.23 Tract equip cervical tract

E0860 UE 26.67 Tract equip cervical tract

E0870 NU 111.27 Tract frame attach footboard

E0870 RR 12.38 Tract frame attach footboard

E0870 UE 83.83 Tract frame attach footboard

E0880 NU 120.11 Trac stand free stand extrem

E0880 RR 18.85 Trac stand free stand extrem

E0880 UE 90.91 Trac stand free stand extrem

E0890 NU 107.78 Traction frame attach pelvic

E0890 RR 31.41 Traction frame attach pelvic

E0890 UE 92.79 Traction frame attach pelvic

E0900 NU 104.19 Trac stand free stand pelvic

E0900 RR 26.43 Trac stand free stand pelvic

E0900 UE 78.17 Trac stand free stand pelvic

E0910 RR 9.27 Trapeze bar attached to bed

E0911 RR 35.19 Hd trapeze bar attach to bed

E0912 RR 70.64 Hd trapeze bar free standing

E0920 RR 37.54 Fracture frame attached to b

E0930 RR 41.90 Fracture frame free standing

E0935 RR 21.76 Cont pas motion exercise dev

E0940 RR 17.48 Trapeze bar free standing

E0941 RR 35.29 Gravity assisted traction de

E0942 NU 16.90 Cervical head harness/halter

E0942 RR 1.91 Cervical head harness/halter

E0942 UE 12.67 Cervical head harness/halter

E0944 NU 43.88 Pelvic belt/harness/boot

E0944 RR 4.42 Pelvic belt/harness/boot

E0944 UE 32.91 Pelvic belt/harness/boot

E0945 NU 42.40 Belt/harness extremity

E0945 RR 4.24 Belt/harness extremity

E0945 UE 32.82 Belt/harness extremity

E0946 RR 48.11 Fracture frame dual w cross

E0947 NU 493.15 Fracture frame attachmnts pe

E0947 RR 51.13 Fracture frame attachmnts pe

E0947 UE 369.85 Fracture frame attachmnts pe

E0948 NU 476.99 Fracture frame attachmnts ce

E0948 RR 47.68 Fracture frame attachmnts ce

E0948 UE 336.42 Fracture frame attachmnts ce

E0950 NU 62.73 Tray

E0950 NU KU 72.85 Tray

E0950 RR 6.27 Tray

E0950 RR KU 7.30 Tray

E0950 UE 47.05 Tray

E0950 UE KU 54.65 Tray

E0951 NU 10.85 Loop heel

E0951 NU KU 13.31 Loop heel

E0951 RR 1.09 Loop heel

E0951 RR KU 1.37 Loop heel

E0951 UE 8.14 Loop heel

E0951 UE KU 9.97 Loop heel

E0952 NU 13.20 Toe loop/holder, each

E0952 NU KU 13.21 Toe loop/holder, each

E0952 RR 1.33 Toe loop/holder, each

E0952 RR KU 1.37 Toe loop/holder, each

E0952 UE 9.90 Toe loop/holder, each

E0952 UE KU 9.90 Toe loop/holder, each

E0953 NU 61.97 W/c lateral thigh/knee sup

E0953 NU KU 81.28 W/C LATERAL THIGH/KNEE SUP

E0953 RR 6.20 W/c lateral thigh/knee sup

E0953 RR KU 8.13 W/C LATERAL THIGH/KNEE SUP

E0953 UE 46.48 W/c lateral thigh/knee sup

E0953 UE KU 60.96 W/C LATERAL THIGH/KNEE SUP

E0954 NU 43.08 Foot box, any type each foot

E0954 NU KU 46.54 FOOT BOX, ANY TYPE EACH FOOT

E0954 RR 4.33 Foot box, any type each foot

E0954 RR KU 4.66 FOOT BOX, ANY TYPE EACH FOOT

E0954 UE 32.31 Foot box, any type each foot

E0954 UE KU 34.90 FOOT BOX, ANY TYPE EACH FOOT

E0955 RR 11.76 Cushioned headrest

E0955 RR KU 16.68 Cushioned headrest

E0956 NU 61.97 W/c lateral trunk/hip suppor

E0956 NU KU 81.28 W/c lateral trunk/hip suppor

E0956 RR 6.20 W/c lateral trunk/hip suppor

E0956 RR KU 8.13 W/c lateral trunk/hip suppor

E0956 UE 46.48 W/c lateral trunk/hip suppor

E0956 UE KU 60.96 W/c lateral trunk/hip suppor

E0957 NU 98.31 W/c medial thigh support

E0957 NU KU 113.74 W/c medial thigh support

E0957 RR 9.83 W/c medial thigh support

E0957 RR KU 11.38 W/c medial thigh support

E0957 UE 73.74 W/c medial thigh support

E0957 UE KU 85.30 W/c medial thigh support

E0958 RR 33.54 Whlchr att- conv 1 arm drive

E0959 NU 35.12 Amputee adapter

E0959 RR 3.51 Amputee adapter

E0959 UE 26.34 Amputee adapter

E0960 NU 59.56 W/c shoulder harness/straps

E0960 NU KU 75.02 W/c shoulder harness/straps

E0960 RR 5.96 W/c shoulder harness/straps

E0960 RR KU 7.52 W/c shoulder harness/straps

E0960 UE 44.68 W/c shoulder harness/straps

E0960 UE KU 56.28 W/c shoulder harness/straps

E0961 NU 16.35 Wheelchair brake extension

E0961 RR 1.63 Wheelchair brake extension

E0961 UE 12.08 Wheelchair brake extension

E0966 NU 56.38 Wheelchair head rest extensi

E0966 RR 5.64 Wheelchair head rest extensi

E0966 UE 42.29 Wheelchair head rest extensi

E0967 NU 58.82 Man wc rim/projection rep ea

E0967 RR 5.88 Man wc rim/projection rep ea

E0967 UE 44.12 Man wc rim/projection rep ea

E0968 RR 17.14 Wheelchair commode seat

E0969 NU 142.22 Wheelchair narrowing device

E0969 RR 14.20 Wheelchair narrowing device

E0969 UE 106.66 Wheelchair narrowing device

E0971 NU 25.45 Wheelchair anti-tipping devi

E0971 RR 2.55 Wheelchair anti-tipping devi

E0971 UE 19.09 Wheelchair anti-tipping devi

E0973 NU 46.85 W/ch access det adj armrest

E0973 NU KU 80.58 W/ch access det adj armrest

E0973 RR 4.68 W/ch access det adj armrest

E0973 RR KU 7.68 W/ch access det adj armrest

E0973 UE 35.14 W/ch access det adj armrest

E0973 UE KU 60.44 W/ch access det adj armrest

E0974 NU 59.47 W/ch access anti-rollback

E0974 RR 5.95 W/ch access anti-rollback

E0974 UE 44.61 W/ch access anti-rollback

E0978 NU 20.54 W/c acc,saf belt pelv strap

E0978 NU KU 34.60 W/c acc,saf belt pelv strap

E0978 RR 2.06 W/c acc,saf belt pelv strap

E0978 RR KU 3.45 W/c acc,saf belt pelv strap

E0978 UE 15.41 W/c acc,saf belt pelv strap

E0978 UE KU 25.96 W/c acc,saf belt pelv strap

E0980 NU 30.57 Wheelchair safety vest

E0980 RR 3.04 Wheelchair safety vest

E0980 UE 22.93 Wheelchair safety vest

E0981 NU 33.05 Seat upholstery, replacement

E0981 NU KU 33.05 Seat upholstery, replacement

E0981 RR 3.36 Seat upholstery, replacement

E0981 RR KU 3.36 Seat upholstery, replacement

E0981 UE 25.02 Seat upholstery, replacement

E0981 UE KU 25.02 Seat upholstery, replacement

E0982 NU 36.12 Back upholstery, replacement

E0982 NU KU 36.10 Back upholstery, replacement

E0982 RR 3.61 Back upholstery, replacement

E0982 RR KU 3.60 Back upholstery, replacement

E0982 UE 27.09 Back upholstery, replacement

E0982 UE KU 27.10 Back upholstery, replacement

E0983 RR 231.51 Add pwr joystick

E0984 RR 161.81 Add pwr tiller

E0985 RR 17.23 W/c seat lift mechanism

E0985 RR KU 19.42 W/c seat lift mechanism

E0986 RR 465.36 Man w/c push-rim powr system

E0988 RR 286.38 Lever-activated wheel drive

E0990 NU 61.81 Wheelchair elevating leg res

E0990 NU KU 82.30 Wheelchair elevating leg res

E0990 RR 6.18 Wheelchair elevating leg res

E0990 RR KU 9.27 Wheelchair elevating leg res

E0990 UE 46.36 Wheelchair elevating leg res

E0990 UE KU 64.31 Wheelchair elevating leg res

E0992 NU 66.78 Wheelchair solid seat insert

E0992 RR 6.68 Wheelchair solid seat insert

E0992 UE 50.09 Wheelchair solid seat insert

E0994 NU 16.79 Wheelchair arm rest

E0994 RR 1.67 Wheelchair arm rest

E0994 UE 12.59 Wheelchair arm rest

E0995 NU 21.31 Wc calf rest, pad replacemnt

E0995 NU KU 21.30 Wc calf rest, pad replacemnt

E0995 RR 2.13 Wc calf rest, pad replacemnt

E0995 RR KU 2.14 Wc calf rest, pad replacemnt

E0995 UE 15.96 Wc calf rest, pad replacemnt

E0995 UE KU 15.96 Wc calf rest, pad replacemnt

E1002 RR 298.95 Pwr seat tilt

E1002 RR KU 334.19 Pwr seat tilt

E1003 RR 349.91 Pwr seat recline

E1003 RR KU 362.09 Pwr seat recline

E1004 RR 384.60 Pwr seat recline mech

E1004 RR KU 401.47 Pwr seat recline mech

E1005 RR 420.72 Pwr seat recline pwr

E1005 RR KU 434.56 Pwr seat recline pwr

E1006 RR 518.74 Pwr seat combo w/o shear

E1006 RR KU 532.30 Pwr seat combo w/o shear

E1007 RR 643.91 Pwr seat combo w/shear

E1007 RR KU 720.77 Pwr seat combo w/shear

E1008 RR 660.47 Pwr seat combo pwr shear

E1008 RR KU 720.83 Pwr seat combo pwr shear

E1009 NU 0.00 Add mech leg elevation

E1009 RR 0.00 Add mech leg elevation

E1009 UE 0.00 Add mech leg elevation

E1010 RR 89.75 Add pwr leg elevation

E1010 RR KU 94.32 Add pwr leg elevation

E1011 NU 0.00 Ped wc modify width adjustm

E1011 RR 0.00 Ped wc modify width adjustm

E1011 UE 0.00 Ped wc modify width adjustm

E1012 RR 89.75 Ctr mount pwr elev leg rest

E1012 RR KU 94.32 Ctr mount pwr elev leg rest

E1014 RR 34.94 Reclining back add ped w/c

E1015 NU 97.15 Shock absorber for man w/c

E1015 RR 9.72 Shock absorber for man w/c

E1015 UE 72.86 Shock absorber for man w/c

E1016 NU 88.63 Shock absorber for power w/c

E1016 NU KU 108.29 Shock absorber for power w/c

E1016 RR 8.87 Shock absorber for power w/c

E1016 RR KU 10.85 Shock absorber for power w/c

E1016 UE 66.47 Shock absorber for power w/c

E1016 UE KU 81.20 Shock absorber for power w/c

E1017 NU 0.00 Hd shck absrbr for hd man wc

E1017 RR 0.00 Hd shck absrbr for hd man wc

E1017 UE 0.00 Hd shck absrbr for hd man wc

E1018 NU 0.00 Hd shck absrber for hd powwc

E1018 RR 0.00 Hd shck absrber for hd powwc

E1018 UE 0.00 Hd shck absrber for hd powwc

E1020 RR 14.88 Residual limb support system

E1020 RR KU 20.06 Residual limb support system

E1028 RR 11.41 W/c manual swingaway

E1028 RR KU 17.03 W/c manual swingaway

E1029 RR 30.24 W/c vent tray fixed

E1029 RR KU 30.46 W/c vent tray fixed

E1030 RR 94.45 W/c vent tray gimbaled

E1030 RR KU 96.08 W/c vent tray gimbaled

E1031 RR 34.94 Rollabout chair with casters

E1035 RR 486.82 Patient transfer system <300

E1036 RR 693.01 Patient transfer system >300

E1037 RR 86.07 Transport chair, ped size

E1038 RR 12.64 Transport chair pt wt<=300lb

E1039 RR 26.86 Transport chair pt wt >300lb

E1050 RR 82.82 Whelchr fxd full length arms

E1060 RR 110.47 Wheelchair detachable arms

E1070 RR 104.79 Wheelchair detachable foot r

E1083 RR 65.06 Hemi-wheelchair fixed arms

E1084 RR 93.85 Hemi-wheelchair detachable a

E1087 RR 112.35 Wheelchair lightwt fixed arm

E1088 RR 135.89 Wheelchair lightweight det a

E1092 RR 104.50 Wheelchair wide w/ leg rests

E1093 RR 105.73 Wheelchair wide w/ foot rest

E1100 RR 84.41 Whchr s-recl fxd arm leg res

E1110 RR 93.31 Wheelchair semi-recl detach

E1150 RR 78.04 Wheelchair standard w/ leg r

E1160 RR 59.80 Wheelchair fixed arms

E1161 RR 226.36 Manual adult wc w tiltinspac

E1170 RR 72.63 Whlchr ampu fxd arm leg rest

E1171 RR 65.18 Wheelchair amputee w/o leg r

E1172 RR 79.66 Wheelchair amputee detach ar

E1180 RR 82.40 Wheelchair amputee w/ foot r

E1190 RR 95.20 Wheelchair amputee w/ leg re

E1195 RR 102.15 Wheelchair amputee heavy dut

E1200 RR 70.75 Wheelchair amputee fixed arm

E1221 RR 45.23 Wheelchair spec size w foot

E1222 RR 61.88 Wheelchair spec size w/ leg

E1223 RR 70.81 Wheelchair spec size w foot

E1224 RR 67.52 Wheelchair spec size w/ leg

E1225 RR 31.08 Manual semi-reclining back

E1226 NU 327.91 Manual fully reclining back

E1226 RR 32.79 Manual fully reclining back

E1226 UE 245.93 Manual fully reclining back

E1227 NU 265.48 Wheelchair spec sz spec ht a

E1227 RR 26.55 Wheelchair spec sz spec ht a

E1227 UE 199.13 Wheelchair spec sz spec ht a

E1228 RR 26.81 Wheelchair spec sz spec ht b

E1230 NU 2144.83 Power operated vehicle

E1230 RR 212.81 Power operated vehicle

E1230 UE 1608.59 Power operated vehicle

E1231 NU 0.00 Rigid ped w/c tilt-in-space

E1231 RR 0.00 Rigid ped w/c tilt-in-space

E1231 UE 0.00 Rigid ped w/c tilt-in-space

E1232 RR 204.59 Folding ped wc tilt-in-space

E1233 RR 211.96 Rig ped wc tltnspc w/o seat

E1234 RR 184.54 Fld ped wc tltnspc w/o seat

E1235 RR 177.71 Rigid ped wc adjustable

E1236 RR 156.77 Folding ped wc adjustable

E1237 RR 158.14 Rgd ped wc adjstabl w/o seat

E1238 RR 156.77 Fld ped wc adjstabl w/o seat

E1240 RR 98.56 Whchr litwt det arm leg rest

E1270 RR 64.19 Wheelchair lightweight leg r

E1280 RR 106.73 Whchr h-duty det arm leg res

E1295 RR 98.77 Wheelchair heavy duty fixed

E1296 NU 399.80 Wheelchair special seat heig

E1296 RR 40.62 Wheelchair special seat heig

E1296 UE 299.85 Wheelchair special seat heig

E1297 NU 85.07 Wheelchair special seat dept

E1297 RR 9.45 Wheelchair special seat dept

E1297 UE 63.79 Wheelchair special seat dept

E1298 NU 405.31 Wheelchair spec seat depth/w

E1298 RR 41.47 Wheelchair spec seat depth/w

E1298 UE 303.97 Wheelchair spec seat depth/w

E1310 NU 1746.21 Whirlpool non-portable

E1310 RR 158.03 Whirlpool non-portable

E1310 UE 1309.65 Whirlpool non-portable

E1353 27.10 Oxygen supplies regulator

E1355 20.42 Oxygen supplies stand/rack

E1372 NU 108.22 Oxy suppl heater for nebuliz

E1372 RR 10.82 Oxy suppl heater for nebuliz

E1372 UE 81.17 Oxy suppl heater for nebuliz

E1390 RR 59.70 Oxygen concentrator

E1390 RR QF 59.70 Oxygen concentrator

E1391 RR 59.70 Oxygen concentrator, dual

E1391 RR QF 59.70 Oxygen concentrator, dual

E1392 RR 31.82 Portable oxygen concentrator


E1405 RR 84.39 O2/water vapor enrich w/heat

E1406 RR 64.50 O2/water vapor enrich w/o he

E1700 RR 28.05 Jaw motion rehab system

E1701 10.14 Repl cushions for jaw motion

E1702 21.59 Repl measr scales jaw motion

E1800 RR 117.20 Adjust elbow ext/flex device

E1801 RR 119.26 Sps elbow device

E1802 RR 312.65 Adjst forearm pro/sup device

E1805 RR 120.88 Adjust wrist ext/flex device

E1806 RR 97.90 Sps wrist device

E1810 RR 119.19 Adjust knee ext/flex device

E1811 RR 123.98 Sps knee device

E1812 RR 82.26 Knee ext/flex w act res ctrl

E1815 RR 120.88 Adjust ankle ext/flex device

E1816 RR 125.94 Sps ankle device

E1818 RR 128.55 Sps forearm device

E1820 NU 73.76 Soft interface material

E1820 RR 7.39 Soft interface material

E1820 UE 55.34 Soft interface material

E1821 NU 100.68 Replacement interface spsd

E1821 RR 10.05 Replacement interface spsd

E1821 UE 75.54 Replacement interface spsd

E1825 RR 120.88 Adjust finger ext/flex devc

E1830 RR 120.88 Adjust toe ext/flex device

E1831 RR 63.21 Static str toe dev ext/flex

E1840 RR 364.85 Adj shoulder ext/flex device

E1841 RR 433.36 Static str shldr dev rom adj

E2000 RR 47.89 Gastric suction pump hme mdl

E2100 NU 615.32 Bld glucose monitor w voice

E2100 RR 61.54 Bld glucose monitor w voice

E2100 UE 461.49 Bld glucose monitor w voice

E2101 NU 180.39 Bld glucose monitor w lance

E2101 RR 18.04 Bld glucose monitor w lance

E2101 UE 135.29 Bld glucose monitor w lance

E2120 RR 271.24 Pulse gen sys tx endolymp fl

E2201 NU 260.92 Man w/ch acc seat w>=20"<24"

E2201 RR 26.10 Man w/ch acc seat w>=20"<24"

E2201 UE 195.70 Man w/ch acc seat w>=20"<24"

E2202 NU 366.72 Seat width 24-27 in

E2202 RR 36.68 Seat width 24-27 in

E2202 UE 275.04 Seat width 24-27 in

E2203 NU 354.24 Frame depth less than 22 in

E2203 RR 35.43 Frame depth less than 22 in

E2203 UE 265.68 Frame depth less than 22 in

E2204 NU 611.56 Frame depth 22 to 25 in

E2204 RR 61.16 Frame depth 22 to 25 in

E2204 UE 458.67 Frame depth 22 to 25 in

E2205 NU 28.40 Manual wc accessory, handrim

E2205 RR 2.84 Manual wc accessory, handrim

E2205 UE 21.30 Manual wc accessory, handrim

E2206 NU 31.14 Man wc whl lock comp repl ea

E2206 RR 3.11 Man wc whl lock comp repl ea

E2206 UE 23.35 Man wc whl lock comp repl ea

E2207 NU 35.98 Crutch and cane holder

E2207 NU KU 41.47 Crutch and cane holder

E2207 RR 3.60 Crutch and cane holder

E2207 RR KU 4.16 Crutch and cane holder

E2207 UE 26.99 Crutch and cane holder

E2207 UE KU 31.11 Crutch and cane holder

E2208 NU 65.66 Cylinder tank carrier

E2208 NU KU 97.95 Cylinder tank carrier

E2208 RR 6.57 Cylinder tank carrier

E2208 RR KU 9.79 Cylinder tank carrier

E2208 UE 49.25 Cylinder tank carrier

E2208 UE KU 73.46 Cylinder tank carrier

E2209 NU 66.88 Arm trough each

E2209 NU KU 88.36 Arm trough each

E2209 RR 6.69 Arm trough each

E2209 RR KU 8.85 Arm trough each

E2209 UE 50.16 Arm trough each

E2209 UE KU 66.28 Arm trough each

E2210 NU 4.29 Wheelchair bearings

E2210 NU KU 5.39 Wheelchair bearings

E2210 RR 0.43 Wheelchair bearings

E2210 RR KU 0.54 Wheelchair bearings

E2210 UE 3.22 Wheelchair bearings

E2210 UE KU 4.06 Wheelchair bearings

E2211 NU 27.93 Pneumatic propulsion tire

E2211 RR 2.80 Pneumatic propulsion tire

E2211 UE 20.95 Pneumatic propulsion tire

E2212 NU 4.98 Pneumatic prop tire tube

E2212 RR 0.50 Pneumatic prop tire tube

E2212 UE 3.74 Pneumatic prop tire tube

E2213 NU 23.74 Pneumatic prop tire insert

E2213 RR 2.37 Pneumatic prop tire insert

E2213 UE 17.81 Pneumatic prop tire insert

E2214 NU 25.28 Pneumatic caster tire each

E2214 RR 2.53 Pneumatic caster tire each

E2214 UE 18.96 Pneumatic caster tire each

E2215 NU 8.19 Pneumatic caster tire tube

E2215 RR 0.82 Pneumatic caster tire tube

E2215 UE 6.15 Pneumatic caster tire tube

E2216 NU 0.00 Foam filled propulsion tire

E2216 RR 0.00 Foam filled propulsion tire

E2216 UE 0.00 Foam filled propulsion tire

E2217 NU 0.00 Foam filled caster tire each

E2217 RR 0.00 Foam filled caster tire each

E2217 UE 0.00 Foam filled caster tire each

E2218 NU 0.00 Foam propulsion tire each

E2218 RR 0.00 Foam propulsion tire each

E2218 UE 0.00 Foam propulsion tire each

E2219 NU 32.35 Foam caster tire any size ea

E2219 RR 3.24 Foam caster tire any size ea

E2219 UE 24.26 Foam caster tire any size ea

E2220 NU 24.04 Solid propuls tire, repl, ea

E2220 RR 2.41 Solid propuls tire, repl, ea

E2220 UE 18.03 Solid propuls tire, repl, ea

E2221 NU 21.35 Solid caster tire repl, each

E2221 RR 2.13 Solid caster tire repl, each

E2221 UE 16.01 Solid caster tire repl, each

E2222 NU 18.06 Solid caster integ whl, repl

E2222 RR 1.81 Solid caster integ whl, repl

E2222 UE 13.55 Solid caster integ whl, repl

E2224 NU 76.59 Propulsion whl excl tire rep

E2224 RR 7.66 Propulsion whl excl tire rep

E2224 UE 57.45 Propulsion whl excl tire rep

E2225 NU 14.82 Caster wheel excludes tire

E2225 RR 1.48 Caster wheel excludes tire

E2225 UE 11.12 Caster wheel excludes tire

E2226 NU 31.55 Caster fork replacement only

E2226 RR 3.15 Caster fork replacement only

E2226 UE 23.66 Caster fork replacement only

E2227 RR 178.98 Gear reduction drive wheel

E2228 RR 76.44 Mwc acc, wheelchair brake

E2231 NU 115.75 Solid seat support base

E2231 RR 11.58 Solid seat support base

E2231 UE 86.82 Solid seat support base

E2310 RR 87.53 Electro connect btw control

E2310 RR KU 96.48 Electro connect btw control

E2311 RR 176.65 Electro connect btw 2 sys

E2311 RR KU 195.36 Electro connect btw 2 sys

E2312 RR 192.92 Mini-prop remote joystick

E2312 RR KC 246.05 Mini-prop remote joystick

E2313 RR 30.66 Pwc harness, expand control

E2321 RR 118.94 Hand interface joystick

E2321 RR KC 193.73 Hand interface joystick

E2321 RR KU 213.45 Hand interface joystick

E2322 RR 112.37 Mult mech switches

E2322 RR KC 218.42 Mult mech switches

E2322 RR KU 226.02 Mult mech switches

E2323 NU 54.77 Special joystick handle

E2323 NU KU 57.04 Special joystick handle

E2323 RR 5.47 Special joystick handle

E2323 RR KU 5.70 Special joystick handle

E2323 UE 41.08 Special joystick handle

E2323 UE KU 42.76 Special joystick handle

E2324 NU 36.13 Chin cup interface

E2324 NU KU 36.13 Chin cup interface

E2324 RR 3.60 Chin cup interface

E2324 RR KU 3.60 Chin cup interface

E2324 UE 27.10 Chin cup interface

E2324 UE KU 27.10 Chin cup interface

E2325 RR 107.40 Sip and puff interface

E2325 RR KU 111.06 Sip and puff interface

E2326 RR 28.17 Breath tube kit

E2326 RR KU 28.64 Breath tube kit

E2327 RR 210.09 Head control interface mech

E2327 RR KC 319.18 Head control interface mech

E2327 RR KU 327.25 Head control interface mech

E2328 RR 396.53 Head/extremity control inter

E2328 RR KU 408.59 Head/extremity control inter

E2329 RR 143.19 Head control nonproportional

E2329 RR KU 145.62 Head control nonproportional

E2330 RR 274.92 Head control proximity switc

E2330 RR KU 282.16 Head control proximity switc

E2340 NU 342.83 W/c wdth 20-23 in seat frame

E2340 RR 34.30 W/c wdth 20-23 in seat frame

E2340 UE 257.15 W/c wdth 20-23 in seat frame

E2341 NU 514.28 W/c wdth 24-27 in seat frame

E2341 RR 51.43 W/c wdth 24-27 in seat frame

E2341 UE 385.72 W/c wdth 24-27 in seat frame

E2342 NU 428.58 W/c dpth 20-21 in seat frame

E2342 RR 42.86 W/c dpth 20-21 in seat frame

E2342 UE 321.44 W/c dpth 20-21 in seat frame

E2343 NU 685.73 W/c dpth 22-25 in seat frame

E2343 RR 68.56 W/c dpth 22-25 in seat frame

E2343 UE 514.28 W/c dpth 22-25 in seat frame

E2351 NU 569.52 Electronic sgd interface

E2351 NU KU 576.06 Electronic sgd interface

E2351 RR 56.95 Electronic sgd interface

E2351 RR KU 57.63 Electronic sgd interface

E2351 UE 427.14 Electronic sgd interface

E2351 UE KU 432.03 Electronic sgd interface

E2359 NU 135.85 Gr34 sealed leadacid battery

E2359 NU KU 166.60 Gr34 sealed leadacid battery

E2359 RR 13.58 Gr34 sealed leadacid battery

E2359 RR KU 16.66 Gr34 sealed leadacid battery

E2359 UE 101.89 Gr34 sealed leadacid battery

E2359 UE KU 124.93 Gr34 sealed leadacid battery

E2360 NU 84.61 22nf nonsealed leadacid

E2360 NU KU 107.48 22nf nonsealed leadacid

E2360 RR 8.46 22nf nonsealed leadacid

E2360 RR KU 10.80 22nf nonsealed leadacid

E2360 UE 63.46 22nf nonsealed leadacid

E2360 UE KU 80.60 22nf nonsealed leadacid

E2361 NU 92.55 22nf sealed leadacid battery

E2361 NU KU 115.00 22nf sealed leadacid battery

E2361 RR 9.26 22nf sealed leadacid battery

E2361 RR KU 11.50 22nf sealed leadacid battery

E2361 UE 69.41 22nf sealed leadacid battery

E2361 UE KU 86.27 22nf sealed leadacid battery

E2362 NU 77.44 Gr24 nonsealed leadacid

E2362 NU KU 88.00 Gr24 nonsealed leadacid

E2362 RR 7.74 Gr24 nonsealed leadacid

E2362 RR KU 8.80 Gr24 nonsealed leadacid

E2362 UE 58.08 Gr24 nonsealed leadacid

E2362 UE KU 65.99 Gr24 nonsealed leadacid







E2364 NU 81.67 U1nonsealed leadacid battery

E2364 NU KU 107.48 U1nonsealed leadacid battery

E2364 RR 8.17 U1nonsealed leadacid battery

E2364 RR KU 10.80 U1nonsealed leadacid battery

E2364 UE 61.25 U1nonsealed leadacid battery

E2364 UE KU 80.60 U1nonsealed leadacid battery

E2365 NU 63.35 U1 sealed leadacid battery

E2365 NU KU 92.49 U1 sealed leadacid battery

E2365 RR 6.33 U1 sealed leadacid battery

E2365 RR KU 9.24 U1 sealed leadacid battery

E2365 UE 47.52 U1 sealed leadacid battery

E2365 UE KU 69.39 U1 sealed leadacid battery

E2366 NU 135.25 Battery charger, single mode

E2366 NU KU 217.37 Battery charger, single mode

E2366 RR 13.52 Battery charger, single mode

E2366 RR KU 21.80 Battery charger, single mode

E2366 UE 101.44 Battery charger, single mode

E2366 UE KU 163.04 Battery charger, single mode

E2367 NU 261.56 Battery charger, dual mode

E2367 NU KU 345.55 Battery charger, dual mode

E2367 RR 26.15 Battery charger, dual mode

E2367 RR KU 34.55 Battery charger, dual mode

E2367 UE 196.18 Battery charger, dual mode

E2367 UE KU 259.17 Battery charger, dual mode

E2368 RR 33.19 Pwr wc drivewheel motor repl

E2368 RR KU 42.59 Pwr wc drivewheel motor repl

E2369 RR 31.01 Pwr wc drivewheel gear repl

E2369 RR KU 37.12 Pwr wc drivewheel gear repl

E2370 RR 44.00 Pwr wc dr wh motor/gear comb

E2370 RR KU 66.21 Pwr wc dr wh motor/gear comb







E2372 NU 0.00 Gr27 non-sealed leadacid

E2372 RR 0.00 Gr27 non-sealed leadacid

E2372 UE 0.00 Gr27 non-sealed leadacid

E2373 RR 63.77 Hand/chin ctrl spec joystick

E2373 RR KC 98.40 Hand/chin ctrl spec joystick

E2373 RR KU 103.76 Hand/chin ctrl spec joystick

E2374 RR 40.33 Hand/chin ctrl std joystick

E2374 RR KU 44.05 Hand/chin ctrl std joystick

E2375 RR 55.79 Non-expandable controller

E2375 RR KU 70.61 Non-expandable controller

E2376 RR 100.21 Expandable controller, repl

E2376 RR KU 110.69 Expandable controller, repl

E2377 RR 37.12 Expandable controller, initl

E2377 RR KU 40.04 Expandable controller, initl

E2378 RR 46.56 Pw actuator replacement

E2378 RR KU 48.96 Pw actuator replacement

E2381 NU 48.82 Pneum drive wheel tire

E2381 NU KU 62.81 Pneum drive wheel tire

E2381 RR 4.88 Pneum drive wheel tire

E2381 RR KU 6.30 Pneum drive wheel tire

E2381 UE 36.62 Pneum drive wheel tire

E2381 UE KU 47.11 Pneum drive wheel tire

E2382 NU 14.71 Tube, pneum wheel drive tire

E2382 NU KU 17.12 Tube, pneum wheel drive tire

E2382 RR 1.47 Tube, pneum wheel drive tire

E2382 RR KU 1.70 Tube, pneum wheel drive tire

E2382 UE 11.03 Tube, pneum wheel drive tire

E2382 UE KU 12.84 Tube, pneum wheel drive tire

E2383 NU 99.61 Insert, pneum wheel drive

E2383 NU KU 125.23 Insert, pneum wheel drive

E2383 RR 9.96 Insert, pneum wheel drive

E2383 RR KU 12.52 Insert, pneum wheel drive

E2383 UE 74.71 Insert, pneum wheel drive

E2383 UE KU 93.92 Insert, pneum wheel drive

E2384 NU 50.41 Pneumatic caster tire

E2384 NU KU 66.72 Pneumatic caster tire

E2384 RR 5.04 Pneumatic caster tire

E2384 RR KU 6.69 Pneumatic caster tire

E2384 UE 37.81 Pneumatic caster tire

E2384 UE KU 50.05 Pneumatic caster tire

E2385 NU 35.28 Tube, pneumatic caster tire

E2385 NU KU 40.82 Tube, pneumatic caster tire

E2385 RR 3.53 Tube, pneumatic caster tire

E2385 RR KU 4.10 Tube, pneumatic caster tire

E2385 UE 26.46 Tube, pneumatic caster tire

E2385 UE KU 30.60 Tube, pneumatic caster tire

E2386 NU 87.70 Foam filled drive wheel tire

E2386 NU KU 124.09 Foam filled drive wheel tire

E2386 RR 8.77 Foam filled drive wheel tire

E2386 RR KU 12.41 Foam filled drive wheel tire

E2386 UE 65.78 Foam filled drive wheel tire

E2386 UE KU 93.08 Foam filled drive wheel tire

E2387 NU 40.94 Foam filled caster tire

E2387 NU KU 53.54 Foam filled caster tire

E2387 RR 4.10 Foam filled caster tire

E2387 RR KU 5.36 Foam filled caster tire

E2387 UE 30.70 Foam filled caster tire

E2387 UE KU 40.15 Foam filled caster tire

E2388 NU 38.39 Foam drive wheel tire

E2388 NU KU 41.54 Foam drive wheel tire

E2388 RR 3.84 Foam drive wheel tire

E2388 RR KU 4.16 Foam drive wheel tire

E2388 UE 28.80 Foam drive wheel tire

E2388 UE KU 31.17 Foam drive wheel tire

E2389 NU 21.46 Foam caster tire

E2389 NU KU 22.57 Foam caster tire

E2389 RR 2.14 Foam caster tire

E2389 RR KU 2.27 Foam caster tire

E2389 UE 16.10 Foam caster tire

E2389 UE KU 16.91 Foam caster tire

E2390 NU 33.23 Solid drive wheel tire

E2390 NU KU 35.28 Solid drive wheel tire

E2390 RR 3.32 Solid drive wheel tire

E2390 RR KU 3.53 Solid drive wheel tire

E2390 UE 24.92 Solid drive wheel tire

E2390 UE KU 26.44 Solid drive wheel tire

E2391 NU 14.08 Solid caster tire

E2391 NU KU 16.90 Solid caster tire

E2391 RR 1.41 Solid caster tire

E2391 RR KU 1.69 Solid caster tire

E2391 UE 10.57 Solid caster tire

E2391 UE KU 12.67 Solid caster tire

E2392 NU 34.00 Solid caster tire, integrate

E2392 NU KU 44.42 Solid caster tire, integrate

E2392 RR 3.40 Solid caster tire, integrate

E2392 RR KU 4.47 Solid caster tire, integrate

E2392 UE 25.50 Solid caster tire, integrate

E2392 UE KU 33.33 Solid caster tire, integrate

E2394 NU 47.16 Drive wheel excludes tire

E2394 NU KU 63.30 Drive wheel excludes tire

E2394 RR 4.72 Drive wheel excludes tire

E2394 RR KU 6.34 Drive wheel excludes tire

E2394 UE 35.37 Drive wheel excludes tire

E2394 UE KU 47.47 Drive wheel excludes tire

E2395 NU 35.48 Caster wheel excludes tire

E2395 NU KU 44.97 Caster wheel excludes tire

E2395 RR 3.55 Caster wheel excludes tire

E2395 RR KU 4.51 Caster wheel excludes tire

E2395 UE 26.61 Caster wheel excludes tire

E2395 UE KU 33.74 Caster wheel excludes tire

E2396 NU 42.67 Caster fork

E2396 NU KU 50.91 Caster fork

E2396 RR 4.27 Caster fork

E2396 RR KU 5.11 Caster fork

E2396 UE 32.01 Caster fork

E2396 UE KU 38.21 Caster fork

E2397 NU 350.90 Pwc acc, lith-based battery

E2397 NU KU 396.19 Pwc acc, lith-based battery

E2397 RR 35.09 Pwc acc, lith-based battery

E2397 RR KU 39.63 Pwc acc, lith-based battery

E2397 UE 263.18 Pwc acc, lith-based battery

E2397 UE KU 297.11 Pwc acc, lith-based battery

E2402 RR 585.41 Neg press wound therapy pump

E2500 NU 374.10 Sgd digitized pre-rec <=8min

E2500 RR 37.42 Sgd digitized pre-rec <=8min

E2500 UE 280.58 Sgd digitized pre-rec <=8min

E2502 NU 1143.97 Sgd prerec msg >8min <=20min

E2502 RR 114.40 Sgd prerec msg >8min <=20min

E2502 UE 858.00 Sgd prerec msg >8min <=20min

E2504 NU 1509.06 Sgd prerec msg>20min <=40min

E2504 RR 150.93 Sgd prerec msg>20min <=40min

E2504 UE 1131.80 Sgd prerec msg>20min <=40min

E2506 NU 2212.74 Sgd prerec msg > 40 min

E2506 RR 221.26 Sgd prerec msg > 40 min

E2506 UE 1659.51 Sgd prerec msg > 40 min

E2508 NU 3421.62 Sgd spelling phys contact

E2508 RR 342.16 Sgd spelling phys contact

E2508 UE 2566.23 Sgd spelling phys contact

E2510 NU 6474.97 Sgd w multi methods msg/accs

E2510 RR 647.50 Sgd w multi methods msg/accs

E2510 UE 4856.22 Sgd w multi methods msg/accs

E2511 NU 0.00 Sgd sftwre prgrm for pc/pda

E2511 RR 0.00 Sgd sftwre prgrm for pc/pda

E2511 UE 0.00 Sgd sftwre prgrm for pc/pda

E2512 NU 0.00 Sgd accessory, mounting sys

E2512 RR 0.00 Sgd accessory, mounting sys

E2512 UE 0.00 Sgd accessory, mounting sys

E2601 NU 32.68 Gen w/c cushion wdth < 22 in

E2601 NU KU 50.43 Gen w/c cushion wdth < 22 in

E2601 RR 3.27 Gen w/c cushion wdth < 22 in

E2601 RR KU 5.06 Gen w/c cushion wdth < 22 in

E2601 UE 24.51 Gen w/c cushion wdth < 22 in

E2601 UE KU 37.83 Gen w/c cushion wdth < 22 in

E2602 NU 70.21 Gen w/c cushion wdth >=22 in

E2602 NU KU 98.45 Gen w/c cushion wdth >=22 in

E2602 RR 7.02 Gen w/c cushion wdth >=22 in

E2602 RR KU 9.85 Gen w/c cushion wdth >=22 in

E2602 UE 52.66 Gen w/c cushion wdth >=22 in

E2602 UE KU 73.85 Gen w/c cushion wdth >=22 in

E2603 NU 87.46 Skin protect wc cus wd <22in

E2603 NU KU 124.98 Skin protect wc cus wd <22in

E2603 RR 8.75 Skin protect wc cus wd <22in

E2603 RR KU 12.50 Skin protect wc cus wd <22in

E2603 UE 65.59 Skin protect wc cus wd <22in

E2603 UE KU 93.75 Skin protect wc cus wd <22in

E2604 NU 119.71 Skin protect wc cus wd>=22in

E2604 NU KU 155.36 Skin protect wc cus wd>=22in

E2604 RR 11.97 Skin protect wc cus wd>=22in

E2604 RR KU 15.54 Skin protect wc cus wd>=22in

E2604 UE 89.79 Skin protect wc cus wd>=22in

E2604 UE KU 116.54 Skin protect wc cus wd>=22in

E2605 NU 170.48 Position wc cush wdth <22 in

E2605 NU KU 221.95 Position wc cush wdth <22 in

E2605 RR 17.05 Position wc cush wdth <22 in

E2605 RR KU 22.20 Position wc cush wdth <22 in

E2605 UE 127.87 Position wc cush wdth <22 in

E2605 UE KU 166.49 Position wc cush wdth <22 in

E2606 NU 274.01 Position wc cush wdth>=22 in

E2606 NU KU 346.26 Position wc cush wdth>=22 in

E2606 RR 27.40 Position wc cush wdth>=22 in

E2606 RR KU 34.63 Position wc cush wdth>=22 in

E2606 UE 205.50 Position wc cush wdth>=22 in

E2606 UE KU 259.67 Position wc cush wdth>=22 in

E2607 NU 171.61 Skin pro/pos wc cus wd <22in

E2607 NU KU 238.99 Skin pro/pos wc cus wd <22in

E2607 RR 17.16 Skin pro/pos wc cus wd <22in

E2607 RR KU 23.90 Skin pro/pos wc cus wd <22in

E2607 UE 128.71 Skin pro/pos wc cus wd <22in

E2607 UE KU 179.25 Skin pro/pos wc cus wd <22in

E2608 NU 212.37 Skin pro/pos wc cus wd>=22in

E2608 NU KU 287.01 Skin pro/pos wc cus wd>=22in

E2608 RR 21.23 Skin pro/pos wc cus wd>=22in

E2608 RR KU 28.70 Skin pro/pos wc cus wd>=22in

E2608 UE 159.28 Skin pro/pos wc cus wd>=22in

E2608 UE KU 215.26 Skin pro/pos wc cus wd>=22in

E2611 NU 135.16 Gen use back cush wdth <22in

E2611 NU KU 257.55 Gen use back cush wdth <22in

E2611 RR 13.52 Gen use back cush wdth <22in

E2611 RR KU 25.75 Gen use back cush wdth <22in

E2611 UE 101.37 Gen use back cush wdth <22in

E2611 UE KU 193.18 Gen use back cush wdth <22in

E2612 NU 257.89 Gen use back cush wdth>=22in

E2612 NU KU 348.41 Gen use back cush wdth>=22in

E2612 RR 25.79 Gen use back cush wdth>=22in

E2612 RR KU 34.84 Gen use back cush wdth>=22in

E2612 UE 193.42 Gen use back cush wdth>=22in

E2612 UE KU 261.30 Gen use back cush wdth>=22in

E2613 NU 254.07 Position back cush wd <22in

E2613 NU KU 324.09 Position back cush wd <22in

E2613 RR 25.41 Position back cush wd <22in

E2613 RR KU 32.41 Position back cush wd <22in

E2613 UE 190.55 Position back cush wd <22in

E2613 UE KU 243.07 Position back cush wd <22in

E2614 NU 365.25 Position back cush wd>=22in

E2614 NU KU 448.51 Position back cush wd>=22in

E2614 RR 36.52 Position back cush wd>=22in

E2614 RR KU 44.85 Position back cush wd>=22in

E2614 UE 273.95 Position back cush wd>=22in

E2614 UE KU 336.40 Position back cush wd>=22in

E2615 NU 287.33 Pos back post/lat wdth <22in

E2615 NU KU 372.95 Pos back post/lat wdth <22in

E2615 RR 28.74 Pos back post/lat wdth <22in

E2615 RR KU 37.31 Pos back post/lat wdth <22in

E2615 UE 215.50 Pos back post/lat wdth <22in

E2615 UE KU 279.71 Pos back post/lat wdth <22in

E2616 NU 386.14 Pos back post/lat wdth>=22in

E2616 NU KU 501.81 Pos back post/lat wdth>=22in

E2616 RR 38.62 Pos back post/lat wdth>=22in

E2616 RR KU 50.18 Pos back post/lat wdth>=22in

E2616 UE 289.60 Pos back post/lat wdth>=22in

E2616 UE KU 376.36 Pos back post/lat wdth>=22in

E2619 NU 39.53 Replace cover w/c seat cush

E2619 NU KU 42.30 Replace cover w/c seat cush

E2619 RR 3.95 Replace cover w/c seat cush

E2619 RR KU 4.22 Replace cover w/c seat cush

E2619 UE 29.65 Replace cover w/c seat cush

E2619 UE KU 31.76 Replace cover w/c seat cush

E2620 NU 317.29 Wc planar back cush wd <22in

E2620 NU KU 451.60 Wc planar back cush wd <22in

E2620 RR 31.73 Wc planar back cush wd <22in

E2620 RR KU 45.17 Wc planar back cush wd <22in

E2620 UE 237.97 Wc planar back cush wd <22in

E2620 UE KU 338.72 Wc planar back cush wd <22in

E2621 NU 370.63 Wc planar back cush wd>=22in

E2621 NU KU 473.93 Wc planar back cush wd>=22in

E2621 RR 37.07 Wc planar back cush wd>=22in

E2621 RR KU 47.40 Wc planar back cush wd>=22in

E2621 UE 277.98 Wc planar back cush wd>=22in

E2621 UE KU 355.44 Wc planar back cush wd>=22in

E2622 NU 250.77 Adj skin pro w/c cus wd<22in

E2622 NU KU 273.31 Adj skin pro w/c cus wd<22in

E2622 RR 25.08 Adj skin pro w/c cus wd<22in

E2622 RR KU 27.34 Adj skin pro w/c cus wd<22in

E2622 UE 188.08 Adj skin pro w/c cus wd<22in

E2622 UE KU 204.98 Adj skin pro w/c cus wd<22in

E2623 NU 317.11 Adj skin pro wc cus wd>=22in

E2623 NU KU 347.78 Adj skin pro wc cus wd>=22in

E2623 RR 31.71 Adj skin pro wc cus wd>=22in

E2623 RR KU 34.79 Adj skin pro wc cus wd>=22in

E2623 UE 237.84 Adj skin pro wc cus wd>=22in

E2623 UE KU 260.82 Adj skin pro wc cus wd>=22in

E2624 NU 254.82 Adj skin pro/pos cus<22in

E2624 NU KU 275.56 Adj skin pro/pos cus<22in

E2624 RR 25.48 Adj skin pro/pos cus<22in

E2624 RR KU 27.56 Adj skin pro/pos cus<22in

E2624 UE 191.11 Adj skin pro/pos cus<22in

E2624 UE KU 206.69 Adj skin pro/pos cus<22in

E2625 NU 315.37 Adj skin pro/pos wc cus>=22

E2625 NU KU 348.84 Adj skin pro/pos wc cus>=22

E2625 RR 31.54 Adj skin pro/pos wc cus>=22

E2625 RR KU 34.88 Adj skin pro/pos wc cus>=22

E2625 UE 236.53 Adj skin pro/pos wc cus>=22

E2625 UE KU 261.63 Adj skin pro/pos wc cus>=22

E2626 NU 510.22 Seo mobile arm sup att to wc

E2626 NU KU 585.96 Seo mobile arm sup att to wc

E2626 RR 51.03 Seo mobile arm sup att to wc

E2626 RR KU 58.60 Seo mobile arm sup att to wc

E2626 UE 382.66 Seo mobile arm sup att to wc

E2626 UE KU 439.45 Seo mobile arm sup att to wc

E2627 NU 789.45 Arm supp att to wc rancho ty

E2627 NU KU 805.95 Arm supp att to wc rancho ty

E2627 RR 78.95 Arm supp att to wc rancho ty

E2627 RR KU 80.61 Arm supp att to wc rancho ty

E2627 UE 592.09 Arm supp att to wc rancho ty

E2627 UE KU 604.45 Arm supp att to wc rancho ty

E2628 NU 607.16 Mobile arm supports reclinin

E2628 NU KU 607.16 Mobile arm supports reclinin

E2628 RR 60.72 Mobile arm supports reclinin

E2628 RR KU 60.72 Mobile arm supports reclinin

E2628 UE 455.36 Mobile arm supports reclinin

E2628 UE KU 455.35 Mobile arm supports reclinin

E2629 NU 778.61 Friction dampening arm supp

E2629 NU KU 903.92 Friction dampening arm supp

E2629 RR 77.86 Friction dampening arm supp

E2629 RR KU 90.38 Friction dampening arm supp

E2629 UE 583.96 Friction dampening arm supp

E2629 UE KU 677.93 Friction dampening arm supp

E2630 NU 524.90 Monosuspension arm/hand supp

E2630 NU KU 537.29 Monosuspension arm/hand supp

E2630 RR 52.49 Monosuspension arm/hand supp

E2630 RR KU 53.73 Monosuspension arm/hand supp

E2630 UE 393.68 Monosuspension arm/hand supp

E2630 UE KU 402.97 Monosuspension arm/hand supp

E2631 NU 214.92 Elevat proximal arm support

E2631 NU KU 214.94 Elevat proximal arm support

E2631 RR 21.50 Elevat proximal arm support

E2631 RR KU 21.49 Elevat proximal arm support

E2631 UE 161.19 Elevat proximal arm support

E2631 UE KU 161.19 Elevat proximal arm support

E2632 NU 136.66 Offset/lat rocker arm w/ela

E2632 NU KU 136.66 Offset/lat rocker arm w/ela

E2632 RR 13.66 Offset/lat rocker arm w/ela

E2632 RR KU 13.67 Offset/lat rocker arm w/ela

E2632 UE 102.50 Offset/lat rocker arm w/ela

E2632 UE KU 102.49 Offset/lat rocker arm w/ela

E2633 NU 111.55 Mobile arm support supinator

E2633 NU KU 115.91 Mobile arm support supinator

E2633 RR 11.15 Mobile arm support supinator

E2633 RR KU 11.59 Mobile arm support supinator

E2633 UE 83.67 Mobile arm support supinator

E2633 UE KU 86.95 Mobile arm support supinator

K0001 RR 20.62 Standard wheelchair

K0002 RR 35.93 Stnd hemi (low seat) whlchr

K0003 RR 31.20 Lightweight wheelchair

K0004 RR 38.46 High strength ltwt whlchr

K0005 NU 1768.66 Ultralightweight wheelchair

K0005 RR 176.84 Ultralightweight wheelchair

K0005 UE 1326.46 Ultralightweight wheelchair

K0006 RR 56.87 Heavy duty wheelchair

K0007 RR 80.17 Extra heavy duty wheelchair

K0009 RR 71.14 Other manual wheelchair/base

K0010 RR 365.09 Stnd wt frame power whlchr

K0011 RR 489.57 Stnd wt pwr whlchr w control

K0011 RR KF 543.54 Stnd wt pwr whlchr w control

K0012 RR 300.34 Ltwt portbl power whlchr

K0015 RR 11.65 Detach non-adj ht armrst rep

K0015 RR KU 14.92 Detach non-adj ht armrst rep

K0017 NU 38.05 Detach adjust armrest base

K0017 NU KU 42.13 Detach adjust armrest base

K0017 RR 3.81 Detach adjust armrest base

K0017 RR KU 4.21 Detach adjust armrest base

K0017 UE 28.54 Detach adjust armrest base

K0017 UE KU 31.60 Detach adjust armrest base

K0018 NU 21.51 Detach adjust armrst upper

K0018 NU KU 23.53 Detach adjust armrst upper

K0018 RR 2.15 Detach adjust armrst upper

K0018 RR KU 2.35 Detach adjust armrst upper

K0018 UE 16.14 Detach adjust armrst upper

K0018 UE KU 17.66 Detach adjust armrst upper

K0019 NU 10.46 Arm pad repl, each

K0019 NU KU 13.48 Arm pad repl, each

K0019 RR 1.05 Arm pad repl, each

K0019 RR KU 1.35 Arm pad repl, each

K0019 UE 7.85 Arm pad repl, each

K0019 UE KU 10.10 Arm pad repl, each

K0020 NU 37.29 Fixed adjust armrest pair

K0020 NU KU 38.31 Fixed adjust armrest pair

K0020 RR 3.73 Fixed adjust armrest pair

K0020 RR KU 3.83 Fixed adjust armrest pair

K0020 UE 27.97 Fixed adjust armrest pair

K0020 UE KU 28.73 Fixed adjust armrest pair

K0037 NU 33.75 Hi mount flip-up ftrest repl

K0037 NU KU 33.75 Hi mount flip-up ftrest repl

K0037 RR 3.09 Hi mount flip-up ftrest repl

K0037 RR KU 3.10 Hi mount flip-up ftrest repl

K0037 UE 25.32 Hi mount flip-up ftrest repl

K0037 UE KU 25.32 Hi mount flip-up ftrest repl

K0038 NU 19.02 Leg strap each

K0038 NU KU 20.02 Leg strap each

K0038 RR 1.90 Leg strap each

K0038 RR KU 2.01 Leg strap each

K0038 UE 14.26 Leg strap each

K0038 UE KU 14.99 Leg strap each

K0039 NU 40.84 Leg strap h style each

K0039 NU KU 44.42 Leg strap h style each

K0039 RR 4.09 Leg strap h style each

K0039 RR KU 4.47 Leg strap h style each

K0039 UE 30.63 Leg strap h style each

K0039 UE KU 33.33 Leg strap h style each

K0040 NU 43.45 Adjustable angle footplate

K0040 NU KU 61.57 Adjustable angle footplate

K0040 RR 4.34 Adjustable angle footplate

K0040 RR KU 6.15 Adjustable angle footplate

K0040 UE 32.59 Adjustable angle footplate

K0040 UE KU 46.16 Adjustable angle footplate

K0041 NU 39.03 Large size footplate each

K0041 NU KU 43.63 Large size footplate each

K0041 RR 3.90 Large size footplate each

K0041 RR KU 4.40 Large size footplate each

K0041 UE 29.27 Large size footplate each

K0041 UE KU 32.72 Large size footplate each

K0042 NU 25.07 Standard size ftplate rep ea

K0042 NU KU 30.04 Standard size ftplate rep ea

K0042 RR 2.51 Standard size ftplate rep ea

K0042 RR KU 3.00 Standard size ftplate rep ea

K0042 UE 18.80 Standard size ftplate rep ea

K0042 UE KU 22.53 Standard size ftplate rep ea

K0043 NU 15.47 Ftrst lowr exten tube rep ea

K0043 NU KU 16.10 Ftrst lowr exten tube rep ea

K0043 RR 1.55 Ftrst lowr exten tube rep ea

K0043 RR KU 1.60 Ftrst lowr exten tube rep ea

K0043 UE 11.60 Ftrst lowr exten tube rep ea

K0043 UE KU 12.08 Ftrst lowr exten tube rep ea

K0044 NU 13.46 Ftrst upr hanger brac rep ea

K0044 NU KU 13.73 Ftrst upr hanger brac rep ea

K0044 RR 1.35 Ftrst upr hanger brac rep ea

K0044 RR KU 1.38 Ftrst upr hanger brac rep ea

K0044 UE 10.10 Ftrst upr hanger brac rep ea

K0044 UE KU 10.29 Ftrst upr hanger brac rep ea

K0045 NU 44.29 Ftrst compl assembly repl ea

K0045 NU KU 46.69 Ftrst compl assembly repl ea

K0045 RR 4.43 Ftrst compl assembly repl ea

K0045 RR KU 4.67 Ftrst compl assembly repl ea

K0045 UE 33.22 Ftrst compl assembly repl ea

K0045 UE KU 35.02 Ftrst compl assembly repl ea

K0046 NU 15.58 Elev lgrst lwr exten repl ea

K0046 NU KU 16.10 Elev lgrst lwr exten repl ea

K0046 RR 1.56 Elev lgrst lwr exten repl ea

K0046 RR KU 1.60 Elev lgrst lwr exten repl ea

K0046 UE 11.69 Elev lgrst lwr exten repl ea

K0046 UE KU 12.10 Elev lgrst lwr exten repl ea

K0047 NU 55.05 Elev legrst upr hangr rep ea

K0047 NU KU 63.06 Elev legrst upr hangr rep ea

K0047 RR 5.51 Elev legrst upr hangr rep ea

K0047 RR KU 6.32 Elev legrst upr hangr rep ea

K0047 UE 41.28 Elev legrst upr hangr rep ea

K0047 UE KU 47.28 Elev legrst upr hangr rep ea

K0050 NU 25.53 Ratchet assembly replacement

K0050 RR 2.55 Ratchet assembly replacement

K0050 UE 19.16 Ratchet assembly replacement

K0051 NU 40.40 Cam rel asm ft/legrst rep ea

K0051 NU KU 43.38 Cam rel asm ft/legrst rep ea

K0051 RR 4.04 Cam rel asm ft/legrst rep ea

K0051 RR KU 4.37 Cam rel asm ft/legrst rep ea

K0051 UE 30.30 Cam rel asm ft/legrst rep ea

K0051 UE KU 32.52 Cam rel asm ft/legrst rep ea

K0052 NU 58.53 Swingaway detach ftrest repl

K0052 NU KU 76.24 Swingaway detach ftrest repl

K0052 RR 5.86 Swingaway detach ftrest repl

K0052 RR KU 7.62 Swingaway detach ftrest repl

K0052 UE 43.90 Swingaway detach ftrest repl

K0052 UE KU 57.15 Swingaway detach ftrest repl

K0053 NU 67.94 Elevate footrest articulate

K0053 NU KU 84.12 Elevate footrest articulate

K0053 RR 6.79 Elevate footrest articulate

K0053 RR KU 8.41 Elevate footrest articulate

K0053 UE 50.96 Elevate footrest articulate

K0053 UE KU 63.09 Elevate footrest articulate

K0056 NU 77.68 Seat ht <17 or >=21 ltwt wc

K0056 NU KU 90.98 Seat ht <17 or >=21 ltwt wc

K0056 RR 7.77 Seat ht <17 or >=21 ltwt wc

K0056 RR KU 9.10 Seat ht <17 or >=21 ltwt wc

K0056 UE 58.26 Seat ht <17 or >=21 ltwt wc

K0056 UE KU 68.25 Seat ht <17 or >=21 ltwt wc

K0065 NU 36.98 Spoke protectors

K0065 NU KU 42.52 Spoke protectors

K0065 RR 3.70 Spoke protectors

K0065 RR KU 4.25 Spoke protectors

K0065 UE 27.74 Spoke protectors

K0065 UE KU 31.90 Spoke protectors

K0069 NU 76.81 Rr whl compl sol tire rep ea

K0069 NU KU 95.60 Rr whl compl sol tire rep ea

K0069 RR 7.68 Rr whl compl sol tire rep ea

K0069 RR KU 9.95 Rr whl compl sol tire rep ea

K0069 UE 57.61 Rr whl compl sol tire rep ea

K0069 UE KU 71.70 Rr whl compl sol tire rep ea

K0070 RR 13.52 Rr whl compl pne tire rep ea

K0070 RR KU 17.54 Rr whl compl pne tire rep ea

K0071 NU 87.31 Fr cstr comp pne tire rep ea

K0071 NU KU 104.52 Fr cstr comp pne tire rep ea

K0071 RR 8.73 Fr cstr comp pne tire rep ea

K0071 RR KU 10.46 Fr cstr comp pne tire rep ea

K0071 UE 65.49 Fr cstr comp pne tire rep ea

K0071 UE KU 78.36 Fr cstr comp pne tire rep ea

K0072 NU 54.73 Fr cstr semi-pne tire rep ea

K0072 NU KU 62.93 Fr cstr semi-pne tire rep ea

K0072 RR 5.47 Fr cstr semi-pne tire rep ea

K0072 RR KU 6.29 Fr cstr semi-pne tire rep ea

K0072 UE 41.06 Fr cstr semi-pne tire rep ea

K0072 UE KU 47.18 Fr cstr semi-pne tire rep ea

K0073 NU 28.50 Caster pin lock each

K0073 NU KU 32.01 Caster pin lock each

K0073 RR 2.85 Caster pin lock each

K0073 RR KU 3.24 Caster pin lock each

K0073 UE 21.38 Caster pin lock each

K0073 UE KU 24.00 Caster pin lock each

K0077 NU 44.52 Fr cstr asmb sol tire rep ea

K0077 NU KU 56.31 Fr cstr asmb sol tire rep ea

K0077 RR 4.45 Fr cstr asmb sol tire rep ea

K0077 RR KU 5.62 Fr cstr asmb sol tire rep ea

K0077 UE 33.40 Fr cstr asmb sol tire rep ea

K0077 UE KU 42.21 Fr cstr asmb sol tire rep ea

K0098 NU 19.25 Drive belt for pwc, repl

K0098 NU KU 21.79 Drive belt for pwc, repl

K0098 RR 1.93 Drive belt for pwc, repl

K0098 RR KU 2.19 Drive belt for pwc, repl

K0098 UE 14.44 Drive belt for pwc, repl

K0098 UE KU 16.33 Drive belt for pwc, repl

K0105 NU 80.38 Iv hanger

K0105 NU KU 95.12 Iv hanger

K0105 RR 8.04 Iv hanger

K0105 RR KU 9.51 Iv hanger

K0105 UE 60.29 Iv hanger

K0105 UE KU 71.34 Iv hanger

K0195 RR 9.03 Elevating whlchair leg rests

K0455 RR 238.27 Pump uninterrupted infusion

K0552 2.24 Sup/ext non-ins inf pump syr

K0553 213.44 Ther cgm supply allowance

K0554 NU 224.54 Ther cgm receiver/monitor

K0554 RR 22.46 Ther cgm receiver/monitor

K0554 UE 168.41 Ther cgm receiver/monitor

K0601 NU 1.02 Repl batt silver oxide 1.5 v

K0602 NU 5.75 Repl batt silver oxide 3 v

K0603 NU 0.52 Repl batt alkaline 1.5 v

K0604 NU 5.54 Repl batt lithium 3.6 v

K0605 NU 13.24 Repl batt lithium 4.5 v

K0606 RR KF 2409.16 Aed garment w elec analysis

K0607 RR 18.59 Repl batt for aed

K0607 RR KF 20.63 Repl batt for aed

K0608 NU 115.95 Repl garment for aed

K0608 NU KF 128.76 Repl garment for aed

K0608 RR 11.62 Repl garment for aed

K0608 RR KF 12.89 Repl garment for aed

K0608 UE 86.96 Repl garment for aed

K0608 UE KF 96.56 Repl garment for aed

K0609 771.15 Repl electrode for aed

K0609 KF 856.19 Repl electrode for aed

K0672 68.26 Removable soft interface le

K0730 RR 164.93 Ctrl dose inh drug deliv sys

K0733 NU 22.75 12-24hr sealed lead acid

K0733 NU KU 24.91 12-24hr sealed lead acid

K0733 RR 2.28 12-24hr sealed lead acid

K0733 RR KU 2.51 12-24hr sealed lead acid

K0733 UE 17.07 12-24hr sealed lead acid

K0733 UE KU 18.69 12-24hr sealed lead acid

K0738 RR 31.82 Portable gas oxygen system

K0738 RR QF 31.82 Stationary compressed gas 02

K0800 NU 702.43 Pov group 1 std up to 300lbs

K0800 RR 70.24 Pov group 1 std up to 300lbs

K0800 UE 526.83 Pov group 1 std up to 300lbs

K0801 NU 1262.49 Pov group 1 hd 301-450 lbs

K0801 RR 126.25 Pov group 1 hd 301-450 lbs

K0801 UE 946.87 Pov group 1 hd 301-450 lbs

K0802 NU 1670.34 Pov group 1 vhd 451-600 lbs

K0802 RR 167.03 Pov group 1 vhd 451-600 lbs

K0802 UE 1252.76 Pov group 1 vhd 451-600 lbs

K0806 NU 1128.11 Pov group 2 std up to 300lbs

K0806 RR 112.81 Pov group 2 std up to 300lbs

K0806 UE 846.08 Pov group 2 std up to 300lbs

K0807 NU 1748.29 Pov group 2 hd 301-450 lbs

K0807 RR 174.83 Pov group 2 hd 301-450 lbs

K0807 UE 1311.22 Pov group 2 hd 301-450 lbs

K0808 NU 2702.56 Pov group 2 vhd 451-600 lbs

K0808 RR 270.26 Pov group 2 vhd 451-600 lbs

K0808 UE 2026.93 Pov group 2 vhd 451-600 lbs

K0813 RR 213.51 Pwc gp 1 std port seat/back

K0814 RR 223.76 Pwc gp 1 std port cap chair

K0815 RR 248.63 Pwc gp 1 std seat/back

K0816 RR 232.19 Pwc gp 1 std cap chair

K0820 RR 218.37 Pwc gp 2 std port seat/back

K0821 RR 232.42 Pwc gp 2 std port cap chair



K0824 RR 362.58 Pwc gp 2 hd seat/back

K0825 RR 328.31 Pwc gp 2 hd cap chair

K0826 RR 605.97 Pwc gp 2 vhd seat/back

K0827 RR 533.47 Pwc gp vhd cap chair

K0828 RR 706.40 Pwc gp 2 xtra hd seat/back

K0829 RR 708.55 Pwc gp 2 xtra hd cap chair

K0835 RR 289.86 Pwc gp2 std sing pow opt s/b

K0836 RR 300.65 Pwc gp2 std sing pow opt cap

K0837 RR 371.77 Pwc gp 2 hd sing pow opt s/b

K0838 RR 329.52 Pwc gp 2 hd sing pow opt cap

K0839 RR 493.84 Pwc gp2 vhd sing pow opt s/b

K0840 RR 758.22 Pwc gp2 xhd sing pow opt s/b

K0841 RR 326.65 Pwc gp2 std mult pow opt s/b

K0842 RR 326.17 Pwc gp2 std mult pow opt cap

K0843 RR 387.21 Pwc gp2 hd mult pow opt s/b



K0850 RR 758.14 Pwc gp 3 hd seat/back

K0851 RR 728.96 Pwc gp 3 hd cap chair

K0852 RR 875.98 Pwc gp 3 vhd seat/back

K0853 RR 899.86 Pwc gp 3 vhd cap chair

K0854 RR 1192.12 Pwc gp 3 xhd seat/back

K0855 RR 1126.13 Pwc gp 3 xhd cap chair

K0856 RR 701.56 Pwc gp3 std sing pow opt s/b

K0857 RR 715.62 Pwc gp3 std sing pow opt cap

K0858 RR 870.43 Pwc gp3 hd sing pow opt s/b

K0859 RR 830.13 Pwc gp3 hd sing pow opt cap

K0860 RR 1243.52 Pwc gp3 vhd sing pow opt s/b

K0861 RR 702.68 Pwc gp3 std mult pow opt s/b

K0862 RR 870.43 Pwc gp3 hd mult pow opt s/b

K0863 RR 1243.52 Pwc gp3 vhd mult pow opt s/b

K0864 RR 1479.80 Pwc gp3 xhd mult pow opt s/b

L0112 1126.98 Cranial cervical orthosis

L0113 229.62 Cranial cervical torticollis

L0120 21.57 Cerv flex n/adj foam pre ots

L0130 152.46 Flex thermoplastic collar mo

L0140 50.42 Cervical semi-rigid adjustab

L0150 92.50 Cerv semi-rig adj molded chn

L0160 120.81 Cerv sr wire occ/man pre ots

L0170 497.48 Cervical collar molded to pt

L0172 107.87 Cerv col sr foam 2pc pre ots

L0174 211.91 Cerv sr 2pc thor ext pre ots

L0180 293.85 Cer post col occ/man sup adj

L0190 382.11 Cerv collar supp adj cerv ba

L0200 398.34 Cerv col supp adj bar & thor

L0220 108.79 Thor rib belt custom fabrica

L0450 136.59 Tlso flex trunk/thor pre ots

L0452 0.00 Tlso flex custom fab thoraci

L0454 279.26 Tlso trnk sj-t9 pre cst

L0455 279.26 Tlso flex trnk sj-t9 pre ots

L0456 800.84 Tlso flex trnk sj-ss pre cst

L0457 800.84 Tlso flex trnk sj-ss pre ots

L0458 718.11 Tlso 2mod symphis-xipho pre

L0460 808.27 Tlso 2 shl symphys-stern cst

L0462 1005.37 Tlso 3mod sacro-scap pre

L0464 1196.88 Tlso 4mod sacro-scap pre

L0466 290.90 Tlso r fram soft ant pre cst

L0467 290.90 Tlso r fram soft pre ots

L0468 385.40 Tlso rig fram pelvic pre cst

L0469 385.40 Tlso rig fram pelvic pre ots

L0470 491.79 Tlso rigid frame pre subclav

L0472 311.91 Tlso rigid frame hyperex pre

L0480 1098.40 Tlso rigid plastic custom fa

L0482 1275.84 Tlso rigid lined custom fab

L0484 1370.85 Tlso rigid plastic cust fab

L0486 1454.40 Tlso rigidlined cust fab two

L0488 808.27 Tlso rigid lined pre one pie

L0490 227.79 Tlso rigid plastic pre one

L0491 618.40 Tlso 2 piece rigid shell

L0492 406.70 Tlso 3 piece rigid shell

L0621 71.14 Sio flex pelvic/sacr pre ots

L0622 232.98 Sio flex pelvisacral custom

L0623 0.00 Sio rig pnl pelv/sac pre ots

L0624 0.00 Sio panel custom

L0625 44.34 Lo flex l1-below l5 pre ots

L0626 62.76 Lo sag rig pnl stays pre cst

L0627 330.99 Lo sag ri an/pos pnl pre cst

L0628 67.56 Lso flex no ri stays pre ots

L0629 0.00 Lso flex w/rigid stays cust

L0630 130.41 Lso r post pnl sj-t9 pre cst

L0631 826.60 Lso sag r an/pos pnl pre cst

L0632 0.00 Lso sag rigid frame cust

L0633 230.90 Lso sc r pos/lat pnl pre cst

L0634 0.00 Lso flexion control custom

L0635 738.36 Lso sagit rigid panel prefab

L0636 1093.05 Lso sagittal rigid panel cus

L0637 865.01 Lso sc r ant/pos pnl pre cst

L0638 1061.98 Lso sag-coronal panel custom

L0639 865.01 Lso s/c shell/panel prefab

L0640 842.58 Lso s/c shell/panel custom

L0641 62.76 Lo rig pos pnl l1-l5 pre ots

L0642 330.99 Lo sag ri an/pos pnl pre ots

L0643 130.41 Lso sag ctr rigi pos pre ots

L0648 826.60 Lso sag r an/pos pnl pre ots

L0649 230.90 Lso sc r pos/lat pnl pre ots

L0650 865.01 Lso sc r ant/pos pnl pre ots

L0651 865.01 Lso sag-co shell pnl pre ots

L0700 1576.94 Ctlso a-p-l control molded

L0710 1611.04 Ctlso a-p-l control w/ inter

L0810 2014.81 Halo cervical into jckt vest

L0820 1808.43 Halo cervical into body jack

L0830 2548.59 Halo cerv into milwaukee typ

L0859 1062.11 Mri compatible system

L0861 173.54 Halo repl liner/interface

L0970 103.73 Tlso corset front

L0972 93.16 Lso corset front

L0974 138.35 Tlso full corset

L0976 123.34 Lso full corset

L0978 162.81 Axillary crutch extension

L0980 17.77 Peroneal straps pair pre ots

L0982 12.56 Stocking sup grips 4 pre ots

L0984 52.15 Protect body sock ea pre ots

L1000 1582.14 Ctlso milwauke initial model

L1001 0.00 Ctlso infant immobilizer

L1005 2577.17 Tension based scoliosis orth

L1010 51.77 Ctlso axilla sling

L1020 66.67 Kyphosis pad

L1025 127.27 Kyphosis pad floating

L1030 49.07 Lumbar bolster pad

L1040 64.21 Lumbar or lumbar rib pad

L1050 77.42 Sternal pad

L1060 92.85 Thoracic pad

L1070 90.66 Trapezius sling

L1080 51.00 Outrigger

L1085 137.97 Outrigger bil w/ vert extens

L1090 91.27 Lumbar sling

L1100 145.76 Ring flange plastic/leather

L1110 197.01 Ring flange plas/leather mol

L1120 33.32 Covers for upright each

L1200 1208.62 Furnsh initial orthosis only

L1210 201.84 Lateral thoracic extension

L1220 192.81 Anterior thoracic extension

L1230 494.25 Milwaukee type superstructur

L1240 66.82 Lumbar derotation pad

L1250 66.82 Anterior asis pad

L1260 68.21 Anterior thoracic derotation

L1270 69.30 Abdominal pad

L1280 79.71 Rib gusset (elastic) each

L1290 63.10 Lateral trochanteric pad

L1300 1420.84 Body jacket mold to patient

L1310 1459.93 Post-operative body jacket

L1600 99.40 Ho flex frejka w/cov pre cst

L1610 43.86 Ho frejka cov only pre cst

L1620 124.24 Ho flex pavlik harns pre cst

L1630 130.71 Abduct control hip semi-flex

L1640 397.89 Pelv band/spread bar thigh c

L1650 201.35 Ho abduction hip adjustable

L1652 287.02 Ho bi thighcuffs w sprdr bar

L1660 132.01 Ho abduction static plastic

L1680 939.87 Pelvic & hip control thigh c

L1685 959.19 Post-op hip abduct custom fa

L1686 885.68 Ho post-op hip abduction

L1690 1557.06 Combination bilateral ho

L1700 1177.99 Leg perthes orth toronto typ

L1710 1378.96 Legg perthes orth newington

L1720 1016.46 Legg perthes orthosis trilat

L1730 873.04 Legg perthes orth scottish r

L1755 1385.47 Legg perthes patten bottom t

L1810 75.97 Ko elastic with joints

L1812 75.97 Ko elastic w/joints pre ots

L1820 117.70 Ko elas w/ condyle pads & jo

L1830 71.57 Ko immob canvas long pre ots

L1831 236.98 Knee orth pos locking joint

L1832 545.55 Ko adj jnt pos r sup pre cst

L1833 545.55 Ko adj jnt pos r sup pre ots

L1834 598.80 Ko w/0 joint rigid molded to

L1836 107.45 Ko rigid w/o joints pre ots

L1840 797.61 Ko derot ant cruciate custom

L1843 722.48 Ko single upright pre cst

L1844 1252.28 Ko w/adj jt rot cntrl molded

L1845 749.73 Ko double upright pre cst

L1846 919.24 Ko w adj flex/ext rotat mold

L1847 463.13 Ko dbl upright w/air pre cst

L1848 463.13 Ko dbl upright w/air pre ots

L1850 234.48 Ko swedish type pre ots

L1851 722.48 Ko single upright prefab ots

L1852 749.73 Ko double upright prefab ots

L1860 827.74 Ko supracondylar socket mold

L1900 208.10 Afo sprng wir drsflx calf bd

L1902 71.91 Afo ankle gauntlet pre ots

L1904 432.44 Afo molded ankle gauntlet

L1906 92.77 Afo multilig ank sup pre ots

L1907 453.08 Afo supramalleolar custom

L1910 210.68 Afo sing bar clasp attach sh

L1920 269.68 Afo sing upright w/ adjust s

L1930 182.48 Afo plastic

L1932 718.53 Afo rig ant tib prefab tcf/=

L1940 381.49 Afo molded to patient plasti

L1945 912.06 Afo molded plas rig ant tib

L1950 604.74 Afo spiral molded to pt plas

L1951 676.23 Afo spiral prefabricated

L1960 456.11 Afo pos solid ank plastic mo

L1970 548.89 Afo plastic molded w/ankle j

L1971 377.42 Afo w/ankle joint, prefab

L1980 283.10 Afo sing solid stirrup calf

L1990 343.84 Afo doub solid stirrup calf

L2000 814.63 Kafo sing fre stirr thi/calf

L2005 3299.50 Kafo sng/dbl mechanical act

L2010 759.93 Kafo sng solid stirrup w/o j

L2020 956.85 Kafo dbl solid stirrup band/

L2030 868.61 Kafo dbl solid stirrup w/o j

L2034 1640.61 Kafo pla sin up w/wo k/a cus

L2035 140.90 Kafo plastic pediatric size

L2036 1483.11 Kafo plas doub free knee mol

L2037 1383.66 Kafo plas sing free knee mol

L2038 1405.59 Kafo w/o joint multi-axis an

L2040 170.47 Hkafo torsion bil rot straps

L2050 367.46 Hkafo torsion cable hip pelv

L2060 447.87 Hkafo torsion ball bearing j

L2070 115.00 Hkafo torsion unilat rot str

L2080 277.45 Hkafo unilat torsion cable

L2090 338.24 Hkafo unilat torsion ball br

L2106 524.48 Afo tib fx cast plaster mold

L2108 913.21 Afo tib fx cast molded to pt

L2112 420.03 Afo tibial fracture soft

L2114 526.83 Afo tib fx semi-rigid

L2116 606.17 Afo tibial fracture rigid

L2126 1014.02 Kafo fem fx cast thermoplas

L2128 1435.91 Kafo fem fx cast molded to p

L2132 778.50 Kafo femoral fx cast soft

L2134 830.71 Kafo fem fx cast semi-rigid

L2136 991.52 Kafo femoral fx cast rigid

L2180 92.54 Plas shoe insert w ank joint

L2182 76.67 Drop lock knee

L2184 104.81 Limited motion knee joint

L2186 145.38 Adj motion knee jnt lerman t

L2188 278.39 Quadrilateral brim

L2190 71.94 Waist belt

L2192 315.87 Pelvic band & belt thigh fla

L2200 36.68 Limited ankle motion ea jnt

L2210 53.08 Dorsiflexion assist each joi

L2220 63.17 Dorsi & plantar flex ass/res

L2230 59.19 Split flat caliper stirr & p

L2232 80.14 Rocker bottom, contact afo

L2240 73.26 Round caliper and plate atta

L2250 297.01 Foot plate molded stirrup at

L2260 154.63 Reinforced solid stirrup

L2265 90.85 Long tongue stirrup

L2270 42.59 Varus/valgus strap padded/li

L2275 100.42 Plastic mod low ext pad/line

L2280 351.15 Molded inner boot

L2300 220.18 Abduction bar jointed adjust

L2310 110.26 Abduction bar-straight

L2320 158.71 Non-molded lacer

L2330 332.23 Lacer molded to patient mode

L2335 205.12 Anterior swing band

L2340 444.05 Pre-tibial shell molded to p

L2350 766.93 Prosthetic type socket molde

L2360 39.91 Extended steel shank

L2370 258.62 Patten bottom

L2375 109.23 Torsion ank & half solid sti

L2380 94.97 Torsion straight knee joint

L2385 103.32 Straight knee joint heavy du

L2387 148.86 Add le poly knee custom kafo

L2390 86.51 Offset knee joint each

L2395 120.69 Offset knee joint heavy duty

L2397 94.03 Suspension sleeve lower ext

L2405 70.19 Knee joint drop lock ea jnt

L2415 97.79 Knee joint cam lock each joi

L2425 115.42 Knee disc/dial lock/adj flex

L2430 115.42 Knee jnt ratchet lock ea jnt

L2492 104.79 Knee lift loop drop lock rin

L2500 250.70 Thi/glut/ischia wgt bearing

L2510 562.48 Th/wght bear quad-lat brim m

L2520 371.04 Th/wght bear quad-lat brim c

L2525 1001.07 Th/wght bear nar m-l brim mo

L2526 571.27 Th/wght bear nar m-l brim cu

L2530 181.25 Thigh/wght bear lacer non-mo

L2540 326.13 Thigh/wght bear lacer molded

L2550 221.54 Thigh/wght bear high roll cu

L2570 367.42 Hip clevis type 2 posit jnt

L2580 358.00 Pelvic control pelvic sling

L2600 196.04 Hip clevis/thrust bearing fr

L2610 207.65 Hip clevis/thrust bearing lo

L2620 233.48 Pelvic control hip heavy dut

L2622 264.70 Hip joint adjustable flexion

L2624 255.44 Hip adj flex ext abduct cont

L2627 1393.85 Plastic mold recipro hip & c

L2628 1371.07 Metal frame recipro hip & ca

L2630 191.01 Pelvic control band & belt u

L2640 259.22 Pelvic control band & belt b

L2650 110.36 Pelv & thor control gluteal

L2660 143.77 Thoracic control thoracic ba

L2670 139.43 Thorac cont paraspinal uprig

L2680 129.15 Thorac cont lat support upri

L2750 64.47 Plating chrome/nickel pr bar

L2755 105.19 Carbon graphite lamination

L2760 46.87 Extension per extension per

L2768 104.90 Ortho sidebar disconnect

L2780 52.21 Non-corrosive finish

L2785 24.55 Drop lock retainer each

L2795 66.58 Knee control full kneecap

L2800 102.33 Knee cap medial or lateral p

L2810 80.33 Knee control condylar pad

L2820 66.99 Soft interface below knee se

L2830 72.47 Soft interface above knee se

L2840 42.84 Tibial length sock fx or equ

L2850 47.76 Femoral lgth sock fx or equa

L3000 252.94 Ft insert ucb berkeley shell

L3001 106.51 Foot insert remov molded spe

L3002 130.04 Foot insert plastazote or eq

L3003 140.33 Foot insert silicone gel eac

L3010 140.33 Foot longitudinal arch suppo

L3020 159.75 Foot longitud/metatarsal sup

L3030 61.46 Foot arch support remov prem

L3031 98.63 Foot lamin/prepreg composite

L3040 37.88 Ft arch suprt premold longit

L3050 37.88 Foot arch supp premold metat

L3060 59.38 Foot arch supp longitud/meta

L3070 25.58 Arch suprt att to sho longit

L3080 25.58 Arch supp att to shoe metata

L3090 32.78 Arch supp att to shoe long/m

L3100 34.82 Hallus-valgus nt dyn pre ots

L3140 71.70 Abduction rotation bar shoe

L3150 65.54 Abduct rotation bar w/o shoe

L3170 40.98 Foot plas heel stabi pre ots

L3224 51.31 Woman's shoe oxford brace

L3225 52.69 Man's shoe oxford brace

L3300 41.98 Sho lift taper to metatarsal

L3310 65.54 Shoe lift elev heel/sole neo

L3330 455.70 Lifts elevation metal extens

L3332 59.38 Shoe lifts tapered to one-ha

L3334 30.74 Shoe lifts elevation heel /i

L3340 68.64 Shoe wedge sach

L3350 18.45 Shoe heel wedge

L3360 28.67 Shoe sole wedge outside sole

L3370 39.91 Shoe sole wedge between sole

L3380 39.91 Shoe clubfoot wedge

L3390 39.91 Shoe outflare wedge

L3400 32.78 Shoe metatarsal bar wedge ro

L3410 74.75 Shoe metatarsal bar between

L3420 44.05 Full sole/heel wedge btween

L3430 129.03 Sho heel count plast reinfor

L3440 61.46 Heel leather reinforced

L3450 85.01 Shoe heel sach cushion type

L3455 32.78 Shoe heel new leather standa

L3460 27.63 Shoe heel new rubber standar

L3465 47.11 Shoe heel thomas with wedge

L3470 50.18 Shoe heel thomas extend to b

L3480 50.18 Shoe heel pad & depress for

L3500 23.55 Ortho shoe add leather insol

L3510 23.55 Orthopedic shoe add rub insl

L3520 25.58 O shoe add felt w leath insl

L3530 25.58 Ortho shoe add half sole

L3540 40.98 Ortho shoe add full sole

L3550 7.15 O shoe add standard toe tap

L3560 18.45 O shoe add horseshoe toe tap

L3570 68.64 O shoe add instep extension

L3580 52.22 O shoe add instep velcro clo

L3590 43.01 O shoe convert to sof counte

L3595 33.78 Ortho shoe add march bar

L3600 61.46 Trans shoe calip plate exist

L3610 80.89 Trans shoe caliper plate new

L3620 61.46 Trans shoe solid stirrup exi

L3630 80.89 Trans shoe solid stirrup new

L3640 34.82 Shoe dennis browne splint bo

L3650 51.29 So 8 abd restraint pre ots

L3660 77.58 So 8 ab rstr can/web pre ots

L3670 102.53 So acro/clav can web pre ots

L3671 660.32 So cap design w/o jnts cf

L3674 866.21 So airplane w/wo joint cf

L3675 128.61 So vest canvas/web pre ots

L3702 211.60 Eo w/o joints cf

L3710 117.95 Eo elas w/metal jnts pre ots

L3720 526.33 Forearm/arm cuffs free motio

L3730 680.44 Forearm/arm cuffs ext/flex a

L3740 806.73 Cuffs adj lock w/ active con

L3760 366.46 Eo adj jt prefab custom fit

L3761 366.46 Eo, adj lock joint prefab ot

L3762 78.80 Eo rigid w/o joints pre ots

L3763 514.39 Ewho rigid w/o jnts cf

L3764 671.40 Ewho w/joint(s) cf

L3765 939.63 Ewhfo rigid w/o jnts cf

L3766 995.00 Ewhfo w/joint(s) cf

L3806 332.88 Whfo w/joint(s) custom fab

L3807 183.24 Whfo w/o joints pre cst

L3808 274.03 Whfo, rigid w/o joints

L3809 183.24 Whfo w/o joints pre ots

L3900 1068.51 Hinge extension/flex wrist/f

L3901 1213.43 Hinge ext/flex wrist finger

L3904 2210.50 Whfo electric custom fitted

L3905 726.73 Who w/nontorsion jnt(s) cf

L3906 322.67 Who w/o joints cf

L3908 50.78 Who cock-up nonmolde pre ots

L3912 87.97 Hfo flexion glove pre ots

L3913 198.48 Hfo w/o joints cf

L3915 389.53 Who nontorsion jnts pre cst

L3916 389.53 Who nontorsion jnts pre ots

L3917 77.44 Metacarp fx orthosis pre cst

L3918 77.44 Metacarp fx orthosis pre ots

L3919 198.48 Ho w/o joints cf

L3921 235.38 Hfo w/joint(s) cf

L3923 70.73 Hfo without joints pre cst

L3924 70.73 Hfo without joints pre ots

L3925 37.94 Fo pip dip jnt/sprng pre ots

L3927 25.62 Fo pip dip no jt spr pre ots

L3929 67.21 Hfo nontorsion jnts pre cst

L3930 67.21 Hfo nontorsion jnts pre ots

L3931 137.64 Whfo nontorsion joint prefab

L3933 156.34 Fo w/o joints cf

L3935 161.88 Fo nontorsion joint cf

L3956 0.00 Add joint upper ext orthosis

L3960 555.25 Sewho airplan desig abdu pos

L3961 1231.20 Sewho cap design w/o jnts cf

L3962 541.59 Sewho erbs palsey design abd

L3967 1453.63 Sewho airplane w/o jnts cf

L3971 1379.84 Sewho cap design w/jnt(s) cf

L3973 1453.63 Sewho airplane w/jnt(s) cf

L3975 1231.20 Sewhfo cap design w/o jnt cf

L3976 1231.20 Sewhfo airplane w/o jnts cf

L3977 1379.84 Sewhfo cap desgn w/jnt(s) cf

L3978 1453.63 Sewhfo airplane w/jnt(s) cf

L3980 241.71 Up ext fx orthos humeral nos

L3981 737.62 Ue fx orth shoul cap forearm

L3982 281.79 Upper ext fx orthosis rad/ul

L3984 259.80 Upper ext fx orthosis wrist

L3995 26.92 Sock fracture or equal each

L4000 1061.89 Repl girdle milwaukee orth

L4002 0.00 Replace strap, any orthosis

L4010 517.69 Replace trilateral socket br

L4020 724.00 Replace quadlat socket brim

L4030 389.46 Replace socket brim cust fit

L4040 317.81 Replace molded thigh lacer

L4045 253.04 Replace non-molded thigh lac

L4050 318.46 Replace molded calf lacer

L4055 206.21 Replace non-molded calf lace

L4060 245.15 Replace high roll cuff

L4070 217.09 Replace prox & dist upright

L4080 89.05 Repl met band kafo-afo prox

L4090 70.26 Repl met band kafo-afo calf/

L4100 92.26 Repl leath cuff kafo prox th

L4110 69.50 Repl leath cuff kafo-afo cal

L4130 389.74 Replace pretibial shell

L4350 77.21 Ankle control ortho pre ots

L4360 237.36 Pneumat walking boot pre cst

L4361 237.36 Pneuma/vac walk boot pre ots

L4370 156.97 Pneum full leg splnt pre ots

L4386 127.66 Non-pneum walk boot pre cst

L4387 127.66 Non-pneum walk boot pre ots

L4392 18.94 Replace afo soft interface

L4394 13.82 Replace foot drop spint

L4396 135.11 Static or dynami afo pre cst

L4397 135.11 Static or dynami afo pre ots

L4398 62.21 Foot drop splint pre ots

L4631 1283.92 Afo, walk boot type, cus fab

L5000 458.05 Sho insert w arch toe filler

L5010 1000.51 Mold socket ank hgt w/ toe f

L5020 1628.63 Tibial tubercle hgt w/ toe f

L5050 1886.03 Ank symes mold sckt sach ft

L5060 2269.86 Symes met fr leath socket ar

L5100 1964.74 Molded socket shin sach foot

L5105 3118.46 Plast socket jts/thgh lacer

L5150 2885.95 Mold sckt ext knee shin sach

L5160 3138.99 Mold socket bent knee shin s

L5200 2734.33 Kne sing axis fric shin sach

L5210 1994.20 No knee/ankle joints w/ ft b

L5220 2266.77 No knee joint with artic ali

L5230 3126.32 Fem focal defic constant fri

L5250 4264.03 Hip canad sing axi cons fric

L5270 4226.67 Tilt table locking hip sing

L5280 4184.41 Hemipelvect canad sing axis

L5301 1886.91 Bk mold socket sach ft endo

L5312 2710.75 Knee disart, sach ft, endo

L5321 2701.06 Ak open end sach

L5331 3822.10 Hip disart canadian sach ft

L5341 4153.41 Hemipelvectomy canadian sach

L5400 989.09 Postop dress & 1 cast chg bk

L5410 433.35 Postop dsg bk ea add cast ch

L5420 1249.17 Postop dsg & 1 cast chg ak/d

L5430 551.40 Postop dsg ak ea add cast ch

L5450 352.74 Postop app non-wgt bear dsg

L5460 519.91 Postop app non-wgt bear dsg

L5500 1055.48 Init bk ptb plaster direct

L5505 1429.39 Init ak ischal plstr direct

L5510 1196.45 Prep bk ptb plaster molded

L5520 1181.81 Perp bk ptb thermopls direct

L5530 1495.93 Prep bk ptb thermopls molded

L5535 1474.23 Prep bk ptb open end socket

L5540 1556.72 Prep bk ptb laminated socket

L5560 1597.26 Prep ak ischial plast molded

L5570 1660.59 Prep ak ischial direct form

L5580 1938.62 Prep ak ischial thermo mold

L5585 2102.66 Prep ak ischial open end

L5590 1975.59 Prep ak ischial laminated

L5595 3472.56 Hip disartic sach thermopls

L5600 3787.59 Hip disart sach laminat mold

L5610 1701.47 Above knee hydracadence

L5611 1324.09 Ak 4 bar link w/fric swing

L5613 2014.02 Ak 4 bar ling w/hydraul swig

L5614 1361.39 4-bar link above knee w/swng

L5616 1116.15 Ak univ multiplex sys frict

L5617 451.39 Ak/bk self-aligning unit ea

L5618 260.03 Test socket symes

L5620 228.48 Test socket below knee

L5622 348.93 Test socket knee disarticula

L5624 332.91 Test socket above knee

L5626 467.96 Test socket hip disarticulat

L5628 443.22 Test socket hemipelvectomy

L5629 338.46 Below knee acrylic socket

L5630 368.82 Syme typ expandabl wall sckt

L5631 441.06 Ak/knee disartic acrylic soc

L5632 182.48 Symes type ptb brim design s

L5634 249.99 Symes type poster opening so

L5636 209.40 Symes type medial opening so

L5637 279.71 Below knee total contact

L5638 399.94 Below knee leather socket

L5639 938.25 Below knee wood socket

L5640 571.23 Knee disarticulat leather so

L5642 511.41 Above knee leather socket

L5643 1279.11 Hip flex inner socket ext fr

L5644 485.40 Above knee wood socket

L5645 655.72 Bk flex inner socket ext fra

L5646 450.28 Below knee cushion socket

L5647 653.72 Below knee suction socket

L5648 541.06 Above knee cushion socket

L5649 1642.59 Isch containmt/narrow m-l so

L5650 401.20 Tot contact ak/knee disart s

L5651 986.94 Ak flex inner socket ext fra

L5652 358.29 Suction susp ak/knee disart

L5653 478.30 Knee disart expand wall sock

L5654 272.55 Socket insert symes

L5655 230.77 Socket insert below knee

L5656 325.07 Socket insert knee articulat

L5658 316.57 Socket insert above knee

L5661 550.13 Multi-durometer symes

L5665 420.79 Multi-durometer below knee

L5666 62.53 Below knee cuff suspension

L5668 83.49 Bk molded distal cushion

L5670 254.15 Bk molded supracondylar susp

L5671 408.78 Bk/ak locking mechanism

L5672 310.55 Bk removable medial brim sus

L5673 577.38 Socket insert w lock mech

L5676 297.80 Bk knee joints single axis p

L5677 405.20 Bk knee joints polycentric p

L5678 32.63 Bk joint covers pair

L5679 481.13 Socket insert w/o lock mech

L5680 284.63 Bk thigh lacer non-molded

L5681 1061.22 Intl custm cong/latyp insert

L5682 513.95 Bk thigh lacer glut/ischia m

L5683 1061.22 Initial custom socket insert

L5684 39.55 Bk fork strap

L5685 103.33 Below knee sus/seal sleeve

L5686 53.35 Bk back check

L5688 50.20 Bk waist belt webbing

L5690 97.21 Bk waist belt padded and lin

L5692 112.83 Ak pelvic control belt light

L5694 149.09 Ak pelvic control belt pad/l

L5695 156.40 Ak sleeve susp neoprene/equa

L5696 170.92 Ak/knee disartic pelvic join

L5697 69.43 Ak/knee disartic pelvic band

L5698 86.34 Ak/knee disartic silesian ba

L5699 153.23 Shoulder harness

L5700 2367.58 Replace socket below knee

L5701 2937.20 Replace socket above knee

L5702 3701.90 Replace socket hip

L5703 1719.13 Symes ankle w/o (sach) foot

L5704 482.74 Custom shape cover bk

L5705 885.05 Custom shape cover ak

L5706 863.25 Custom shape cvr knee disart

L5707 1159.77 Custom shape cvr hip disart

L5710 295.57 Kne-shin exo sng axi mnl loc

L5711 448.38 Knee-shin exo mnl lock ultra

L5712 354.12 Knee-shin exo frict swg & st

L5714 365.18 Knee-shin exo variable frict

L5716 598.97 Knee-shin exo mech stance ph

L5718 748.65 Knee-shin exo frct swg & sta

L5722 781.24 Knee-shin pneum swg frct exo

L5724 1240.46 Knee-shin exo fluid swing ph

L5726 1628.86 Knee-shin ext jnts fld swg e

L5728 2029.34 Knee-shin fluid swg & stance

L5780 978.44 Knee-shin pneum/hydra pneum

L5781 3228.03 Lower limb pros vacuum pump

L5782 3403.08 Hd low limb pros vacuum pump

L5785 426.97 Exoskeletal bk ultralt mater

L5790 590.90 Exoskeletal ak ultra-light m

L5795 882.37 Exoskel hip ultra-light mate

L5810 410.48 Endoskel knee-shin mnl lock

L5811 599.36 Endo knee-shin mnl lck ultra

L5812 464.57 Endo knee-shin frct swg & st

L5814 2996.23 Endo knee-shin hydral swg ph

L5816 698.91 Endo knee-shin polyc mch sta

L5818 789.21 Endo knee-shin frct swg & st

L5822 1531.13 Endo knee-shin pneum swg frc

L5824 1260.30 Endo knee-shin fluid swing p

L5826 2544.67 Miniature knee joint

L5828 2402.41 Endo knee-shin fluid swg/sta

L5830 1707.01 Endo knee-shin pneum/swg pha

L5840 3010.11 Multi-axial knee/shin system

L5845 1446.04 Knee-shin sys stance flexion

L5848 867.54 Knee-shin sys hydraul stance

L5850 109.16 Endo ak/hip knee extens assi

L5855 253.80 Mech hip extension assist

L5856 19367.29 Elec knee-shin swing/stance

L5857 6872.27 Elec knee-shin swing only

L5858 14994.05 Stance phase only

L5859 11705.74 Knee-shin pro flex/ext cont

L5910 299.75 Endo below knee alignable sy

L5920 436.05 Endo ak/hip alignable system

L5925 276.14 Above knee manual lock

L5930 2715.54 High activity knee frame

L5940 412.22 Endo bk ultra-light material

L5950 696.41 Endo ak ultra-light material

L5960 834.17 Endo hip ultra-light materia

L5961 3738.81 Endo poly hip, pneu/hyd/rot

L5962 483.06 Below knee flex cover system

L5964 865.27 Above knee flex cover system

L5966 1114.59 Hip flexible cover system

L5968 2931.75 Multiaxial ankle w dorsiflex

L5970 180.41 Foot external keel sach foot

L5971 180.41 Sach foot, replacement

L5972 289.63 Flexible keel foot

L5973 14124.43 Ank-foot sys dors-plant flex

L5974 244.37 Foot single axis ankle/foot

L5975 374.01 Combo ankle/foot prosthesis

L5976 460.24 Energy storing foot

L5978 239.83 Ft prosth multiaxial ankl/ft

L5979 1924.47 Multi-axial ankle/ft prosth

L5980 3047.05 Flex foot system

L5981 2633.77 Flex-walk sys low ext prosth

L5982 475.10 Exoskeletal axial rotation u

L5984 470.88 Endoskeletal axial rotation

L5985 227.83 Lwr ext dynamic prosth pylon

L5986 523.53 Multi-axial rotation unit

L5987 5803.71 Shank ft w vert load pylon

L5988 1611.70 Vertical shock reducing pylo

L5990 1463.67 User adjustable heel height

L6000 1091.94 Part hand thumb rem

L6010 1215.14 Part hand little/ring

L6020 1132.93 Part hand no fingers

L6026 3475.37 Part hand myo exclu term dev

L6050 1561.14 Wrst mld sck flx hng tri pad

L6055 2481.48 Wrst mold sock w/exp interfa

L6100 1581.67 Elb mold sock flex hinge pad

L6110 1677.63 Elbow mold sock suspension t

L6120 1955.03 Elbow mold doub splt soc ste

L6130 2127.44 Elbow stump activated lock h

L6200 2241.98 Elbow mold outsid lock hinge

L6205 3736.01 Elbow molded w/ expand inter

L6250 2206.86 Elbow inter loc elbow forarm

L6300 3061.78 Shlder disart int lock elbow

L6310 2517.91 Shoulder passive restor comp

L6320 1404.42 Shoulder passive restor cap

L6350 3218.98 Thoracic intern lock elbow

L6360 2642.61 Thoracic passive restor comp

L6370 1989.47 Thoracic passive restor cap

L6380 1074.49 Postop dsg cast chg wrst/elb

L6382 1285.78 Postop dsg cast chg elb dis/

L6384 1569.00 Postop dsg cast chg shlder/t

L6386 376.26 Postop ea cast chg & realign

L6388 361.28 Postop applicat rigid dsg on

L6400 1910.95 Below elbow prosth tiss shap

L6450 2533.72 Elb disart prosth tiss shap

L6500 2535.80 Above elbow prosth tiss shap

L6550 3133.78 Shldr disar prosth tiss shap

L6570 3802.35 Scap thorac prosth tiss shap

L6580 1327.27 Wrist/elbow bowden cable mol

L6582 1131.07 Wrist/elbow bowden cbl dir f

L6584 1832.13 Elbow fair lead cable molded

L6586 1602.73 Elbow fair lead cable dir fo

L6588 2645.74 Shdr fair lead cable molded

L6590 2420.12 Shdr fair lead cable direct

L6600 163.29 Polycentric hinge pair

L6605 152.43 Single pivot hinge pair

L6610 136.82 Flexible metal hinge pair

L6611 332.18 Additional switch, ext power

L6615 168.71 Disconnect locking wrist uni

L6616 71.08 Disconnect insert locking wr

L6620 264.79 Flexion/extension wrist unit

L6621 1845.34 Flex/ext wrist w/wo friction

L6623 606.09 Spring-ass rot wrst w/ latch

L6624 3038.40 Flex/ext/rotation wrist unit

L6625 441.04 Rotation wrst w/ cable lock

L6628 450.70 Quick disconn hook adapter o

L6629 120.23 Lamination collar w/ couplin

L6630 177.11 Stainless steel any wrist

L6632 59.08 Latex suspension sleeve each

L6635 164.05 Lift assist for elbow

L6637 340.54 Nudge control elbow lock

L6638 2017.53 Elec lock on manual pw elbow

L6640 232.39 Shoulder abduction joint pai

L6641 154.45 Excursion amplifier pulley t

L6642 219.90 Excursion amplifier lever ty

L6645 267.05 Shoulder flexion-abduction j

L6646 2544.56 Multipo locking shoulder jnt

L6647 418.90 Shoulder lock actuator

L6648 2624.35 Ext pwrd shlder lock/unlock

L6650 278.17 Shoulder universal joint

L6655 61.74 Standard control cable extra

L6660 75.43 Heavy duty control cable

L6665 43.12 Teflon or equal cable lining

L6670 40.89 Hook to hand cable adapter

L6672 138.58 Harness chest/shlder saddle

L6675 98.69 Harness figure of 8 sing con

L6676 99.66 Harness figure of 8 dual con

L6677 239.33 Ue triple control harness

L6680 190.66 Test sock wrist disart/bel e

L6682 213.70 Test sock elbw disart/above

L6684 286.46 Test socket shldr disart/tho

L6686 532.71 Suction socket

L6687 474.03 Frame typ socket bel elbow/w

L6688 458.54 Frame typ sock above elb/dis

L6689 553.74 Frame typ socket shoulder di

L6690 599.67 Frame typ sock interscap-tho

L6691 358.63 Removable insert each

L6692 459.59 Silicone gel insert or equal

L6693 2290.44 Lockingelbow forearm cntrbal

L6694 577.38 Elbow socket ins use w/lock

L6695 481.13 Elbow socket ins use w/o lck

L6696 1061.22 Cus elbo skt in for con/atyp

L6697 1061.22 Cus elbo skt in not con/atyp

L6698 408.78 Below/above elbow lock mech

L6703 290.64 Term dev, passive hand mitt

L6704 481.29 Term dev, sport/rec/work att

L6706 286.75 Term dev mech hook vol open

L6707 1208.52 Term dev mech hook vol close

L6708 687.42 Term dev mech hand vol open

L6709 1112.56 Term dev mech hand vol close

L6711 542.39 Ped term dev, hook, vol open

L6712 998.67 Ped term dev, hook, vol clos

L6713 1260.44 Ped term dev, hand, vol open

L6714 1067.57 Ped term dev, hand, vol clos

L6715 2547.08 Term device, multi art digit

L6721 1897.50 Hook/hand, hvy dty, vol open

L6722 1635.79 Hook/hand, hvy dty, vol clos

L6805 295.83 Term dev modifier wrist unit

L6810 161.25 Term dev precision pinch dev

L6880 19275.85 Elec hand ind art digits

L6881 3298.29 Term dev auto grasp feature

L6882 2501.91 Microprocessor control uplmb

L6883 1304.12 Replc sockt below e/w disa

L6884 1834.72 Replc sockt above elbow disa

L6885 2642.61 Replc sockt shldr dis/interc

L6890 139.78 Prefab glove for term device

L6895 508.75 Custom glove for term device

L6900 1320.36 Hand restorat thumb/1 finger

L6905 1296.22 Hand restoration multiple fi

L6910 1330.66 Hand restoration no fingers

L6915 514.47 Hand restoration replacmnt g

L6920 6334.74 Wrist disarticul switch ctrl

L6925 6944.70 Wrist disart myoelectronic c

L6930 5992.81 Below elbow switch control

L6935 7091.46 Below elbow myoelectronic ct

L6940 7812.72 Elbow disarticulation switch

L6945 8738.38 Elbow disart myoelectronic c

L6950 8279.82 Above elbow switch control

L6955 10069.87 Above elbow myoelectronic ct

L6960 10690.70 Shldr disartic switch contro

L6965 12246.15 Shldr disartic myoelectronic

L6970 13162.17 Interscapular-thor switch ct

L6975 14531.20 Interscap-thor myoelectronic

L7007 2980.74 Adult electric hand

L7008 5035.57 Pediatric electric hand

L7009 3048.16 Adult electric hook

L7040 2390.69 Prehensile actuator

L7045 1328.32 Pediatric electric hook

L7170 4818.72 Electronic elbow hosmer swit

L7180 28694.16 Electronic elbow sequential

L7181 32325.89 Electronic elbo simultaneous

L7185 4933.56 Electron elbow adolescent sw

L7186 7533.96 Electron elbow child switch

L7190 6423.31 Elbow adolescent myoelectron

L7191 8114.70 Elbow child myoelectronic ct

L7259 3426.73 Electronic wrist rotator any

L7360 245.56 Six volt bat otto bock/eq ea

L7362 221.21 Battery chrgr six volt otto

L7364 408.91 Twelve volt battery utah/equ

L7366 550.89 Battery chrgr 12 volt utah/e

L7367 314.10 Replacemnt lithium ionbatter

L7368 407.17 Lithium ion battery charger

L7400 247.27 Add ue prost be/wd, ultlite

L7401 276.82 Add ue prost a/e ultlite mat

L7402 298.95 Add ue prost s/d ultlite mat

L7403 297.09 Add ue prost b/e acrylic

L7404 448.43 Add ue prost a/e acrylic

L7405 586.47 Add ue prost s/d acrylic

L7700 118.43 Pros soc insert gasket/seal

L8000 30.01 Mastectomy bra

L8001 101.20 Breast prosthesis bra & form

L8002 133.09 Brst prsth bra & bilat form

L8015 48.37 Ext breastprosthesis garment

L8020 205.61 Mastectomy form

L8030 266.11 Breast prosthes w/o adhesive

L8031 266.11 Breast prosthesis w adhesive

L8032 31.60 Reusable nipple prosthesis

L8035 2955.72 Custom breast prosthesis

L8040 2056.31 Nasal prosthesis

L8040 KM 1953.51 Nasal prosthesis

L8040 KN 822.51 Nasal prosthesis

L8041 2478.54 Midfacial prosthesis

L8041 KM 2354.61 Midfacial prosthesis

L8041 KN 991.43 Midfacial prosthesis

L8042 2784.87 Orbital prosthesis

L8042 KM 2645.61 Orbital prosthesis

L8042 KN 1113.95 Orbital prosthesis

L8043 3119.09 Upper facial prosthesis

L8043 KM 2963.13 Upper facial prosthesis

L8043 KN 1247.63 Upper facial prosthesis

L8044 3453.24 Hemi-facial prosthesis

L8044 KM 3280.59 Hemi-facial prosthesis

L8044 KN 1381.28 Hemi-facial prosthesis

L8045 2410.64 Auricular prosthesis

L8045 KM 2290.11 Auricular prosthesis

L8045 KN 964.26 Auricular prosthesis

L8046 2227.89 Partial facial prosthesis

L8046 KM 2116.51 Partial facial prosthesis

L8046 KN 891.16 Partial facial prosthesis

L8047 1141.81 Nasal septal prosthesis

L8047 KM 1084.72 Nasal septal prosthesis

L8047 KN 456.71 Nasal septal prosthesis

L8300 69.33 Truss single w/ standard pad

L8310 109.45 Truss double w/ standard pad

L8320 49.07 Truss addition to std pad wa

L8330 40.57 Truss add to std pad scrotal

L8400 14.27 Sheath below knee

L8410 19.06 Sheath above knee

L8415 18.74 Sheath upper limb

L8417 60.62 Pros sheath/sock w gel cushn

L8420 16.84 Prosthetic sock multi ply bk

L8430 18.19 Prosthetic sock multi ply ak

L8435 17.28 Pros sock multi ply upper lm

L8440 34.37 Shrinker below knee

L8460 54.77 Shrinker above knee

L8465 48.48 Shrinker upper limb

L8470 5.48 Pros sock single ply bk

L8480 7.57 Pros sock single ply ak

L8485 9.50 Pros sock single ply upper l

L8500 723.15 Artificial larynx

L8501 99.27 Tracheostomy speaking valve

L8507 33.79 Trach-esoph voice pros pt in

L8509 88.11 Trach-esoph voice pros md in

L8510 203.86 Voice amplifier

L8511 58.68 Indwelling trach insert

L8512 1.74 Gel cap for trach voice pros

L8513 4.19 Trach pros cleaning device

L8514 76.08 Repl trach puncture dilator

L8515 50.92 Gel cap app device for trach

L8600 514.38 Implant breast silicone/eq

L8603 359.86 Collagen imp urinary 2.5 ml

L8605 577.84 Inj bulking agent anal canal

L8606 179.14 Synthetic implnt urinary 1ml

L8607 34.60 Inj vocal cord bulking agent

L8609 5256.49 Artificial cornea

L8610 483.51 Ocular implant

L8612 507.77 Aqueous shunt prosthesis

L8613 251.59 Ossicular implant

L8614 16025.31 Cochlear device

L8615 363.87 Coch implant headset replace

L8616 84.75 Coch implant microphone repl

L8617 74.03 Coch implant trans coil repl

L8618 21.16 Coch implant tran cable repl

L8619 6879.55 Coch imp ext proc/contr rplc

L8621 0.50 Repl zinc air battery

L8622 0.26 Repl alkaline battery

L8623 52.18 Lith ion batt cid,non-earlvl

L8624 130.11 Lith ion batt cid, ear level

L8625 152.36 Charger coch impl/aoi battry

L8627 5877.35 Cid ext speech process repl

L8628 1002.18 Cid ext controller repl

L8629 144.46 Cid transmit coil and cable

L8630 276.87 Metacarpophalangeal implant

L8631 1751.43 Mcp joint repl 2 pc or more

L8641 287.67 Metatarsal joint implant

L8642 268.61 Hallux implant

L8658 270.61 Interphalangeal joint spacer

L8659 1556.82 Interphalangeal joint repl

L8670 457.47 Vascular graft, synthetic

L8679 6759.74 Imp neurosti pls gn any type

L8681 886.57 Pt prgrm for implt neurostim

L8682 4829.72 Implt neurostim radiofq rec

L8683 4251.25 Radiofq trsmtr for implt neu

L8684 652.60 Radiof trsmtr implt scrl neu

L8689 1391.64 External recharg sys intern

L8690 3837.98 Aud osseo dev, int/ext comp

L8691 1389.38 Aoi snd proc repl excl actua

L8693 1223.34 Aud osseo dev, abutment

L8694 761.89 Aoi transducer/actuator repl

L8695 13.43 External recharg sys extern

L8696 174.87 Ext antenna phren nerve stim

Q0477 69.19 Pwr module pt cable lvad rpl

Q0478 148.26 Power adapter, combo vad

Q0479 9687.76 Power module combo vad, rep

Q0480 72661.75 Driver pneumatic vad, rep

Q0481 11723.12 Microprcsr cu elec vad, rep

Q0482 3671.91 Microprcsr cu combo vad, rep

Q0483 15126.60 Monitor elec vad, rep

Q0484 2937.55 Monitor elec or comb vad rep

Q0485 283.60 Monitor cable elec vad, rep

Q0486 236.05 Mon cable elec/pneum vad rep

Q0487 275.40 Leads any type vad, rep only

Q0489 13113.94 Pwr pck base combo vad, rep

Q0490 567.26 Emr pwr source elec vad, rep

Q0491 891.78 Emr pwr source combo vad rep

Q0492 71.83 Emr pwr cbl elec vad, rep

Q0493 204.58 Emr pwr cbl combo vad, rep

Q0494 173.12 Emr hd pmp elec/combo, rep

Q0495 3369.94 Charger elec/combo vad, rep

Q0496 1209.52 Battery elec/combo vad, rep

Q0497 377.69 Bat clps elec/comb vad, rep

Q0498 414.41 Holster elec/combo vad, rep

Q0499 134.64 Belt/vest elec/combo vad rep

Q0500 24.64 Filters elec/combo vad, rep

Q0501 412.00 Shwr cov elec/combo vad, rep

Q0502 524.54 Mobility cart pneum vad, rep

Q0503 1049.11 Battery pneum vad replacemnt

Q0504 553.60 Pwr adpt pneum vad, rep veh

Q0506 689.10 Lith-ion batt elec/pneum vad

Q4001 41.87 Cast sup body cast plaster

Q4002 158.19 Cast sup body cast fiberglas

Q4003 30.06 Cast sup shoulder cast plstr

Q4004 104.07 Cast sup shoulder cast fbrgl

Q4005 11.08 Cast sup long arm adult plst

Q4006 24.97 Cast sup long arm adult fbrg

Q4007 5.54 Cast sup long arm ped plster

Q4008 12.48 Cast sup long arm ped fbrgls

Q4009 7.40 Cast sup sht arm adult plstr

Q4010 16.65 Cast sup sht arm adult fbrgl

Q4011 3.69 Cast sup sht arm ped plaster

Q4012 8.34 Cast sup sht arm ped fbrglas

Q4013 13.47 Cast sup gauntlet plaster

Q4014 22.71 Cast sup gauntlet fiberglass

Q4015 6.75 Cast sup gauntlet ped plster

Q4016 11.36 Cast sup gauntlet ped fbrgls

Q4017 7.79 Cast sup lng arm splint plst

Q4018 12.41 Cast sup lng arm splint fbrg

Q4019 3.90 Cast sup lng arm splnt ped p

Q4020 6.22 Cast sup lng arm splnt ped f

Q4021 5.76 Cast sup sht arm splint plst

Q4022 10.40 Cast sup sht arm splint fbrg

Q4023 2.90 Cast sup sht arm splnt ped p

Q4024 5.21 Cast sup sht arm splnt ped f

Q4025 32.31 Cast sup hip spica plaster

Q4026 100.90 Cast sup hip spica fiberglas

Q4027 16.17 Cast sup hip spica ped plstr

Q4028 50.48 Cast sup hip spica ped fbrgl

Q4029 24.72 Cast sup long leg plaster

Q4030 65.06 Cast sup long leg fiberglass

Q4031 12.35 Cast sup lng leg ped plaster

Q4032 32.53 Cast sup lng leg ped fbrgls

Q4033 23.06 Cast sup lng leg cylinder pl

Q4034 57.32 Cast sup lng leg cylinder fb

Q4035 11.53 Cast sup lngleg cylndr ped p

Q4036 28.68 Cast sup lngleg cylndr ped f

Q4037 14.05 Cast sup shrt leg plaster

Q4038 35.22 Cast sup shrt leg fiberglass

Q4039 7.05 Cast sup shrt leg ped plster

Q4040 17.61 Cast sup shrt leg ped fbrgls

Q4041 17.10 Cast sup lng leg splnt plstr

Q4042 29.19 Cast sup lng leg splnt fbrgl

Q4043 8.56 Cast sup lng leg splnt ped p

Q4044 14.60 Cast sup lng leg splnt ped f

Q4045 9.93 Cast sup sht leg splnt plstr

Q4046 15.96 Cast sup sht leg splnt fbrgl

Q4047 4.95 Cast sup sht leg splnt ped p

Q4048 7.98 Cast sup sht leg splnt ped f

Q4049 1.80 Finger splint, static

V2020 51.53 Vision svcs frames purchases

V2100 39.55 Lens spher single plano 4.00

V2101 41.45 Single visn sphere 4.12-7.00

V2102 61.06 Singl visn sphere 7.12-20.00

V2103 37.26 Spherocylindr 4.00d/12-2.00d

V2104 40.38 Spherocylindr 4.00d/2.12-4d

V2105 44.94 Spherocylinder 4.00d/4.25-6d

V2106 49.87 Spherocylinder 4.00d/>6.00d

V2107 46.23 Spherocylinder 4.25d/12-2d



V2110 53.61 Spherocylinder 4.25d/over 6d

V2111 54.95 Spherocylindr 7.25d/.25-2.25



V2114 74.48 Spherocylinder over 12.00d

V2115 65.92 Lens lenticular bifocal

V2118 80.35 Lens aniseikonic single

V2121 65.03 Lenticular lens, single

V2200 54.48 Lens spher bifoc plano 4.00d

V2201 59.64 Lens sphere bifocal 4.12-7.0

V2202 72.05 Lens sphere bifocal 7.12-20.

V2203 56.20 Lens sphcyl bifocal 4.00d/.1

V2204 59.25 Lens sphcy bifocal 4.00d/2.1

V2205 64.06 Lens sphcy bifocal 4.00d/4.2

V2206 68.82 Lens sphcy bifocal 4.00d/ove

V2207 60.83 Lens sphcy bifocal 4.25-7d/.

V2208 65.25 Lens sphcy bifocal 4.25-7/2.

V2209 69.79 Lens sphcy bifocal 4.25-7/4.

V2210 78.04 Lens sphcy bifocal 4.25-7/ov

V2211 72.19 Lens sphcy bifo 7.25-12/.25-

V2212 75.23 Lens sphcyl bifo 7.25-12/2.2

V2213 71.11 Lens sphcyl bifo 7.25-12/4.2

V2214 91.76 Lens sphcyl bifocal over 12.

V2215 78.10 Lens lenticular bifocal

V2218 110.84 Lens aniseikonic bifocal

V2219 48.79 Lens bifocal seg width over

V2220 39.57 Lens bifocal add over 3.25d

V2221 77.88 Lenticular lens, bifocal

V2300 65.10 Lens sphere trifocal 4.00d

V2301 76.31 Lens sphere trifocal 4.12-7.

V2302 89.86 Lens sphere trifocal 7.12-20

V2303 59.64 Lens sphcy trifocal 4.0/.12-

V2304 69.72 Lens sphcy trifocal 4.0/2.25

V2305 80.74 Lens sphcy trifocal 4.0/4.25

V2306 85.72 Lens sphcyl trifocal 4.00/>6

V2307 79.10 Lens sphcy trifocal 4.25-7/.

V2308 82.22 Lens sphc trifocal 4.25-7/2.

V2309 85.94 Lens sphc trifocal 4.25-7/4.

V2310 91.19 Lens sphc trifocal 4.25-7/>6

V2311 82.35 Lens sphc trifo 7.25-12/.25-

V2312 82.84 Lens sphc trifo 7.25-12/2.25

V2313 85.93 Lens sphc trifo 7.25-12/4.25

V2314 110.38 Lens sphcyl trifocal over 12

V2315 98.06 Lens lenticular trifocal

V2318 153.42 Lens aniseikonic trifocal

V2319 54.42 Lens trifocal seg width > 28

V2320 57.40 Lens trifocal add over 3.25d

V2321 96.65 Lenticular lens, trifocal

V2410 85.56 Lens variab asphericity sing

V2430 95.59 Lens variable asphericity bi

V2500 89.06 Contact lens pmma spherical

V2501 121.07 Cntct lens pmma-toric/prism

V2502 159.32 Contact lens pmma bifocal

V2503 153.61 Cntct lens pmma color vision

V2510 120.40 Cntct gas permeable sphericl

V2511 156.13 Cntct toric prism ballast

V2512 192.10 Cntct lens gas permbl bifocl

V2513 156.54 Contact lens extended wear

V2520 111.55 Contact lens hydrophilic

V2521 176.02 Cntct lens hydrophilic toric

V2522 157.06 Cntct lens hydrophil bifocl

V2523 155.23 Cntct lens hydrophil extend

V2530 209.70 Contact lens gas impermeable

V2531 436.84 Contact lens gas permeable

V2623 1257.00 Plastic eye prosth custom

V2624 66.71 Polishing artifical eye

V2625 304.17 Enlargemnt of eye prosthesis

V2626 163.97 Reduction of eye prosthesis

V2627 1446.00 Scleral cover shell

V2628 250.04 Fabrication & fitting

V2630 97.82 Anter chamber intraocul lens

V2631 97.82 Iris support intraoclr lens

V2632 97.82 Post chmbr intraocular lens

V2700 44.24 Balance lens

V2710 61.80 Glass/plastic slab off prism

V2715 10.11 Prism lens/es

V2718 24.34 Fresnell prism press-on lens

V2730 17.33 Special base curve

V2744 13.48 Tint photochromatic lens/es

V2745 9.58 Tint, any color/solid/grad

V2750 17.87 Anti-reflective coating

V2755 13.65 Uv lens/es

V2760 16.89 Scratch resistant coating

V2762 48.08 Polarization, any lens

V2770 16.04 Occluder lens/es

V2780 10.30 Oversize lens/es

V2782 51.94 Lens, 1.54-1.65 p/1.60-1.79g

V2783 58.56 Lens, >= 1.66 p/>=1.80 g

V2784 38.08 Lens polycarb or equal

V2786 0.00 Occupational multifocal lens

Durable Medical Equipment, Prosthetics, Orthotics, and ... DME Fee... · Durable Medical Equipment,...

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Transcript of Durable Medical Equipment, Prosthetics, Orthotics, and ... DME Fee... · Durable Medical Equipment,...