hcpcs mod mod2 juris catg tn (nr) 0.43 sterile water/saline, … · 2019-03-15 · d. os: 9.86. ext...

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) April 2018 Fee Schedule

HCPCS Mod Mod2 JURIS CATG TN (NR) Description

A4216 D OS 0.43 Sterile water/saline, 10 ml

A4217 D SU 3.00 Sterile water/saline, 500 ml

A4217 AU D OS 3.00 Sterile water/saline, 500 ml

A4221 D SU 19.71 Supp non-insulin inf cath/wk

A4222 D SU 37.38 Infusion supplies with pump

A4224 D SU 19.71 Supply insulin inf cath/wk

A4225 D SU 2.64 Sup/ext insulin inf pump syr

A4233 NU D IN 0.51 Alkalin batt for glucose mon

A4234 NU D IN 2.36 J-cell batt for glucose mon

A4235 NU D IN 1.00 Lithium batt for glucose mon

A4236 NU D IN 1.16 Silvr oxide batt glucose mon

A4253 NU D IN 8.32 Blood glucose/reagent strips

A4255 D SU 4.63 Glucose monitor platforms

A4256 D SU 3.38 Calibrator solution/chips

A4257 D SU 14.36 Replace lensshield cartridge

A4258 D SU 2.12 Lancet device each

A4259 D SU 1.42 Lancets per box

A4265 D SU 3.83 Paraffin

A4280 D PO 6.01 Brst prsths adhsv attchmnt

A4310 D OS 8.28 Insert tray w/o bag/cath

A4311 D OS 16.05 Catheter w/o bag 2-way latex

A4312 D OS 20.30 Cath w/o bag 2-way silicone

A4313 D OS 20.85 Catheter w/bag 3-way

A4314 D OS 27.35 Cath w/drainage 2-way latex

A4315 D OS 29.69 Cath w/drainage 2-way silcne

A4316 D OS 31.96 Cath w/drainage 3-way

A4320 D OS 5.14 Irrigation tray

A4321 D OS 0.00 Cath therapeutic irrig agent

A4322 D OS 3.43 Irrigation syringe

A4326 D OS 12.14 Male external catheter

A4327 D OS 49.96 Fem urinary collect dev cup

A4328 D OS 11.09 Fem urinary collect pouch

A4330 D OS 6.85 Stool collection pouch

A4331 D OS 3.58 Extension drainage tubing

A4332 D OS 0.13 Lube sterile packet

A4333 D OS 2.49 Urinary cath anchor device

A4334 D OS 5.54 Urinary cath leg strap

A4336 D OS 1.62 Urethral insert

A4338 D OS 12.16 Indwelling catheter latex

A4340 D OS 35.74 Indwelling catheter special

A4344 D OS 16.49 Cath indw foley 2 way silicn

A4346 D OS 22.04 Cath indw foley 3 way

A4349 D OS 2.27 Disposable male external cat

A4351 D OS 1.73 Straight tip urine catheter

A4352 D OS 6.15 Coude tip urinary catheter

A4353 D OS 7.88 Intermittent urinary cath

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

April 2018 Fee Schedule


A4354 D OS 13.28 Cath insertion tray w/bag

A4355 D OS 10.04 Bladder irrigation tubing

A4356 D OS 51.35 Ext ureth clmp or compr dvc

A4357 D OS 9.29 Bedside drainage bag

A4358 D OS 6.34 Urinary leg or abdomen bag

A4360 D OS 0.55 Disposable ext urethral dev

A4361 D OS 20.67 Ostomy face plate

A4362 D OS 3.52 Solid skin barrier

A4363 D OS 2.27 Ostomy clamp, replacement

A4364 D OS 2.93 Adhesive, liquid or equal

A4366 D OS 1.46 Ostomy vent

A4367 D OS 7.04 Ostomy belt

A4368 D OS 0.28 Ostomy filter

A4369 D OS 2.73 Skin barrier liquid per oz

A4371 D OS 4.10 Skin barrier powder per oz

A4372 D OS 4.72 Skin barrier solid 4x4 equiv

A4373 D OS 7.06 Skin barrier with flange

A4375 D OS 19.33 Drainable plastic pch w fcpl

A4376 D OS 53.56 Drainable rubber pch w fcplt

A4377 D OS 4.83 Drainable plstic pch w/o fp

A4378 D OS 34.60 Drainable rubber pch w/o fp

A4379 D OS 16.90 Urinary plastic pouch w fcpl

A4380 D OS 42.01 Urinary rubber pouch w fcplt

A4381 D OS 5.21 Urinary plastic pouch w/o fp

A4382 D OS 27.70 Urinary hvy plstc pch w/o fp

A4383 D OS 31.73 Urinary rubber pouch w/o fp

A4384 D OS 10.82 Ostomy faceplt/silicone ring

A4385 D OS 5.74 Ost skn barrier sld ext wear

A4387 D OS 2.53 Ost clsd pouch w att st barr

A4388 D OS 4.91 Drainable pch w ex wear barr

A4389 D OS 7.00 Drainable pch w st wear barr

A4390 D OS 10.81 Drainable pch ex wear convex

A4391 D OS 7.96 Urinary pouch w ex wear barr

A4392 D OS 9.20 Urinary pouch w st wear barr

A4393 D OS 10.18 Urine pch w ex wear bar conv

A4394 D OS 2.91 Ostomy pouch liq deodorant

A4395 D OS 0.05 Ostomy pouch solid deodorant

A4396 D OS 45.56 Peristomal hernia supprt blt

A4397 D OS 4.58 Irrigation supply sleeve

A4398 D OS 15.56 Ostomy irrigation bag

A4399 D OS 13.13 Ostomy irrig cone/cath w brs

A4400 D OS 46.75 Ostomy irrigation set

A4402 D OS 1.53 Lubricant per ounce

A4404 D OS 1.61 Ostomy ring each

A4405 D OS 3.84 Nonpectin based ostomy paste

A4406 D OS 6.44 Pectin based ostomy paste




A4407 D OS 9.86 Ext wear ost skn barr <=4sq"

A4408 D OS 11.11 Ext wear ost skn barr >4sq"

A4409 D OS 7.00 Ost skn barr convex <=4 sq i

A4410 D OS 10.18 Ost skn barr extnd >4 sq

A4411 D OS 5.74 Ost skn barr extnd =4sq

A4412 D OS 3.04 Ost pouch drain high output

A4413 D OS 6.20 2 pc drainable ost pouch

A4414 D OS 5.54 Ost sknbar w/o conv<=4 sq in

A4415 D OS 6.74 Ost skn barr w/o conv >4 sqi

A4416 D OS 3.10 Ost pch clsd w barrier/filtr

A4417 D OS 4.19 Ost pch w bar/bltinconv/fltr

A4418 D OS 2.04 Ost pch clsd w/o bar w filtr

A4419 D OS 1.95 Ost pch for bar w flange/flt

A4420 D OS 0.00 Ost pch clsd for bar w lk fl

A4422 D OS 0.13 Ost pouch absorbent material

A4423 D OS 2.09 Ost pch for bar w lk fl/fltr

A4424 D OS 5.36 Ost pch drain w bar & filter

A4425 D OS 4.03 Ost pch drain for barrier fl

A4426 D OS 3.07 Ost pch drain 2 piece system

A4427 D OS 3.13 Ost pch drain/barr lk flng/f

A4428 D OS 7.33 Urine ost pouch w faucet/tap

A4429 D OS 9.28 Urine ost pouch w bltinconv

A4430 D OS 9.58 Ost urine pch w b/bltin conv

A4431 D OS 7.00 Ost pch urine w barrier/tapv

A4432 D OS 4.04 Os pch urine w bar/fange/tap

A4433 D OS 3.77 Urine ost pch bar w lock fln

A4434 D OS 4.23 Ost pch urine w lock flng/ft

A4435 D OS 6.49 1pc ost pch drain hgh output

A4450 AU D OS 0.09 Non-waterproof tape

A4450 AV D OS 0.09 Non-waterproof tape

A4450 AW D OS 0.12 Non-waterproof tape

A4452 AU D OS 0.40 Waterproof tape

A4452 AV D OS 0.40 Waterproof tape

A4452 AW D OS 0.44 Waterproof tape

A4455 D OS 1.37 Adhesive remover per ounce

A4456 D OS 0.27 Adhesive remover, wipes

A4461 D SD 3.71 Surgicl dress hold non-reuse

A4463 D SD 14.98 Surgical dress holder reuse

A4481 D OS 0.42 Tracheostoma filter

A4483 D OS 0.00 Moisture exchanger

A4556 D SU 11.62 Electrodes, pair

A4557 D SU 10.53 Lead wires, pair

A4558 D SU 5.22 Conductive gel or paste

A4559 D SU 0.11 Coupling gel or paste

A4561 L PO 23.18 Pessary rubber, any type

A4562 L PO 57.61 Pessary, non rubber,any type




A4565 L SC 8.66 Slings

A4595 D SU 10.34 Tens suppl 2 lead per month

A4602 NU D IN 4.19 Replace lithium battery 1.5v

A4604 NU D IN 38.55 Tubing with heating element

A4605 NU D IN 18.46 Trach suction cath close sys

A4608 D OX 56.41 Transtracheal oxygen cath

A4614 D IN 26.76 Hand-held pefr meter

A4615 D SU 0.82 Cannula nasal

A4616 D SU 0.07 Tubing (oxygen) per foot

A4617 D SU 3.49 Mouth piece

A4618 NU D IN 8.51 Breathing circuits

A4618 RR D IN 0.99 Breathing circuits

A4618 UE D IN 6.38 Breathing circuits

A4619 NU D IN 1.95 Face tent

A4620 D SU 0.71 Variable concentration mask

A4623 D OS 6.26 Tracheostomy inner cannula

A4624 NU D IN 2.52 Tracheal suction tube

A4625 D OS 6.62 Trach care kit for new trach

A4626 D OS 3.05 Tracheostomy cleaning brush

A4628 NU D IN 4.21 Oropharyngeal suction cath

A4629 D OS 5.23 Tracheostomy care kit

A4630 NU D IN 7.03 Repl bat t.e.n.s. own by pt

A4633 NU D IN 46.18 Uvl replacement bulb

A4635 NU D IN 4.90 Underarm crutch pad

A4635 RR D IN 0.70 Underarm crutch pad

A4635 UE D IN 3.26 Underarm crutch pad

A4636 NU D IN 3.01 Handgrip for cane etc

A4636 RR D IN 0.30 Handgrip for cane etc

A4636 UE D IN 2.26 Handgrip for cane etc

A4637 NU D IN 1.67 Repl tip cane/crutch/walker

A4637 RR D IN 0.17 Repl tip cane/crutch/walker

A4637 UE D IN 1.26 Repl tip cane/crutch/walker

A4638 NU D IN 0.00 Repl batt pulse gen sys

A4638 RR D IN 0.00 Repl batt pulse gen sys

A4638 UE D IN 0.00 Repl batt pulse gen sys

A4639 RR D CR 32.33 Infrared ht sys replcmnt pad

A4640 NU D IN 49.45 Alternating pressure pad

A4640 RR D IN 4.94 Alternating pressure pad

A4640 UE D IN 37.09 Alternating pressure pad

A5051 D OS 2.33 Pouch clsd w barr attached

A5052 D OS 1.67 Clsd ostomy pouch w/o barr

A5053 D OS 1.66 Clsd ostomy pouch faceplate

A5054 D OS 2.02 Clsd ostomy pouch w/flange

A5055 D OS 1.38 Stoma cap

A5056 D OS 5.26 1 pc ost pouch w filter

A5057 D OS 10.81 1 pc ost pou w built-in conv




A5061 D OS 3.97 Pouch drainable w barrier at

A5062 D OS 2.46 Drnble ostomy pouch w/o barr

A5063 D OS 3.04 Drain ostomy pouch w/flange

A5071 D OS 6.76 Urinary pouch w/barrier

A5072 D OS 3.40 Urinary pouch w/o barrier

A5073 D OS 3.40 Urinary pouch on barr w/flng

A5081 D OS 3.59 Stoma plug or seal, any type

A5082 D OS 11.38 Continent stoma catheter

A5083 D OS 0.72 Stoma absorptive cover

A5093 D OS 1.87 Ostomy accessory convex inse

A5102 D OS 25.41 Bedside drain btl w/wo tube

A5105 D OS 45.89 Urinary suspensory

A5112 D OS 36.25 Urinary leg bag

A5113 D OS 4.51 Latex leg strap

A5114 D OS 8.57 Foam/fabric leg strap

A5120 AU D OS 0.26 Skin barrier, wipe or swab

A5120 AV D PO 0.26 Skin barrier, wipe or swab

A5121 D OS 8.39 Solid skin barrier 6x6

A5122 D OS 12.29 Solid skin barrier 8x8

A5126 D OS 1.26 Disk/foam pad +or- adhesive

A5131 D OS 16.29 Appliance cleaner

A5200 D OS 12.73 Percutaneous catheter anchor

A5500 D TS 71.56 Diab shoe for density insert

A5501 D TS 214.65 Diabetic custom molded shoe

A5503 D TS 35.27 Diabetic shoe w/roller/rockr

A5504 D TS 35.27 Diabetic shoe with wedge

A5505 D TS 35.27 Diab shoe w/metatarsal bar

A5506 D TS 35.27 Diabetic shoe w/off set heel

A5507 D TS 35.27 Modification diabetic shoe

A5512 D TS 29.19 Multi den insert direct form

A5513 D TS 43.56 Multi den insert custom mold

A6010 J SD 34.86 Collagen based wound filler

A6011 J SD 2.57 Collagen gel/paste wound fil

A6021 J SD 23.66 Collagen dressing <=16 sq in

A6022 J SD 23.66 Collagen drsg>16<=48 sq in

A6023 J SD 214.19 Collagen dressing >48 sq in

A6024 J SD 6.97 Collagen dsg wound filler

A6154 J SD 16.19 Wound pouch each

A6196 J SD 8.28 Alginate dressing <=16 sq in

A6197 J SD 18.50 Alginate drsg >16 <=48 sq in

A6199 J SD 5.95 Alginate drsg wound filler

A6203 J SD 3.79 Composite drsg <= 16 sq in

A6204 J SD 7.01 Composite drsg >16<=48 sq in

A6207 J SD 8.26 Contact layer >16<= 48 sq in

A6209 J SD 8.41 Foam drsg <=16 sq in w/o bdr

A6210 J SD 22.42 Foam drg >16<=48 sq in w/o b




A6211 J SD 33.06 Foam drg > 48 sq in w/o brdr

A6212 J SD 10.93 Foam drg <=16 sq in w/border

A6214 J SD 11.58 Foam drg > 48 sq in w/border

A6216 J SD 0.05 Non-sterile gauze<=16 sq in

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

A6219 J SD 1.08 Gauze <= 16 sq in w/border

A6220 J SD 2.91 Gauze >16 <=48 sq in w/bordr

A6222 J SD 2.40 Gauze <=16 in no w/sal w/o b

A6223 J SD 2.73 Gauze >16<=48 no w/sal w/o b

A6224 J SD 4.06 Gauze > 48 in no w/sal w/o b

A6229 J SD 4.06 Gauze >16<=48 sq in watr/sal

A6231 J SD 5.28 Hydrogel dsg<=16 sq in

A6232 J SD 7.72 Hydrogel dsg>16<=48 sq in

A6233 J SD 21.58 Hydrogel dressing >48 sq in

A6234 J SD 7.36 Hydrocolld drg <=16 w/o bdr

A6235 J SD 18.93 Hydrocolld drg >16<=48 w/o b

A6236 J SD 30.67 Hydrocolld drg > 48 in w/o b

A6237 J SD 8.91 Hydrocolld drg <=16 in w/bdr

A6238 J SD 25.66 Hydrocolld drg >16<=48 w/bdr

A6240 J SD 13.78 Hydrocolld drg filler paste

A6241 J SD 2.89 Hydrocolloid drg filler dry

A6242 J SD 6.82 Hydrogel drg <=16 in w/o bdr

A6243 J SD 13.87 Hydrogel drg >16<=48 w/o bdr

A6244 J SD 44.21 Hydrogel drg >48 in w/o bdr

A6245 J SD 8.18 Hydrogel drg <= 16 in w/bdr

A6246 J SD 11.18 Hydrogel drg >16<=48 in w/b

A6247 J SD 26.76 Hydrogel drg > 48 sq in w/b

A6248 J SD 18.29 Hydrogel drsg gel filler

A6251 J SD 2.24 Absorpt drg <=16 sq in w/o b

A6252 J SD 3.67 Absorpt drg >16 <=48 w/o bdr

A6253 J SD 7.13 Absorpt drg > 48 sq in w/o b

A6254 J SD 1.35 Absorpt drg <=16 sq in w/bdr

A6255 J SD 3.42 Absorpt drg >16<=48 in w/bdr

A6257 J SD 1.73 Transparent film <= 16 sq in

A6258 J SD 4.85 Transparent film >16<=48 in

A6259 J SD 12.31 Transparent film > 48 sq in

A6266 J SD 2.16 Impreg gauze no h20/sal/yard

A6402 J SD 0.13 Sterile gauze <= 16 sq in

A6403 J SD 0.48 Sterile gauze>16 <= 48 sq in

A6407 J SD 2.11 Packing strips, non-impreg

A6410 J SD 0.43 Sterile eye pad

A6411 J SD 0.00 Non-sterile eye pad

A6441 J SD 0.77 Pad band w>=3" <5"/yd

A6442 J SD 0.18 Conform band n/s w<3"/yd

A6443 J SD 0.31 Conform band n/s w>=3"<5"/yd

A6444 J SD 0.63 Conform band n/s w>=5"/yd




A6445 J SD 0.36 Conform band s w <3"/yd

A6446 J SD 0.45 Conform band s w>=3" <5"/yd

A6447 J SD 0.77 Conform band s w >=5"/yd

A6448 J SD 1.30 Lt compres band <3"/yd

A6449 J SD 1.97 Lt compres band >=3" <5"/yd

A6450 J SD 1.97 Lt compres band >=5"/yd

A6451 J SD 1.97 Mod compres band w>=3"<5"/yd

A6452 J SD 6.65 High compres band w>=3"<5"yd

A6453 J SD 0.70 Self-adher band w <3"/yd

A6454 J SD 0.88 Self-adher band w>=3" <5"/yd

A6455 J SD 1.57 Self-adher band >=5"/yd

A6456 J SD 1.43 Zinc paste band w >=3"<5"/yd

A6457 J SD 1.28 Tubular dressing

A6501 J SD 0.00 Compres burngarment bodysuit

A6502 J SD 0.00 Compres burngarment chinstrp

A6503 J SD 0.00 Compres burngarment facehood

A6504 J SD 0.00 Cmprsburngarment glove-wrist

A6505 J SD 0.00 Cmprsburngarment glove-elbow

A6506 J SD 0.00 Cmprsburngrmnt glove-axilla

A6507 J SD 0.00 Cmprs burngarment foot-knee

A6508 J SD 0.00 Cmprs burngarment foot-thigh

A6509 J SD 0.00 Compres burn garment jacket

A6510 J SD 0.00 Compres burn garment leotard

A6511 J SD 0.00 Compres burn garment panty

A6513 D SD 0.00 Compress burn mask face/neck

A6531 AW D SD 48.69 Compression stocking bk30-40

A6532 AW D SD 68.61 Compression stocking bk40-50

A6545 D SD 0.00 Grad comp non-elastic bk

A6545 AW D SD 95.87 Grad comp non-elastic bk

A6550 D SU 24.48 Neg pres wound ther drsg set

A7000 NU D IN 8.20 Disposable canister for pump

A7001 NU D IN 33.79 Nondisposable pump canister

A7002 NU D IN 3.66 Tubing used w suction pump

A7003 NU D IN 1.47 Nebulizer administration set

A7004 NU D IN 1.24 Disposable nebulizer sml vol

A7005 NU D IN 11.73 Nondisposable nebulizer set

A7006 NU D IN 7.47 Filtered nebulizer admin set

A7007 NU D IN 3.26 Lg vol nebulizer disposable

A7008 NU D IN 10.52 Disposable nebulizer prefill

A7009 NU D IN 47.32 Nebulizer reservoir bottle

A7010 NU D IN 15.76 Disposable corrugated tubing

A7012 NU D IN 2.89 Nebulizer water collec devic

A7013 NU D IN 0.57 Disposable compressor filter

A7014 NU D IN 3.20 Compressor nondispos filter

A7015 NU D IN 1.28 Aerosol mask used w nebulize

A7016 NU D IN 7.91 Nebulizer dome & mouthpiece




A7017 NU D IN 122.07 Nebulizer not used w oxygen

A7017 RR D IN 12.21 Nebulizer not used w oxygen

A7017 UE D IN 91.55 Nebulizer not used w oxygen

A7018 D SU 0.32 Water distilled w/nebulizer

A7020 NU D IN 16.30 Interface, cough stim device

A7025 RR D CR 48.96 Replace chest compress vest

A7026 NU D IN 32.35 Replace chst cmprss sys hose

A7027 NU D IN 120.01 Combination oral/nasal mask

A7028 NU D IN 33.56 Repl oral cushion combo mask

A7029 NU D IN 15.00 Repl nasal pillow comb mask

A7030 NU D IN 86.33 Cpap full face mask

A7031 NU D IN 33.48 Replacement facemask interfa

A7032 NU D IN 18.78 Replacement nasal cushion

A7033 NU D IN 15.12 Replacement nasal pillows

A7034 NU D IN 54.47 Nasal application device

A7035 NU D IN 17.88 Pos airway press headgear

A7036 NU D IN 10.40 Pos airway press chinstrap

A7037 NU D IN 11.54 Pos airway pressure tubing

A7038 NU D IN 2.01 Pos airway pressure filter

A7039 NU D IN 5.91 Filter, non disposable w pap

A7040 L PO 45.78 One way chest drain valve

A7041 L PO 86.02 Water seal drain container

A7044 NU D IN 82.95 Pap oral interface

A7045 NU D IN 11.42 Repl exhalation port for pap

A7045 RR D IN 1.14 Repl exhalation port for pap

A7045 UE D IN 8.57 Repl exhalation port for pap

A7046 NU D IN 13.29 Repl water chamber, pap dev

A7047 NU D IN 136.08 Resp suction oral interface

A7048 L PO 47.88 Vacuum drain bottle/tube kit

A7501 D OS 118.20 Tracheostoma valve w diaphra

A7502 D OS 56.19 Replacement diaphragm/fplate

A7503 D OS 12.77 Hmes filter holder or cap

A7504 D OS 0.77 Tracheostoma hmes filter

A7505 D OS 5.28 Hmes or trach valve housing

A7506 D OS 0.37 Hmes/trachvalve adhesivedisk

A7507 D OS 2.80 Integrated filter & holder

A7508 D OS 3.23 Housing & integrated adhesiv

A7509 D OS 1.59 Heat & moisture exchange sys

A7520 D OS 53.44 Trach/laryn tube non-cuffed

A7521 D OS 52.94 Trach/laryn tube cuffed

A7522 D OS 50.83 Trach/laryn tube stainless

A7524 D OS 87.13 Tracheostoma stent/stud/bttn

A7525 D OS 2.33 Tracheostomy mask

A7526 D OS 3.81 Tracheostomy tube collar

A7527 D OS 4.03 Trach/laryn tube plug/stop

A8000 NU D IN 172.61 Soft protect helmet prefab




A8000 RR D IN 17.26 Soft protect helmet prefab

A8000 UE D IN 129.48 Soft protect helmet prefab

A8001 NU D IN 172.61 Hard protect helmet prefab

A8001 RR D IN 17.26 Hard protect helmet prefab

A8001 UE D IN 129.48 Hard protect helmet prefab

A8002 NU D IN 0.00 Soft protect helmet custom

A8002 RR D IN 0.00 Soft protect helmet custom

A8002 UE D IN 0.00 Soft protect helmet custom

A8003 NU D IN 0.00 Hard protect helmet custom

A8003 RR D IN 0.00 Hard protect helmet custom

A8003 UE D IN 0.00 Hard protect helmet custom

A8004 NU D IN 0.00 Repl soft interface, helmet

A8004 RR D IN 0.00 Repl soft interface, helmet

A8004 UE D IN 0.00 Repl soft interface, helmet

E0100 NU D IN 23.72 Cane adjust/fixed with tip

E0100 RR D IN 5.68 Cane adjust/fixed with tip

E0100 UE D IN 18.91 Cane adjust/fixed with tip

E0105 NU D IN 54.26 Cane adjust/fixed quad/3 pro

E0105 RR D IN 8.48 Cane adjust/fixed quad/3 pro

E0105 UE D IN 42.40 Cane adjust/fixed quad/3 pro

E0110 NU D IN 78.53 Crutch forearm pair

E0110 RR D IN 15.29 Crutch forearm pair

E0110 UE D IN 58.89 Crutch forearm pair

E0111 NU D IN 50.94 Crutch forearm each

E0111 RR D IN 8.06 Crutch forearm each

E0111 UE D IN 39.32 Crutch forearm each

E0112 NU D IN 35.40 Crutch underarm pair wood

E0112 RR D IN 9.51 Crutch underarm pair wood

E0112 UE D IN 27.00 Crutch underarm pair wood

E0113 NU D IN 20.22 Crutch underarm each wood

E0113 RR D IN 4.92 Crutch underarm each wood

E0113 UE D IN 15.16 Crutch underarm each wood

E0114 NU D IN 52.06 Crutch underarm pair no wood

E0114 RR D IN 8.19 Crutch underarm pair no wood

E0114 UE D IN 39.04 Crutch underarm pair no wood

E0116 NU D IN 26.55 Crutch underarm each no wood

E0116 RR D IN 5.18 Crutch underarm each no wood

E0116 UE D IN 19.98 Crutch underarm each no wood

E0117 RR D CR 21.68 Underarm springassist crutch

E0130 NU D IN 44.80 Walker rigid adjust/fixed ht

E0130 RR D IN 4.48 Walker rigid adjust/fixed ht

E0130 UE D IN 33.60 Walker rigid adjust/fixed ht

E0135 NU D IN 45.00 Walker folding adjust/fixed

E0135 RR D IN 4.50 Walker folding adjust/fixed

E0135 UE D IN 33.75 Walker folding adjust/fixed

E0140 RR D CR 28.13 Walker w trunk support




E0141 NU D IN 47.55 Rigid wheeled walker adj/fix

E0141 RR D IN 4.76 Rigid wheeled walker adj/fix

E0141 UE D IN 35.66 Rigid wheeled walker adj/fix

E0143 NU D IN 47.55 Walker folding wheeled w/o s

E0143 RR D IN 4.76 Walker folding wheeled w/o s

E0143 UE D IN 35.66 Walker folding wheeled w/o s

E0144 RR D CR 26.08 Enclosed walker w rear seat

E0147 NU D IN 384.94 Walker variable wheel resist

E0147 RR D IN 38.49 Walker variable wheel resist

E0147 UE D IN 288.71 Walker variable wheel resist

E0148 NU D IN 82.23 Heavyduty walker no wheels

E0148 RR D IN 8.22 Heavyduty walker no wheels

E0148 UE D IN 61.67 Heavyduty walker no wheels

E0149 RR D CR 12.25 Heavy duty wheeled walker

E0153 NU D IN 78.10 Forearm crutch platform atta

E0153 RR D IN 8.83 Forearm crutch platform atta

E0153 UE D IN 58.56 Forearm crutch platform atta

E0154 NU D IN 46.48 Walker platform attachment

E0154 RR D IN 4.65 Walker platform attachment

E0154 UE D IN 34.86 Walker platform attachment

E0155 NU D IN 19.83 Walker wheel attachment,pair

E0155 RR D IN 1.98 Walker wheel attachment,pair

E0155 UE D IN 14.87 Walker wheel attachment,pair

E0156 NU D IN 15.68 Walker seat attachment

E0156 RR D IN 1.57 Walker seat attachment

E0156 UE D IN 11.76 Walker seat attachment

E0157 NU D IN 56.08 Walker crutch attachment

E0157 RR D IN 5.61 Walker crutch attachment

E0157 UE D IN 42.06 Walker crutch attachment

E0158 NU D IN 21.04 Walker leg extenders set of4

E0158 RR D IN 2.10 Walker leg extenders set of4

E0158 UE D IN 15.78 Walker leg extenders set of4

E0159 NU D IN 14.61 Brake for wheeled walker

E0159 RR D IN 1.46 Brake for wheeled walker

E0159 UE D IN 10.96 Brake for wheeled walker

E0160 NU D IN 26.08 Sitz type bath or equipment

E0160 RR D IN 2.61 Sitz type bath or equipment

E0160 UE D IN 19.56 Sitz type bath or equipment

E0161 NU D IN 24.43 Sitz bath/equipment w/faucet

E0161 RR D IN 2.44 Sitz bath/equipment w/faucet

E0161 UE D IN 18.32 Sitz bath/equipment w/faucet

E0162 NU D IN 163.99 Sitz bath chair

E0162 RR D IN 17.20 Sitz bath chair

E0162 UE D IN 127.16 Sitz bath chair

E0163 NU D IN 53.29 Commode chair with fixed arm

E0163 RR D IN 5.33 Commode chair with fixed arm




E0163 UE D IN 39.97 Commode chair with fixed arm

E0165 RR D CR 12.27 Commode chair with detacharm

E0167 NU D IN 9.86 Commode chair pail or pan

E0167 RR D IN 0.99 Commode chair pail or pan

E0167 UE D IN 7.40 Commode chair pail or pan

E0168 NU D IN 117.53 Heavyduty/wide commode chair

E0168 RR D IN 11.75 Heavyduty/wide commode chair

E0168 UE D IN 88.15 Heavyduty/wide commode chair

E0170 RR D CR 157.74 Commode chair electric

E0171 RR D CR 28.99 Commode chair non-electric

E0175 NU D IN 74.55 Commode chair foot rest

E0175 RR D IN 7.45 Commode chair foot rest

E0175 UE D IN 54.87 Commode chair foot rest

E0181 RR D CR 15.44 Press pad alternating w/ pum

E0182 RR D CR 19.15 Replace pump, alt press pad

E0184 NU D IN 157.86 Dry pressure mattress

E0184 RR D IN 15.79 Dry pressure mattress

E0184 UE D IN 118.40 Dry pressure mattress

E0185 NU D IN 168.56 Gel pressure mattress pad

E0185 RR D IN 16.86 Gel pressure mattress pad

E0185 UE D IN 126.42 Gel pressure mattress pad

E0186 RR D CR 17.59 Air pressure mattress

E0187 RR D CR 19.18 Water pressure mattress

E0188 NU D IN 23.47 Synthetic sheepskin pad

E0188 RR D IN 2.35 Synthetic sheepskin pad

E0188 UE D IN 17.60 Synthetic sheepskin pad

E0189 NU D IN 48.74 Lambswool sheepskin pad

E0189 RR D IN 4.87 Lambswool sheepskin pad

E0189 UE D IN 36.55 Lambswool sheepskin pad

E0191 NU D IN 9.56 Protector heel or elbow

E0191 RR D IN 0.99 Protector heel or elbow

E0191 UE D IN 7.13 Protector heel or elbow

E0193 RR D CR 675.35 Powered air flotation bed

E0194 RR D CR 3239.15 Air fluidized bed

E0196 RR D CR 29.45 Gel pressure mattress

E0197 RR D CR 16.49 Air pressure pad for mattres

E0198 RR D CR 24.94 Water pressure pad for mattr

E0199 NU D IN 28.85 Dry pressure pad for mattres

E0199 RR D IN 2.89 Dry pressure pad for mattres

E0199 UE D IN 21.64 Dry pressure pad for mattres

E0200 NU D IN 89.23 Heat lamp without stand

E0200 RR D IN 12.11 Heat lamp without stand

E0200 UE D IN 66.96 Heat lamp without stand

E0202 RR D CR 70.47 Phototherapy light w/ photom

E0205 NU D IN 218.42 Heat lamp with stand

E0205 RR D IN 24.02 Heat lamp with stand




E0205 UE D IN 163.81 Heat lamp with stand

E0210 NU D IN 31.23 Electric heat pad standard

E0210 RR D IN 2.94 Electric heat pad standard

E0210 UE D IN 23.42 Electric heat pad standard

E0215 NU D IN 79.74 Electric heat pad moist

E0215 RR D IN 8.34 Electric heat pad moist

E0215 UE D IN 59.81 Electric heat pad moist

E0217 NU D IN 558.78 Water circ heat pad w pump

E0217 RR D IN 62.21 Water circ heat pad w pump

E0217 UE D IN 419.05 Water circ heat pad w pump

E0225 NU D IN 437.42 Hydrocollator unit

E0225 RR D IN 43.12 Hydrocollator unit

E0225 UE D IN 328.06 Hydrocollator unit

E0235 RR D CR 16.50 Paraffin bath unit portable

E0236 RR D CR 49.79 Pump for water circulating p

E0239 NU D IN 430.34 Hydrocollator unit portable

E0239 RR D IN 43.04 Hydrocollator unit portable

E0239 UE D IN 322.76 Hydrocollator unit portable

E0249 NU D IN 112.11 Pad water circulating heat u

E0249 RR D IN 12.32 Pad water circulating heat u

E0249 UE D IN 84.08 Pad water circulating heat u

E0250 RR D CR 60.09 Hosp bed fixed ht w/ mattres

E0251 RR D CR 55.54 Hosp bed fixd ht w/o mattres

E0255 RR D CR 60.86 Hospital bed var ht w/ mattr

E0256 RR D CR 57.92 Hospital bed var ht w/o matt

E0260 RR D CR 61.04 Hosp bed semi-electr w/ matt

E0261 RR D CR 60.80 Hosp bed semi-electr w/o mat

E0265 RR D CR 139.64 Hosp bed total electr w/ mat

E0266 RR D CR 121.51 Hosp bed total elec w/o matt

E0271 NU D IN 123.89 Mattress innerspring

E0271 RR D IN 12.39 Mattress innerspring

E0271 UE D IN 92.92 Mattress innerspring

E0272 NU D IN 139.13 Mattress foam rubber

E0272 RR D IN 13.91 Mattress foam rubber

E0272 UE D IN 104.35 Mattress foam rubber

E0275 NU D IN 13.31 Bed pan standard

E0275 RR D IN 1.33 Bed pan standard

E0275 UE D IN 9.99 Bed pan standard

E0276 NU D IN 11.10 Bed pan fracture

E0276 RR D IN 1.11 Bed pan fracture

E0276 UE D IN 8.32 Bed pan fracture

E0277 RR D CR 196.44 Powered pres-redu air mattrs

E0280 NU D IN 29.81 Bed cradle

E0280 RR D IN 2.98 Bed cradle

E0280 UE D IN 22.36 Bed cradle

E0290 RR D CR 55.13 Hosp bed fx ht w/o rails w/m




E0291 RR D CR 41.97 Hosp bed fx ht w/o rail w/o

E0292 RR D CR 58.41 Hosp bed var ht no sr w/matt

E0293 RR D CR 53.25 Hosp bed var ht no sr no mat

E0294 RR D CR 60.93 Hosp bed semi-elect w/ mattr

E0295 RR D CR 60.80 Hosp bed semi-elect w/o matt

E0296 RR D CR 108.95 Hosp bed total elect w/ matt

E0297 RR D CR 96.15 Hosp bed total elect w/o mat

E0300 RR D CR 242.78 Enclosed ped crib hosp grade

E0301 RR D CR 163.93 Hd hosp bed, 350-600 lbs

E0302 RR D CR 471.43 Ex hd hosp bed > 600 lbs

E0303 RR D CR 167.05 Hosp bed hvy dty xtra wide

E0304 RR D CR 489.71 Hosp bed xtra hvy dty x wide

E0305 RR D CR 10.73 Rails bed side half length

E0310 NU D IN 113.43 Rails bed side full length

E0310 RR D IN 11.34 Rails bed side full length

E0310 UE D IN 85.08 Rails bed side full length

E0316 RR D CR 177.29 Bed safety enclosure

E0325 NU D IN 8.60 Urinal male jug-type

E0325 RR D IN 0.86 Urinal male jug-type

E0325 UE D IN 6.40 Urinal male jug-type

E0326 NU D IN 9.21 Urinal female jug-type

E0326 RR D IN 0.92 Urinal female jug-type

E0326 UE D IN 6.91 Urinal female jug-type

E0371 RR D CR 196.44 Nonpower mattress overlay

E0372 RR D CR 196.44 Powered air mattress overlay

E0373 RR D CR 196.44 Nonpowered pressure mattress

E0424 RR D OX 70.23 Stationary compressed gas 02

E0424 RR QB D OX 70.23 Stationary compressed gas 02

E0424 RR QF D OX 70.23 Stationary compressed gas 02

E0431 RR D OX 17.29 Portable gaseous 02

E0431 RR QB D OX 35.12 Portable gaseous 02

E0431 RR QF D OX 35.12 Portable gaseous 02

E0433 RR D OX 37.44 Portable liquid oxygen sys

E0433 RR QB D OX 37.44 Portable liquid oxygen sys

E0433 RR QF D OX 37.44 Portable liquid oxygen sys

E0434 RR D OX 17.29 Portable liquid 02

E0434 RR QB D OX 35.12 Portable liquid 02

E0434 RR QF D OX 35.12 Portable liquid 02

E0439 RR D OX 70.23 Stationary liquid 02

E0439 RR QB D OX 70.23 Stationary liquid 02

E0439 RR QF D OX 70.23 Stationary liquid 02

E0441 D OX 53.32 Stationary o2 contents, gas

E0442 D OX 53.32 Stationary o2 contents, liq

E0443 D OX 48.31 Portable 02 contents, gas

E0444 D OX 48.31 Portable 02 contents, liquid

E0462 RR D CR 327.98 Rocking bed w/ or w/o side r




E0465 RR D FS 1074.31 Home vent invasive interface

E0466 RR D FS 1074.31 Home vent non-invasive inter

E0470 RR D CR 104.60 Rad w/o backup non-inv intfc

E0471 RR D CR 257.60 Rad w/backup non inv intrfc

E0472 RR D CR 389.42 Rad w backup invasive intrfc

E0480 RR D CR 42.04 Percussor elect/pneum home m

E0482 RR D CR 453.72 Cough stimulating device

E0483 RR D CR 1196.55 Chest compression gen system

E0484 NU D IN 41.57 Non-elec oscillatory pep dvc

E0484 RR D IN 4.15 Non-elec oscillatory pep dvc

E0484 UE D IN 31.18 Non-elec oscillatory pep dvc

E0485 NU D IN 0.00 Oral device/appliance prefab

E0485 RR D IN 0.00 Oral device/appliance prefab

E0485 UE D IN 0.00 Oral device/appliance prefab

E0486 NU D IN 0.00 Oral device/appliance cusfab

E0486 RR D IN 0.00 Oral device/appliance cusfab

E0486 UE D IN 0.00 Oral device/appliance cusfab

E0500 RR D FS 105.03 Ippb all types

E0550 RR D CR 56.42 Humidif extens supple w ippb

E0560 NU D IN 153.99 Humidifier supplemental w/ i

E0560 RR D IN 16.57 Humidifier supplemental w/ i

E0560 UE D IN 115.49 Humidifier supplemental w/ i

E0561 NU D IN 72.02 Humidifier nonheated w pap

E0561 RR D IN 7.20 Humidifier nonheated w pap

E0561 UE D IN 54.02 Humidifier nonheated w pap

E0562 NU D IN 135.74 Humidifier heated used w pap

E0562 RR D IN 13.57 Humidifier heated used w pap

E0562 UE D IN 101.81 Humidifier heated used w pap

E0565 RR D CR 40.59 Compressor air power source

E0570 RR D CR 5.75 Nebulizer with compression

E0572 RR D CR 30.80 Aerosol compressor adjust pr

E0574 RR D CR 42.70 Ultrasonic generator w svneb

E0575 RR D CR 115.68 Nebulizer ultrasonic

E0580 NU D IN 126.72 Nebulizer for use w/ regulat

E0580 RR D IN 12.67 Nebulizer for use w/ regulat

E0580 UE D IN 95.04 Nebulizer for use w/ regulat

E0585 RR D CR 29.05 Nebulizer w/ compressor & he

E0600 RR D CR 43.80 Suction pump portab hom modl

E0601 RR D CR 40.56 Cont airway pressure device

E0602 NU D IN 33.22 Manual breast pump

E0602 RR D IN 3.34 Manual breast pump

E0602 UE D IN 24.92 Manual breast pump

E0605 NU D IN 29.74 Vaporizer room type

E0605 RR D IN 3.44 Vaporizer room type

E0605 UE D IN 24.52 Vaporizer room type

E0606 RR D CR 25.84 Drainage board postural




E0607 NU D IN 75.20 Blood glucose monitor home

E0607 RR D IN 7.51 Blood glucose monitor home

E0607 UE D IN 56.39 Blood glucose monitor home

E0610 NU D IN 267.70 Pacemaker monitr audible/vis

E0610 RR D IN 28.23 Pacemaker monitr audible/vis

E0610 UE D IN 200.80 Pacemaker monitr audible/vis

E0615 NU D IN 538.89 Pacemaker monitr digital/vis

E0615 RR D IN 65.84 Pacemaker monitr digital/vis

E0615 UE D IN 404.20 Pacemaker monitr digital/vis

E0617 RR D CR 342.19 Automatic ext defibrillator

E0617 RR KF D CR 379.94 Automatic ext defibrillator

E0618 RR D CR 315.55 Apnea monitor

E0619 RR D CR 0.00 Apnea monitor w recorder

E0620 RR D CR 98.40 Cap bld skin piercing laser

E0621 NU D IN 77.91 Patient lift sling or seat

E0621 RR D IN 7.79 Patient lift sling or seat

E0621 UE D IN 58.43 Patient lift sling or seat

E0627 NU D IN 253.13 Seat lift mech, electric any

E0627 RR D IN 25.31 Seat lift mech, electric any

E0627 UE D IN 189.85 Seat lift mech, electric any

E0629 NU D IN 251.99 Seat lift mech, non-electric

E0629 RR D IN 25.20 Seat lift mech, non-electric

E0629 UE D IN 188.99 Seat lift mech, non-electric

E0630 RR D CR 57.84 Patient lift hydraulic

E0635 RR D CR 113.16 Patient lift electric

E0636 RR D CR 956.24 Pt support & positioning sys

E0639 RR D CR 125.55 Moveable patient lift system

E0640 RR D CR 125.55 Fixed patient lift system

E0650 NU D IN 689.00 Pneuma compresor non-segment

E0650 RR D IN 100.03 Pneuma compresor non-segment

E0650 UE D IN 516.75 Pneuma compresor non-segment

E0651 NU D IN 1033.67 Pneum compressor segmental

E0651 RR D IN 105.60 Pneum compressor segmental

E0651 UE D IN 775.27 Pneum compressor segmental

E0652 NU D IN 5966.74 Pneum compres w/cal pressure

E0652 RR D IN 589.69 Pneum compres w/cal pressure

E0652 UE D IN 4471.06 Pneum compres w/cal pressure

E0655 NU D IN 103.72 Pneumatic appliance half arm

E0655 RR D IN 12.14 Pneumatic appliance half arm

E0655 UE D IN 77.82 Pneumatic appliance half arm

E0656 RR D CR 65.04 Segmental pneumatic trunk

E0657 RR D CR 61.09 Segmental pneumatic chest

E0660 NU D IN 164.89 Pneumatic appliance full leg

E0660 RR D IN 16.49 Pneumatic appliance full leg

E0660 UE D IN 123.65 Pneumatic appliance full leg

E0665 NU D IN 154.19 Pneumatic appliance full arm




E0665 RR D IN 15.83 Pneumatic appliance full arm

E0665 UE D IN 115.78 Pneumatic appliance full arm

E0666 NU D IN 152.37 Pneumatic appliance half leg

E0666 RR D IN 15.28 Pneumatic appliance half leg

E0666 UE D IN 114.27 Pneumatic appliance half leg

E0667 NU D IN 364.40 Seg pneumatic appl full leg

E0667 RR D IN 41.15 Seg pneumatic appl full leg

E0667 UE D IN 273.30 Seg pneumatic appl full leg

E0668 NU D IN 497.33 Seg pneumatic appl full arm

E0668 RR D IN 49.08 Seg pneumatic appl full arm

E0668 UE D IN 373.01 Seg pneumatic appl full arm

E0669 NU D IN 206.32 Seg pneumatic appli half leg

E0669 RR D IN 20.64 Seg pneumatic appli half leg

E0669 UE D IN 154.77 Seg pneumatic appli half leg

E0670 NU D IN 1414.80 Seg pneum int legs/trunk

E0670 RR D IN 151.46 Seg pneum int legs/trunk

E0670 UE D IN 1061.05 Seg pneum int legs/trunk

E0671 NU D IN 467.48 Pressure pneum appl full leg

E0671 RR D IN 46.77 Pressure pneum appl full leg

E0671 UE D IN 350.59 Pressure pneum appl full leg

E0672 NU D IN 363.22 Pressure pneum appl full arm

E0672 RR D IN 36.34 Pressure pneum appl full arm

E0672 UE D IN 272.43 Pressure pneum appl full arm

E0673 NU D IN 301.82 Pressure pneum appl half leg

E0673 RR D IN 30.19 Pressure pneum appl half leg

E0673 UE D IN 226.40 Pressure pneum appl half leg

E0675 RR D CR 432.81 Pneumatic compression device

E0691 NU D IN 1011.35 Uvl pnl 2 sq ft or less

E0691 RR D IN 101.13 Uvl pnl 2 sq ft or less

E0691 UE D IN 758.52 Uvl pnl 2 sq ft or less

E0692 NU D IN 1269.99 Uvl sys panel 4 ft

E0692 RR D IN 126.98 Uvl sys panel 4 ft

E0692 UE D IN 952.48 Uvl sys panel 4 ft

E0693 NU D IN 1565.53 Uvl sys panel 6 ft

E0693 RR D IN 156.56 Uvl sys panel 6 ft

E0693 UE D IN 1174.15 Uvl sys panel 6 ft

E0694 NU D IN 4982.94 Uvl md cabinet sys 6 ft

E0694 RR D IN 498.29 Uvl md cabinet sys 6 ft

E0694 UE D IN 3737.23 Uvl md cabinet sys 6 ft

E0705 NU D IN 48.00 Transfer device

E0705 NU KU D IN 62.05 Transfer device

E0705 RR D IN 4.80 Transfer device

E0705 RR KU D IN 6.24 Transfer device

E0705 UE D IN 36.00 Transfer device

E0705 UE KU D IN 45.43 Transfer device

E0720 NU D TE 71.36 Tens two lead




E0730 NU D TE 72.11 Tens four lead

E0731 NU D IN 89.39 Conductive garment for tens/

E0740 RR D CR 58.86 Non-implant pelv flr e-stim

E0744 RR D CR 87.60 Neuromuscular stim for scoli

E0745 RR D CR 85.64 Neuromuscular stim for shock

E0747 NU KF D IN 4407.51 Elec osteogen stim not spine

E0747 RR KF D IN 437.98 Elec osteogen stim not spine

E0747 UE KF D IN 3274.70 Elec osteogen stim not spine

E0748 NU KF D IN 4378.96 Elec osteogen stim spinal

E0748 RR KF D IN 437.87 Elec osteogen stim spinal

E0748 UE KF D IN 3284.22 Elec osteogen stim spinal

E0749 RR KF L CR 272.04 Elec osteogen stim implanted

E0760 NU KF D IN 3638.84 Osteogen ultrasound stimltor

E0760 RR KF D IN 363.89 Osteogen ultrasound stimltor

E0760 UE KF D IN 2729.10 Osteogen ultrasound stimltor

E0762 RR D CR 123.75 Trans elec jt stim dev sys

E0764 RR KF D CR 1245.54 Functional neuromuscularstim

E0765 NU D IN 94.69 Nerve stimulator for tx n&v

E0765 RR D IN 9.48 Nerve stimulator for tx n&v

E0765 UE D IN 71.04 Nerve stimulator for tx n&v

E0776 NU D IN 139.97 Iv pole

E0776 RR D IN 14.00 Iv pole

E0776 UE D IN 104.98 Iv pole

E0779 RR D CR 17.77 Amb infusion pump mechanical

E0780 NU D IN 11.55 Mech amb infusion pump <8hrs

E0781 RR D CR 235.66 External ambulatory infus pu

E0782 NU KF L IN 4832.21 Non-programble infusion pump

E0782 RR KF L IN 483.24 Non-programble infusion pump

E0782 UE KF L IN 3624.15 Non-programble infusion pump

E0783 NU KF L IN 7832.15 Programmable infusion pump

E0783 RR KF L IN 783.24 Programmable infusion pump

E0783 UE KF L IN 5874.13 Programmable infusion pump

E0784 RR D CR 424.92 Ext amb infusn pump insulin

E0785 KF L IN 452.04 Replacement impl pump cathet

E0786 NU KF L IN 8987.98 Implantable pump replacement

E0786 RR KF L IN 898.78 Implantable pump replacement

E0786 UE KF L IN 6740.99 Implantable pump replacement

E0791 RR D CR 279.97 Parenteral infusion pump sta

E0840 NU D IN 70.09 Tract frame attach headboard

E0840 RR D IN 15.62 Tract frame attach headboard

E0840 UE D IN 52.55 Tract frame attach headboard

E0849 RR D CR 58.01 Cervical pneum trac equip

E0850 NU D IN 108.32 Traction stand free standing

E0850 RR D IN 13.80 Traction stand free standing

E0850 UE D IN 81.26 Traction stand free standing

E0855 RR D CR 56.57 Cervical traction equipment




E0856 RR D CR 17.32 Cervic collar w air bladders

E0860 NU D IN 38.39 Tract equip cervical tract

E0860 RR D IN 6.23 Tract equip cervical tract

E0860 UE D IN 30.07 Tract equip cervical tract

E0870 NU D IN 111.27 Tract frame attach footboard

E0870 RR D IN 12.83 Tract frame attach footboard

E0870 UE D IN 83.83 Tract frame attach footboard

E0880 NU D IN 120.11 Trac stand free stand extrem

E0880 RR D IN 18.85 Trac stand free stand extrem

E0880 UE D IN 90.91 Trac stand free stand extrem

E0890 NU D IN 115.18 Traction frame attach pelvic

E0890 RR D IN 31.41 Traction frame attach pelvic

E0890 UE D IN 92.79 Traction frame attach pelvic

E0900 NU D IN 122.58 Trac stand free stand pelvic

E0900 RR D IN 26.43 Trac stand free stand pelvic

E0900 UE D IN 91.96 Trac stand free stand pelvic

E0910 RR D CR 10.90 Trapeze bar attached to bed

E0911 RR D CR 41.40 Hd trapeze bar attach to bed

E0912 RR D CR 83.10 Hd trapeze bar free standing

E0920 RR D CR 51.95 Fracture frame attached to b

E0930 RR D CR 51.41 Fracture frame free standing

E0935 RR D FS 21.76 Cont pas motion exercise dev

E0940 RR D CR 20.56 Trapeze bar free standing

E0941 RR D CR 48.85 Gravity assisted traction de

E0942 NU D IN 18.98 Cervical head harness/halter

E0942 RR D IN 2.25 Cervical head harness/halter

E0942 UE D IN 14.22 Cervical head harness/halter

E0944 NU D IN 48.81 Pelvic belt/harness/boot

E0944 RR D IN 4.89 Pelvic belt/harness/boot

E0944 UE D IN 36.62 Pelvic belt/harness/boot

E0945 NU D IN 42.40 Belt/harness extremity

E0945 RR D IN 4.24 Belt/harness extremity

E0945 UE D IN 32.82 Belt/harness extremity

E0946 RR D CR 56.60 Fracture frame dual w cross

E0947 NU D IN 594.56 Fracture frame attachmnts pe

E0947 RR D IN 60.15 Fracture frame attachmnts pe

E0947 UE D IN 445.89 Fracture frame attachmnts pe

E0948 NU D IN 594.56 Fracture frame attachmnts ce

E0948 RR D IN 58.01 Fracture frame attachmnts ce

E0948 UE D IN 445.89 Fracture frame attachmnts ce

E0950 NU D IN 73.80 Tray

E0950 NU KU D IN 100.84 Tray

E0950 RR D IN 7.38 Tray

E0950 RR KU D IN 10.11 Tray

E0950 UE D IN 55.35 Tray

E0950 UE KU D IN 75.63 Tray




E0951 NU D IN 12.77 Loop heel

E0951 NU KU D IN 16.66 Loop heel

E0951 RR D IN 1.28 Loop heel

E0951 RR KU D IN 1.66 Loop heel

E0951 UE D IN 9.58 Loop heel

E0951 UE KU D IN 12.50 Loop heel

E0952 NU D IN 15.53 Toe loop/holder, each

E0952 NU KU D IN 15.54 Toe loop/holder, each

E0952 RR D IN 1.57 Toe loop/holder, each

E0952 RR KU D IN 1.61 Toe loop/holder, each

E0952 UE D IN 11.65 Toe loop/holder, each

E0952 UE KU D IN 11.65 Toe loop/holder, each

E0953 NU D IN 72.90 W/c lateral thigh/knee sup

E0953 NU KU D IN 95.62 W/C LATERAL THIGH/KNEE SUP

E0953 RR D IN 7.29 W/c lateral thigh/knee sup

E0953 RR KU D IN 9.56 W/C LATERAL THIGH/KNEE SUP

E0953 UE D IN 54.68 W/c lateral thigh/knee sup

E0953 UE KU D IN 71.72 W/C LATERAL THIGH/KNEE SUP

E0954 NU D IN 50.68 Foot box, any type each foot

E0954 NU KU D IN 55.75 FOOT BOX, ANY TYPE EACH FOOT

E0954 RR D IN 5.09 Foot box, any type each foot

E0954 RR KU D IN 5.58 FOOT BOX, ANY TYPE EACH FOOT

E0954 UE D IN 38.01 Foot box, any type each foot

E0954 UE KU D IN 41.81 FOOT BOX, ANY TYPE EACH FOOT

E0955 RR D CR 13.83 Cushioned headrest

E0955 RR KU D CR 19.62 Cushioned headrest

E0956 NU D IN 72.90 W/c lateral trunk/hip suppor

E0956 NU KU D IN 95.62 W/c lateral trunk/hip suppor

E0956 RR D IN 7.29 W/c lateral trunk/hip suppor

E0956 RR KU D IN 9.56 W/c lateral trunk/hip suppor

E0956 UE D IN 54.68 W/c lateral trunk/hip suppor

E0956 UE KU D IN 71.72 W/c lateral trunk/hip suppor

E0957 NU D IN 115.66 W/c medial thigh support

E0957 NU KU D IN 133.81 W/c medial thigh support

E0957 RR D IN 11.57 W/c medial thigh support

E0957 RR KU D IN 13.39 W/c medial thigh support

E0957 UE D IN 86.75 W/c medial thigh support

E0957 UE KU D IN 100.35 W/c medial thigh support

E0958 RR D CR 39.46 Whlchr att- conv 1 arm drive

E0959 NU D IN 41.32 Amputee adapter

E0959 RR D IN 4.13 Amputee adapter

E0959 UE D IN 30.99 Amputee adapter

E0960 NU D IN 70.07 W/c shoulder harness/straps

E0960 NU KU D IN 88.26 W/c shoulder harness/straps

E0960 RR D IN 7.01 W/c shoulder harness/straps

E0960 RR KU D IN 8.85 W/c shoulder harness/straps




E0960 UE D IN 52.56 W/c shoulder harness/straps

E0960 UE KU D IN 66.21 W/c shoulder harness/straps

E0961 NU D IN 19.23 Wheelchair brake extension

E0961 RR D IN 1.92 Wheelchair brake extension

E0961 UE D IN 14.21 Wheelchair brake extension

E0966 NU D IN 66.33 Wheelchair head rest extensi

E0966 RR D IN 6.63 Wheelchair head rest extensi

E0966 UE D IN 49.75 Wheelchair head rest extensi

E0967 NU D IN 69.20 Man wc rim/projection rep ea

E0967 RR D IN 6.92 Man wc rim/projection rep ea

E0967 UE D IN 51.90 Man wc rim/projection rep ea

E0968 RR D CR 18.40 Wheelchair commode seat

E0969 NU D IN 176.11 Wheelchair narrowing device

E0969 RR D IN 17.45 Wheelchair narrowing device

E0969 UE D IN 132.08 Wheelchair narrowing device

E0971 NU D IN 29.94 Wheelchair anti-tipping devi

E0971 RR D IN 3.00 Wheelchair anti-tipping devi

E0971 UE D IN 22.46 Wheelchair anti-tipping devi

E0973 NU D IN 55.12 W/ch access det adj armrest

E0973 NU KU D IN 105.16 W/ch access det adj armrest

E0973 RR D IN 5.51 W/ch access det adj armrest

E0973 RR KU D IN 10.51 W/ch access det adj armrest

E0973 UE D IN 41.34 W/ch access det adj armrest

E0973 UE KU D IN 78.88 W/ch access det adj armrest

E0974 NU D IN 69.97 W/ch access anti-rollback

E0974 RR D IN 7.00 W/ch access anti-rollback

E0974 UE D IN 52.48 W/ch access anti-rollback

E0978 NU D IN 24.17 W/c acc,saf belt pelv strap

E0978 NU KU D IN 36.92 W/c acc,saf belt pelv strap

E0978 RR D IN 2.42 W/c acc,saf belt pelv strap

E0978 RR KU D IN 3.69 W/c acc,saf belt pelv strap

E0978 UE D IN 18.13 W/c acc,saf belt pelv strap

E0978 UE KU D IN 27.58 W/c acc,saf belt pelv strap

E0980 NU D IN 31.62 Wheelchair safety vest

E0980 RR D IN 3.17 Wheelchair safety vest

E0980 UE D IN 23.58 Wheelchair safety vest

E0981 NU D IN 39.44 Seat upholstery, replacement

E0981 NU KU D IN 44.46 Seat upholstery, replacement

E0981 RR D IN 3.95 Seat upholstery, replacement

E0981 RR KU D IN 4.43 Seat upholstery, replacement

E0981 UE D IN 29.58 Seat upholstery, replacement

E0981 UE KU D IN 33.45 Seat upholstery, replacement

E0982 NU D IN 43.33 Back upholstery, replacement

E0982 NU KU D IN 43.33 Back upholstery, replacement

E0982 RR D IN 4.33 Back upholstery, replacement

E0982 RR KU D IN 4.33 Back upholstery, replacement




E0982 UE D IN 32.61 Back upholstery, replacement

E0982 UE KU D IN 32.60 Back upholstery, replacement

E0983 RR D CR 258.74 Add pwr joystick

E0984 RR D CR 215.02 Add pwr tiller

E0985 RR D CR 20.27 W/c seat lift mechanism

E0985 RR KU D CR 22.85 W/c seat lift mechanism

E0986 RR D CR 547.48 Man w/c push-rim powr system

E0988 RR D CR 336.92 Lever-activated wheel drive

E0990 NU D IN 72.72 Wheelchair elevating leg res

E0990 NU KU D IN 106.88 Wheelchair elevating leg res

E0990 RR D IN 7.27 Wheelchair elevating leg res

E0990 RR KU D IN 10.91 Wheelchair elevating leg res

E0990 UE D IN 54.54 Wheelchair elevating leg res

E0990 UE KU D IN 80.16 Wheelchair elevating leg res

E0992 NU D IN 78.57 Wheelchair solid seat insert

E0992 RR D IN 7.86 Wheelchair solid seat insert

E0992 UE D IN 58.93 Wheelchair solid seat insert

E0994 NU D IN 19.50 Wheelchair arm rest

E0994 RR D IN 1.95 Wheelchair arm rest

E0994 UE D IN 14.63 Wheelchair arm rest

E0995 NU D IN 25.34 Wc calf rest, pad replacemnt

E0995 NU KU D IN 29.48 Wc calf rest, pad replacemnt

E0995 RR D IN 2.53 Wc calf rest, pad replacemnt

E0995 RR KU D IN 2.96 Wc calf rest, pad replacemnt

E0995 UE D IN 19.01 Wc calf rest, pad replacemnt

E0995 UE KU D IN 22.09 Wc calf rest, pad replacemnt

E1002 RR D CR 351.70 Pwr seat tilt

E1002 RR KU D CR 393.17 Pwr seat tilt

E1003 RR D CR 411.66 Pwr seat recline

E1003 RR KU D CR 425.99 Pwr seat recline

E1004 RR D CR 452.47 Pwr seat recline mech

E1004 RR KU D CR 472.32 Pwr seat recline mech

E1005 RR D CR 494.97 Pwr seat recline pwr

E1005 RR KU D CR 511.25 Pwr seat recline pwr

E1006 RR D CR 610.28 Pwr seat combo w/o shear

E1006 RR KU D CR 626.23 Pwr seat combo w/o shear

E1007 RR D CR 757.54 Pwr seat combo w/shear

E1007 RR KU D CR 847.97 Pwr seat combo w/shear

E1008 RR D CR 777.02 Pwr seat combo pwr shear

E1008 RR KU D CR 848.03 Pwr seat combo pwr shear

E1009 NU D IN 0.00 Add mech leg elevation

E1009 RR D IN 0.00 Add mech leg elevation

E1009 UE D IN 0.00 Add mech leg elevation

E1010 RR D CR 105.59 Add pwr leg elevation

E1010 RR KU D CR 110.96 Add pwr leg elevation

E1011 NU D IN 0.00 Ped wc modify width adjustm




E1011 RR D IN 0.00 Ped wc modify width adjustm

E1011 UE D IN 0.00 Ped wc modify width adjustm

E1012 RR D CR 105.59 Ctr mount pwr elev leg rest

E1012 RR KU D CR 110.96 Ctr mount pwr elev leg rest

E1014 RR D CR 41.11 Reclining back add ped w/c

E1015 NU D IN 114.29 Shock absorber for man w/c

E1015 RR D IN 11.43 Shock absorber for man w/c

E1015 UE D IN 85.72 Shock absorber for man w/c

E1016 NU D IN 104.27 Shock absorber for power w/c

E1016 NU KU D IN 127.40 Shock absorber for power w/c

E1016 RR D IN 10.43 Shock absorber for power w/c

E1016 RR KU D IN 12.76 Shock absorber for power w/c

E1016 UE D IN 78.20 Shock absorber for power w/c

E1016 UE KU D IN 95.53 Shock absorber for power w/c

E1017 NU D IN 0.00 Hd shck absrbr for hd man wc

E1017 RR D IN 0.00 Hd shck absrbr for hd man wc

E1017 UE D IN 0.00 Hd shck absrbr for hd man wc

E1018 NU D IN 0.00 Hd shck absrber for hd powwc

E1018 RR D IN 0.00 Hd shck absrber for hd powwc

E1018 UE D IN 0.00 Hd shck absrber for hd powwc

E1020 RR D CR 17.51 Residual limb support system

E1020 RR KU D CR 23.60 Residual limb support system

E1028 RR D CR 13.42 W/c manual swingaway

E1028 RR KU D CR 20.03 W/c manual swingaway

E1029 RR D CR 35.58 W/c vent tray fixed

E1029 RR KU D CR 35.84 W/c vent tray fixed

E1030 RR D CR 111.12 W/c vent tray gimbaled

E1030 RR KU D CR 113.04 W/c vent tray gimbaled

E1031 RR D CR 41.11 Rollabout chair with casters

E1035 RR D CR 572.73 Patient transfer system <300

E1036 RR D CR 815.30 Patient transfer system >300

E1037 RR D CR 101.26 Transport chair, ped size

E1038 RR D CR 14.87 Transport chair pt wt<=300lb

E1039 RR D CR 31.60 Transport chair pt wt >300lb

E1050 RR D CR 97.43 Whelchr fxd full length arms

E1060 RR D CR 120.60 Wheelchair detachable arms

E1070 RR D CR 104.79 Wheelchair detachable foot r

E1083 RR D CR 75.33 Hemi-wheelchair fixed arms

E1084 RR D CR 93.85 Hemi-wheelchair detachable a

E1087 RR D CR 142.41 Wheelchair lightwt fixed arm

E1088 RR D CR 169.70 Wheelchair lightweight det a

E1092 RR D CR 144.64 Wheelchair wide w/ leg rests

E1093 RR D CR 109.26 Wheelchair wide w/ foot rest

E1100 RR D CR 99.30 Whchr s-recl fxd arm leg res

E1110 RR D CR 109.43 Wheelchair semi-recl detach

E1150 RR D CR 78.04 Wheelchair standard w/ leg r




E1160 RR D CR 59.80 Wheelchair fixed arms

E1161 RR D CR 266.30 Manual adult wc w tiltinspac

E1170 RR D CR 85.45 Whlchr ampu fxd arm leg rest

E1171 RR D CR 76.68 Wheelchair amputee w/o leg r

E1172 RR D CR 110.26 Wheelchair amputee detach ar

E1180 RR D CR 114.05 Wheelchair amputee w/ foot r

E1190 RR D CR 131.77 Wheelchair amputee w/ leg re

E1195 RR D CR 141.39 Wheelchair amputee heavy dut

E1200 RR D CR 97.93 Wheelchair amputee fixed arm

E1221 RR D CR 47.12 Wheelchair spec size w foot

E1222 RR D CR 64.85 Wheelchair spec size w/ leg

E1223 RR D CR 72.01 Wheelchair spec size w foot

E1224 RR D CR 77.63 Wheelchair spec size w/ leg

E1225 RR D CR 36.56 Manual semi-reclining back

E1226 NU D IN 385.78 Manual fully reclining back

E1226 RR D IN 38.58 Manual fully reclining back

E1226 UE D IN 289.33 Manual fully reclining back

E1227 NU D IN 312.33 Wheelchair spec sz spec ht a

E1227 RR D IN 31.24 Wheelchair spec sz spec ht a

E1227 UE D IN 234.27 Wheelchair spec sz spec ht a

E1228 RR D CR 26.81 Wheelchair spec sz spec ht b

E1230 NU D IN 2268.16 Power operated vehicle

E1230 RR D IN 226.83 Power operated vehicle

E1230 UE D IN 1711.30 Power operated vehicle

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

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

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

E1232 RR D CR 240.69 Folding ped wc tilt-in-space

E1233 RR D CR 249.37 Rig ped wc tltnspc w/o seat

E1234 RR D CR 217.11 Fld ped wc tltnspc w/o seat

E1235 RR D CR 209.07 Rigid ped wc adjustable

E1236 RR D CR 184.44 Folding ped wc adjustable

E1237 RR D CR 186.05 Rgd ped wc adjstabl w/o seat

E1238 RR D CR 184.44 Fld ped wc adjstabl w/o seat

E1240 RR D CR 98.56 Whchr litwt det arm leg rest

E1270 RR D CR 75.52 Wheelchair lightweight leg r

E1280 RR D CR 125.57 Whchr h-duty det arm leg res

E1295 RR D CR 136.71 Wheelchair heavy duty fixed

E1296 NU D IN 487.83 Wheelchair special seat heig

E1296 RR D IN 48.78 Wheelchair special seat heig

E1296 UE D IN 365.90 Wheelchair special seat heig

E1297 NU D IN 102.12 Wheelchair special seat dept

E1297 RR D IN 11.12 Wheelchair special seat dept

E1297 UE D IN 76.61 Wheelchair special seat dept

E1298 NU D IN 476.83 Wheelchair spec seat depth/w

E1298 RR D IN 48.79 Wheelchair spec seat depth/w




E1298 UE D IN 357.61 Wheelchair spec seat depth/w

E1310 NU D IN 2416.89 Whirlpool non-portable

E1310 RR D IN 206.71 Whirlpool non-portable

E1310 UE D IN 1812.67 Whirlpool non-portable

E1353 D OX 31.88 Oxygen supplies regulator

E1355 D OX 24.02 Oxygen supplies stand/rack

E1372 NU D IN 127.32 Oxy suppl heater for nebuliz

E1372 RR D IN 12.73 Oxy suppl heater for nebuliz

E1372 UE D IN 95.49 Oxy suppl heater for nebuliz

E1390 RR D OX 70.23 Oxygen concentrator

E1390 RR QB D OX 70.23 Oxygen concentrator

E1390 RR QF D OX 70.23 Oxygen concentrator

E1391 RR D OX 70.23 Oxygen concentrator, dual

E1391 RR QB D OX 70.23 Oxygen concentrator, dual

E1391 RR QF D OX 70.23 Oxygen concentrator, dual

E1392 RR D OX 37.44 Portable oxygen concentrator

E1392 RR QB D OX 37.44 Portable oxygen concentrator

E1392 RR QF D OX 37.44 Portable oxygen concentrator

E1405 RR D OX 99.28 O2/water vapor enrich w/heat

E1406 RR D OX 75.88 O2/water vapor enrich w/o he

E1700 RR D CR 38.82 Jaw motion rehab system

E1701 D SU 11.93 Repl cushions for jaw motion

E1702 D SU 25.40 Repl measr scales jaw motion

E1800 RR D CR 117.20 Adjust elbow ext/flex device

E1801 RR D CR 136.12 Sps elbow device

E1802 RR D CR 367.82 Adjst forearm pro/sup device

E1805 RR D CR 120.88 Adjust wrist ext/flex device

E1806 RR D CR 111.73 Sps wrist device

E1810 RR D CR 119.19 Adjust knee ext/flex device

E1811 RR D CR 141.54 Sps knee device

E1812 RR D CR 96.78 Knee ext/flex w act res ctrl

E1815 RR D CR 120.88 Adjust ankle ext/flex device

E1816 RR D CR 143.77 Sps ankle device

E1818 RR D CR 146.73 Sps forearm device

E1820 NU D IN 92.00 Soft interface material

E1820 RR D IN 9.19 Soft interface material

E1820 UE D IN 69.01 Soft interface material

E1821 NU D IN 118.45 Replacement interface spsd

E1821 RR D IN 11.82 Replacement interface spsd

E1821 UE D IN 88.87 Replacement interface spsd

E1825 RR D CR 120.88 Adjust finger ext/flex devc

E1830 RR D CR 120.88 Adjust toe ext/flex device

E1831 RR D CR 74.37 Static str toe dev ext/flex

E1840 RR D CR 388.54 Adj shoulder ext/flex device

E1841 RR D CR 509.84 Static str shldr dev rom adj

E2000 RR D CR 54.67 Gastric suction pump hme mdl




E2100 NU D IN 723.90 Bld glucose monitor w voice

E2100 RR D IN 72.40 Bld glucose monitor w voice

E2100 UE D IN 542.93 Bld glucose monitor w voice

E2101 NU D IN 212.22 Bld glucose monitor w lance

E2101 RR D IN 21.22 Bld glucose monitor w lance

E2101 UE D IN 159.16 Bld glucose monitor w lance

E2120 RR D CR 319.10 Pulse gen sys tx endolymp fl

E2201 NU D IN 306.97 Man w/ch acc seat w>=20"<24"

E2201 RR D IN 30.70 Man w/ch acc seat w>=20"<24"

E2201 UE D IN 230.23 Man w/ch acc seat w>=20"<24"

E2202 NU D IN 431.44 Seat width 24-27 in

E2202 RR D IN 43.15 Seat width 24-27 in

E2202 UE D IN 323.58 Seat width 24-27 in

E2203 NU D IN 416.75 Frame depth less than 22 in

E2203 RR D IN 41.68 Frame depth less than 22 in

E2203 UE D IN 312.56 Frame depth less than 22 in

E2204 NU D IN 719.48 Frame depth 22 to 25 in

E2204 RR D IN 71.95 Frame depth 22 to 25 in

E2204 UE D IN 539.61 Frame depth 22 to 25 in

E2205 NU D IN 33.41 Manual wc accessory, handrim

E2205 RR D IN 3.34 Manual wc accessory, handrim

E2205 UE D IN 25.06 Manual wc accessory, handrim

E2206 NU D IN 36.63 Man wc whl lock comp repl ea

E2206 RR D IN 3.66 Man wc whl lock comp repl ea

E2206 UE D IN 27.47 Man wc whl lock comp repl ea

E2207 NU D IN 42.33 Crutch and cane holder

E2207 NU KU D IN 48.79 Crutch and cane holder

E2207 RR D IN 4.23 Crutch and cane holder

E2207 RR KU D IN 4.89 Crutch and cane holder

E2207 UE D IN 31.75 Crutch and cane holder

E2207 UE KU D IN 36.60 Crutch and cane holder

E2208 NU D IN 77.25 Cylinder tank carrier

E2208 NU KU D IN 115.23 Cylinder tank carrier

E2208 RR D IN 7.73 Cylinder tank carrier

E2208 RR KU D IN 11.52 Cylinder tank carrier

E2208 UE D IN 57.94 Cylinder tank carrier

E2208 UE KU D IN 86.42 Cylinder tank carrier

E2209 NU D IN 78.68 Arm trough each

E2209 NU KU D IN 103.95 Arm trough each

E2209 RR D IN 7.87 Arm trough each

E2209 RR KU D IN 10.41 Arm trough each

E2209 UE D IN 59.01 Arm trough each

E2209 UE KU D IN 77.98 Arm trough each

E2210 NU D IN 5.05 Wheelchair bearings

E2210 NU KU D IN 6.34 Wheelchair bearings

E2210 RR D IN 0.51 Wheelchair bearings




E2210 RR KU D IN 0.64 Wheelchair bearings

E2210 UE D IN 3.79 Wheelchair bearings

E2210 UE KU D IN 4.78 Wheelchair bearings

E2211 NU D IN 32.86 Pneumatic propulsion tire

E2211 RR D IN 3.29 Pneumatic propulsion tire

E2211 UE D IN 24.65 Pneumatic propulsion tire

E2212 NU D IN 5.86 Pneumatic prop tire tube

E2212 RR D IN 0.59 Pneumatic prop tire tube

E2212 UE D IN 4.40 Pneumatic prop tire tube

E2213 NU D IN 27.93 Pneumatic prop tire insert

E2213 RR D IN 2.79 Pneumatic prop tire insert

E2213 UE D IN 20.95 Pneumatic prop tire insert

E2214 NU D IN 29.74 Pneumatic caster tire each

E2214 RR D IN 2.98 Pneumatic caster tire each

E2214 UE D IN 22.31 Pneumatic caster tire each

E2215 NU D IN 9.64 Pneumatic caster tire tube

E2215 RR D IN 0.96 Pneumatic caster tire tube

E2215 UE D IN 7.23 Pneumatic caster tire tube

E2216 NU D IN 0.00 Foam filled propulsion tire

E2216 RR D IN 0.00 Foam filled propulsion tire

E2216 UE D IN 0.00 Foam filled propulsion tire

E2217 NU D IN 0.00 Foam filled caster tire each

E2217 RR D IN 0.00 Foam filled caster tire each

E2217 UE D IN 0.00 Foam filled caster tire each

E2218 NU D IN 0.00 Foam propulsion tire each

E2218 RR D IN 0.00 Foam propulsion tire each

E2218 UE D IN 0.00 Foam propulsion tire each

E2219 NU D IN 38.06 Foam caster tire any size ea

E2219 RR D IN 3.81 Foam caster tire any size ea

E2219 UE D IN 28.54 Foam caster tire any size ea

E2220 NU D IN 28.28 Solid propuls tire, repl, ea

E2220 RR D IN 2.83 Solid propuls tire, repl, ea

E2220 UE D IN 21.21 Solid propuls tire, repl, ea

E2221 NU D IN 25.12 Solid caster tire repl, each

E2221 RR D IN 2.51 Solid caster tire repl, each

E2221 UE D IN 18.84 Solid caster tire repl, each

E2222 NU D IN 21.25 Solid caster integ whl, repl

E2222 RR D IN 2.13 Solid caster integ whl, repl

E2222 UE D IN 15.94 Solid caster integ whl, repl

E2224 NU D IN 90.11 Propulsion whl excl tire rep

E2224 RR D IN 9.01 Propulsion whl excl tire rep

E2224 UE D IN 67.59 Propulsion whl excl tire rep

E2225 NU D IN 17.43 Caster wheel excludes tire

E2225 RR D IN 1.74 Caster wheel excludes tire

E2225 UE D IN 13.08 Caster wheel excludes tire

E2226 NU D IN 37.12 Caster fork replacement only




E2226 RR D IN 3.71 Caster fork replacement only

E2226 UE D IN 27.84 Caster fork replacement only

E2227 RR D CR 210.56 Gear reduction drive wheel

E2228 RR D CR 89.93 Mwc acc, wheelchair brake

E2231 NU D IN 136.18 Solid seat support base

E2231 RR D IN 13.62 Solid seat support base

E2231 UE D IN 102.14 Solid seat support base

E2310 RR D CR 102.98 Electro connect btw control

E2310 RR KU D CR 113.50 Electro connect btw control

E2311 RR D CR 207.82 Electro connect btw 2 sys

E2311 RR KU D CR 229.83 Electro connect btw 2 sys

E2312 RR D CR 226.97 Mini-prop remote joystick

E2312 RR KC D CR 289.47 Mini-prop remote joystick

E2313 RR D CR 36.07 Pwc harness, expand control

E2321 RR D CR 139.93 Hand interface joystick

E2321 RR KC D CR 227.92 Hand interface joystick

E2321 RR KU D CR 251.12 Hand interface joystick

E2322 RR D CR 132.20 Mult mech switches

E2322 RR KC D CR 256.97 Mult mech switches

E2322 RR KU D CR 265.91 Mult mech switches

E2323 NU D IN 64.44 Special joystick handle

E2323 NU KU D IN 67.10 Special joystick handle

E2323 RR D IN 6.44 Special joystick handle

E2323 RR KU D IN 6.70 Special joystick handle

E2323 UE D IN 48.33 Special joystick handle

E2323 UE KU D IN 50.31 Special joystick handle

E2324 NU D IN 42.51 Chin cup interface

E2324 NU KU D IN 42.50 Chin cup interface

E2324 RR D IN 4.23 Chin cup interface

E2324 RR KU D IN 4.23 Chin cup interface

E2324 UE D IN 31.88 Chin cup interface

E2324 UE KU D IN 31.88 Chin cup interface

E2325 RR D CR 126.35 Sip and puff interface

E2325 RR KU D CR 130.66 Sip and puff interface

E2326 RR D CR 33.14 Breath tube kit

E2326 RR KU D CR 33.69 Breath tube kit

E2327 RR D CR 247.16 Head control interface mech

E2327 RR KC D CR 375.50 Head control interface mech

E2327 RR KU D CR 385.00 Head control interface mech

E2328 RR D CR 466.50 Head/extremity control inter

E2328 RR KU D CR 480.69 Head/extremity control inter

E2329 RR D CR 168.46 Head control nonproportional

E2329 RR KU D CR 171.32 Head control nonproportional

E2330 RR D CR 323.44 Head control proximity switc

E2330 RR KU D CR 331.95 Head control proximity switc

E2340 NU D IN 403.33 W/c wdth 20-23 in seat frame




E2340 RR D IN 40.35 W/c wdth 20-23 in seat frame

E2340 UE D IN 302.53 W/c wdth 20-23 in seat frame

E2341 NU D IN 605.04 W/c wdth 24-27 in seat frame

E2341 RR D IN 60.50 W/c wdth 24-27 in seat frame

E2341 UE D IN 453.79 W/c wdth 24-27 in seat frame

E2342 NU D IN 504.21 W/c dpth 20-21 in seat frame

E2342 RR D IN 50.42 W/c dpth 20-21 in seat frame

E2342 UE D IN 378.16 W/c dpth 20-21 in seat frame

E2343 NU D IN 806.74 W/c dpth 22-25 in seat frame

E2343 RR D IN 80.66 W/c dpth 22-25 in seat frame

E2343 UE D IN 605.04 W/c dpth 22-25 in seat frame

E2351 NU D IN 670.02 Electronic sgd interface

E2351 NU KU D IN 677.72 Electronic sgd interface

E2351 RR D IN 67.00 Electronic sgd interface

E2351 RR KU D IN 67.80 Electronic sgd interface

E2351 UE D IN 502.52 Electronic sgd interface

E2351 UE KU D IN 508.27 Electronic sgd interface

E2359 NU D IN 159.82 Gr34 sealed leadacid battery

E2359 NU KU D IN 196.00 Gr34 sealed leadacid battery

E2359 RR D IN 15.98 Gr34 sealed leadacid battery

E2359 RR KU D IN 19.60 Gr34 sealed leadacid battery

E2359 UE D IN 119.87 Gr34 sealed leadacid battery

E2359 UE KU D IN 146.98 Gr34 sealed leadacid battery

E2360 NU D IN 99.54 22nf nonsealed leadacid

E2360 NU KU D IN 126.45 22nf nonsealed leadacid

E2360 RR D IN 9.95 22nf nonsealed leadacid

E2360 RR KU D IN 12.71 22nf nonsealed leadacid

E2360 UE D IN 74.66 22nf nonsealed leadacid

E2360 UE KU D IN 94.82 22nf nonsealed leadacid

E2361 NU D IN 108.88 22nf sealed leadacid battery

E2361 NU KU D IN 135.29 22nf sealed leadacid battery

E2361 RR D IN 10.89 22nf sealed leadacid battery

E2361 RR KU D IN 13.53 22nf sealed leadacid battery

E2361 UE D IN 81.66 22nf sealed leadacid battery

E2361 UE KU D IN 101.49 22nf sealed leadacid battery

E2362 NU D IN 91.10 Gr24 nonsealed leadacid

E2362 NU KU D IN 103.53 Gr24 nonsealed leadacid

E2362 RR D IN 9.11 Gr24 nonsealed leadacid

E2362 RR KU D IN 10.35 Gr24 nonsealed leadacid

E2362 UE D IN 68.33 Gr24 nonsealed leadacid

E2362 UE KU D IN 77.63 Gr24 nonsealed leadacid










E2364 NU D IN 96.08 U1nonsealed leadacid battery

E2364 NU KU D IN 126.45 U1nonsealed leadacid battery

E2364 RR D IN 9.61 U1nonsealed leadacid battery

E2364 RR KU D IN 12.71 U1nonsealed leadacid battery

E2364 UE D IN 72.06 U1nonsealed leadacid battery

E2364 UE KU D IN 94.82 U1nonsealed leadacid battery

E2365 NU D IN 74.53 U1 sealed leadacid battery

E2365 NU KU D IN 108.81 U1 sealed leadacid battery

E2365 RR D IN 7.45 U1 sealed leadacid battery

E2365 RR KU D IN 10.87 U1 sealed leadacid battery

E2365 UE D IN 55.90 U1 sealed leadacid battery

E2365 UE KU D IN 81.64 U1 sealed leadacid battery

E2366 NU D IN 159.12 Battery charger, single mode

E2366 NU KU D IN 217.37 Battery charger, single mode

E2366 RR D IN 15.91 Battery charger, single mode

E2366 RR KU D IN 21.80 Battery charger, single mode

E2366 UE D IN 119.34 Battery charger, single mode

E2366 UE KU D IN 163.04 Battery charger, single mode

E2367 NU D IN 307.72 Battery charger, dual mode

E2367 NU KU D IN 406.53 Battery charger, dual mode

E2367 RR D IN 30.77 Battery charger, dual mode

E2367 RR KU D IN 40.65 Battery charger, dual mode

E2367 UE D IN 230.80 Battery charger, dual mode

E2367 UE KU D IN 304.91 Battery charger, dual mode

E2368 RR D CR 39.05 Pwr wc drivewheel motor repl

E2368 RR KU D CR 50.11 Pwr wc drivewheel motor repl

E2369 RR D CR 36.48 Pwr wc drivewheel gear repl

E2369 RR KU D CR 43.67 Pwr wc drivewheel gear repl

E2370 RR D CR 51.77 Pwr wc dr wh motor/gear comb

E2370 RR KU D CR 77.89 Pwr wc dr wh motor/gear comb







E2372 NU D IN 0.00 Gr27 non-sealed leadacid

E2372 RR D IN 0.00 Gr27 non-sealed leadacid

E2372 UE D IN 0.00 Gr27 non-sealed leadacid

E2373 RR D CR 75.02 Hand/chin ctrl spec joystick

E2373 RR KC D CR 115.77 Hand/chin ctrl spec joystick

E2373 RR KU D CR 122.07 Hand/chin ctrl spec joystick

E2374 RR D CR 47.45 Hand/chin ctrl std joystick

E2374 RR KU D CR 51.82 Hand/chin ctrl std joystick

E2375 RR D CR 65.64 Non-expandable controller




E2375 RR KU D CR 83.07 Non-expandable controller

E2376 RR D CR 117.89 Expandable controller, repl

E2376 RR KU D CR 130.22 Expandable controller, repl

E2377 RR D CR 43.67 Expandable controller, initl

E2377 RR KU D CR 47.10 Expandable controller, initl

E2378 RR D CR 54.78 Pw actuator replacement

E2378 RR KU D CR 57.60 Pw actuator replacement

E2381 NU D IN 57.44 Pneum drive wheel tire

E2381 NU KU D IN 73.89 Pneum drive wheel tire

E2381 RR D IN 5.74 Pneum drive wheel tire

E2381 RR KU D IN 7.41 Pneum drive wheel tire

E2381 UE D IN 43.08 Pneum drive wheel tire

E2381 UE KU D IN 55.42 Pneum drive wheel tire

E2382 NU D IN 17.30 Tube, pneum wheel drive tire

E2382 NU KU D IN 20.14 Tube, pneum wheel drive tire

E2382 RR D IN 1.73 Tube, pneum wheel drive tire

E2382 RR KU D IN 2.00 Tube, pneum wheel drive tire

E2382 UE D IN 12.98 Tube, pneum wheel drive tire

E2382 UE KU D IN 15.11 Tube, pneum wheel drive tire

E2383 NU D IN 117.19 Insert, pneum wheel drive

E2383 NU KU D IN 147.33 Insert, pneum wheel drive

E2383 RR D IN 11.72 Insert, pneum wheel drive

E2383 RR KU D IN 14.73 Insert, pneum wheel drive

E2383 UE D IN 87.89 Insert, pneum wheel drive

E2383 UE KU D IN 110.49 Insert, pneum wheel drive

E2384 NU D IN 59.31 Pneumatic caster tire

E2384 NU KU D IN 78.49 Pneumatic caster tire

E2384 RR D IN 5.93 Pneumatic caster tire

E2384 RR KU D IN 7.87 Pneumatic caster tire

E2384 UE D IN 44.48 Pneumatic caster tire

E2384 UE KU D IN 58.88 Pneumatic caster tire

E2385 NU D IN 41.51 Tube, pneumatic caster tire

E2385 NU KU D IN 48.02 Tube, pneumatic caster tire

E2385 RR D IN 4.15 Tube, pneumatic caster tire

E2385 RR KU D IN 4.82 Tube, pneumatic caster tire

E2385 UE D IN 31.13 Tube, pneumatic caster tire

E2385 UE KU D IN 36.00 Tube, pneumatic caster tire

E2386 NU D IN 103.18 Foam filled drive wheel tire

E2386 NU KU D IN 145.99 Foam filled drive wheel tire

E2386 RR D IN 10.32 Foam filled drive wheel tire

E2386 RR KU D IN 14.60 Foam filled drive wheel tire

E2386 UE D IN 77.39 Foam filled drive wheel tire

E2386 UE KU D IN 109.50 Foam filled drive wheel tire

E2387 NU D IN 48.16 Foam filled caster tire

E2387 NU KU D IN 65.46 Foam filled caster tire

E2387 RR D IN 4.82 Foam filled caster tire




E2387 RR KU D IN 6.55 Foam filled caster tire

E2387 UE D IN 36.12 Foam filled caster tire

E2387 UE KU D IN 49.14 Foam filled caster tire

E2388 NU D IN 45.17 Foam drive wheel tire

E2388 NU KU D IN 48.87 Foam drive wheel tire

E2388 RR D IN 4.52 Foam drive wheel tire

E2388 RR KU D IN 4.89 Foam drive wheel tire

E2388 UE D IN 33.88 Foam drive wheel tire

E2388 UE KU D IN 36.67 Foam drive wheel tire

E2389 NU D IN 25.25 Foam caster tire

E2389 NU KU D IN 26.55 Foam caster tire

E2389 RR D IN 2.52 Foam caster tire

E2389 RR KU D IN 2.67 Foam caster tire

E2389 UE D IN 18.94 Foam caster tire

E2389 UE KU D IN 19.89 Foam caster tire

E2390 NU D IN 39.09 Solid drive wheel tire

E2390 NU KU D IN 41.51 Solid drive wheel tire

E2390 RR D IN 3.91 Solid drive wheel tire

E2390 RR KU D IN 4.15 Solid drive wheel tire

E2390 UE D IN 29.32 Solid drive wheel tire

E2390 UE KU D IN 31.11 Solid drive wheel tire

E2391 NU D IN 16.57 Solid caster tire

E2391 NU KU D IN 19.88 Solid caster tire

E2391 RR D IN 1.66 Solid caster tire

E2391 RR KU D IN 1.99 Solid caster tire

E2391 UE D IN 12.43 Solid caster tire

E2391 UE KU D IN 14.91 Solid caster tire

E2392 NU D IN 40.00 Solid caster tire, integrate

E2392 NU KU D IN 52.26 Solid caster tire, integrate

E2392 RR D IN 4.00 Solid caster tire, integrate

E2392 RR KU D IN 5.26 Solid caster tire, integrate

E2392 UE D IN 30.00 Solid caster tire, integrate

E2392 UE KU D IN 39.21 Solid caster tire, integrate

E2394 NU D IN 55.48 Drive wheel excludes tire

E2394 NU KU D IN 74.47 Drive wheel excludes tire

E2394 RR D IN 5.55 Drive wheel excludes tire

E2394 RR KU D IN 7.46 Drive wheel excludes tire

E2394 UE D IN 41.61 Drive wheel excludes tire

E2394 UE KU D IN 55.85 Drive wheel excludes tire

E2395 NU D IN 41.74 Caster wheel excludes tire

E2395 NU KU D IN 52.91 Caster wheel excludes tire

E2395 RR D IN 4.18 Caster wheel excludes tire

E2395 RR KU D IN 5.31 Caster wheel excludes tire

E2395 UE D IN 31.31 Caster wheel excludes tire

E2395 UE KU D IN 39.69 Caster wheel excludes tire

E2396 NU D IN 50.20 Caster fork




E2396 NU KU D IN 64.51 Caster fork

E2396 RR D IN 5.02 Caster fork

E2396 RR KU D IN 6.91 Caster fork

E2396 UE D IN 37.66 Caster fork

E2396 UE KU D IN 48.40 Caster fork

E2397 NU D IN 412.82 Pwc acc, lith-based battery

E2397 NU KU D IN 466.10 Pwc acc, lith-based battery

E2397 RR D IN 41.28 Pwc acc, lith-based battery

E2397 RR KU D IN 46.62 Pwc acc, lith-based battery

E2397 UE D IN 309.62 Pwc acc, lith-based battery

E2397 UE KU D IN 349.55 Pwc acc, lith-based battery

E2402 RR D CR 688.72 Neg press wound therapy pump

E2500 NU D IN 440.12 Sgd digitized pre-rec <=8min

E2500 RR D IN 44.02 Sgd digitized pre-rec <=8min

E2500 UE D IN 330.09 Sgd digitized pre-rec <=8min

E2502 NU D IN 1345.85 Sgd prerec msg >8min <=20min

E2502 RR D IN 134.59 Sgd prerec msg >8min <=20min

E2502 UE D IN 1009.41 Sgd prerec msg >8min <=20min

E2504 NU D IN 1775.37 Sgd prerec msg>20min <=40min

E2504 RR D IN 177.56 Sgd prerec msg>20min <=40min

E2504 UE D IN 1331.53 Sgd prerec msg>20min <=40min

E2506 NU D IN 2603.22 Sgd prerec msg > 40 min

E2506 RR D IN 260.30 Sgd prerec msg > 40 min

E2506 UE D IN 1952.37 Sgd prerec msg > 40 min

E2508 NU D IN 4025.44 Sgd spelling phys contact

E2508 RR D IN 402.54 Sgd spelling phys contact

E2508 UE D IN 3019.09 Sgd spelling phys contact

E2510 NU D IN 7617.61 Sgd w multi methods msg/accs

E2510 RR D IN 761.77 Sgd w multi methods msg/accs

E2510 UE D IN 5713.20 Sgd w multi methods msg/accs

E2511 NU D IN 0.00 Sgd sftwre prgrm for pc/pda

E2511 RR D IN 0.00 Sgd sftwre prgrm for pc/pda

E2511 UE D IN 0.00 Sgd sftwre prgrm for pc/pda

E2512 NU D IN 0.00 Sgd accessory, mounting sys

E2512 RR D IN 0.00 Sgd accessory, mounting sys

E2512 UE D IN 0.00 Sgd accessory, mounting sys

E2601 NU D IN 38.45 Gen w/c cushion wdth < 22 in

E2601 NU KU D IN 59.33 Gen w/c cushion wdth < 22 in

E2601 RR D IN 3.85 Gen w/c cushion wdth < 22 in

E2601 RR KU D IN 5.95 Gen w/c cushion wdth < 22 in

E2601 UE D IN 28.84 Gen w/c cushion wdth < 22 in

E2601 UE KU D IN 44.50 Gen w/c cushion wdth < 22 in

E2602 NU D IN 82.60 Gen w/c cushion wdth >=22 in

E2602 NU KU D IN 115.82 Gen w/c cushion wdth >=22 in

E2602 RR D IN 8.26 Gen w/c cushion wdth >=22 in

E2602 RR KU D IN 11.59 Gen w/c cushion wdth >=22 in




E2602 UE D IN 61.95 Gen w/c cushion wdth >=22 in

E2602 UE KU D IN 86.88 Gen w/c cushion wdth >=22 in

E2603 NU D IN 102.89 Skin protect wc cus wd <22in

E2603 NU KU D IN 147.04 Skin protect wc cus wd <22in

E2603 RR D IN 10.29 Skin protect wc cus wd <22in

E2603 RR KU D IN 14.71 Skin protect wc cus wd <22in

E2603 UE D IN 77.17 Skin protect wc cus wd <22in

E2603 UE KU D IN 110.29 Skin protect wc cus wd <22in

E2604 NU D IN 140.84 Skin protect wc cus wd>=22in

E2604 NU KU D IN 182.78 Skin protect wc cus wd>=22in

E2604 RR D IN 14.08 Skin protect wc cus wd>=22in

E2604 RR KU D IN 18.28 Skin protect wc cus wd>=22in

E2604 UE D IN 105.63 Skin protect wc cus wd>=22in

E2604 UE KU D IN 137.10 Skin protect wc cus wd>=22in

E2605 NU D IN 200.57 Position wc cush wdth <22 in

E2605 NU KU D IN 261.12 Position wc cush wdth <22 in

E2605 RR D IN 20.06 Position wc cush wdth <22 in

E2605 RR KU D IN 26.12 Position wc cush wdth <22 in

E2605 UE D IN 150.43 Position wc cush wdth <22 in

E2605 UE KU D IN 195.87 Position wc cush wdth <22 in

E2606 NU D IN 322.36 Position wc cush wdth>=22 in

E2606 NU KU D IN 407.36 Position wc cush wdth>=22 in

E2606 RR D IN 32.24 Position wc cush wdth>=22 in

E2606 RR KU D IN 40.74 Position wc cush wdth>=22 in

E2606 UE D IN 241.77 Position wc cush wdth>=22 in

E2606 UE KU D IN 305.49 Position wc cush wdth>=22 in

E2607 NU D IN 201.89 Skin pro/pos wc cus wd <22in

E2607 NU KU D IN 281.17 Skin pro/pos wc cus wd <22in

E2607 RR D IN 20.19 Skin pro/pos wc cus wd <22in

E2607 RR KU D IN 28.12 Skin pro/pos wc cus wd <22in

E2607 UE D IN 151.42 Skin pro/pos wc cus wd <22in

E2607 UE KU D IN 210.88 Skin pro/pos wc cus wd <22in

E2608 NU D IN 249.85 Skin pro/pos wc cus wd>=22in

E2608 NU KU D IN 337.66 Skin pro/pos wc cus wd>=22in

E2608 RR D IN 24.98 Skin pro/pos wc cus wd>=22in

E2608 RR KU D IN 33.76 Skin pro/pos wc cus wd>=22in

E2608 UE D IN 187.39 Skin pro/pos wc cus wd>=22in

E2608 UE KU D IN 253.25 Skin pro/pos wc cus wd>=22in

E2611 NU D IN 159.01 Gen use back cush wdth <22in

E2611 NU KU D IN 303.00 Gen use back cush wdth <22in

E2611 RR D IN 15.90 Gen use back cush wdth <22in

E2611 RR KU D IN 30.29 Gen use back cush wdth <22in

E2611 UE D IN 119.26 Gen use back cush wdth <22in

E2611 UE KU D IN 227.27 Gen use back cush wdth <22in

E2612 NU D IN 303.40 Gen use back cush wdth>=22in

E2612 NU KU D IN 409.89 Gen use back cush wdth>=22in




E2612 RR D IN 30.34 Gen use back cush wdth>=22in

E2612 RR KU D IN 40.99 Gen use back cush wdth>=22in

E2612 UE D IN 227.55 Gen use back cush wdth>=22in

E2612 UE KU D IN 307.41 Gen use back cush wdth>=22in

E2613 NU D IN 298.90 Position back cush wd <22in

E2613 NU KU D IN 381.28 Position back cush wd <22in

E2613 RR D IN 29.89 Position back cush wd <22in

E2613 RR KU D IN 38.13 Position back cush wd <22in

E2613 UE D IN 224.18 Position back cush wd <22in

E2613 UE KU D IN 285.96 Position back cush wd <22in

E2614 NU D IN 429.71 Position back cush wd>=22in

E2614 NU KU D IN 527.66 Position back cush wd>=22in

E2614 RR D IN 42.97 Position back cush wd>=22in

E2614 RR KU D IN 52.76 Position back cush wd>=22in

E2614 UE D IN 322.29 Position back cush wd>=22in

E2614 UE KU D IN 395.76 Position back cush wd>=22in

E2615 NU D IN 338.04 Pos back post/lat wdth <22in

E2615 NU KU D IN 438.77 Pos back post/lat wdth <22in

E2615 RR D IN 33.81 Pos back post/lat wdth <22in

E2615 RR KU D IN 43.89 Pos back post/lat wdth <22in

E2615 UE D IN 253.53 Pos back post/lat wdth <22in

E2615 UE KU D IN 329.07 Pos back post/lat wdth <22in

E2616 NU D IN 454.28 Pos back post/lat wdth>=22in

E2616 NU KU D IN 590.36 Pos back post/lat wdth>=22in

E2616 RR D IN 45.43 Pos back post/lat wdth>=22in

E2616 RR KU D IN 59.04 Pos back post/lat wdth>=22in

E2616 UE D IN 340.71 Pos back post/lat wdth>=22in

E2616 UE KU D IN 442.78 Pos back post/lat wdth>=22in

E2619 NU D IN 46.51 Replace cover w/c seat cush

E2619 NU KU D IN 49.77 Replace cover w/c seat cush

E2619 RR D IN 4.65 Replace cover w/c seat cush

E2619 RR KU D IN 4.97 Replace cover w/c seat cush

E2619 UE D IN 34.88 Replace cover w/c seat cush

E2619 UE KU D IN 37.37 Replace cover w/c seat cush

E2620 NU D IN 373.28 Wc planar back cush wd <22in

E2620 NU KU D IN 531.29 Wc planar back cush wd <22in

E2620 RR D IN 37.33 Wc planar back cush wd <22in

E2620 RR KU D IN 53.14 Wc planar back cush wd <22in

E2620 UE D IN 279.96 Wc planar back cush wd <22in

E2620 UE KU D IN 398.49 Wc planar back cush wd <22in

E2621 NU D IN 436.04 Wc planar back cush wd>=22in

E2621 NU KU D IN 557.56 Wc planar back cush wd>=22in

E2621 RR D IN 43.61 Wc planar back cush wd>=22in

E2621 RR KU D IN 55.76 Wc planar back cush wd>=22in

E2621 UE D IN 327.03 Wc planar back cush wd>=22in

E2621 UE KU D IN 418.17 Wc planar back cush wd>=22in




E2622 NU D IN 295.02 Adj skin pro w/c cus wd<22in

E2622 NU KU D IN 321.54 Adj skin pro w/c cus wd<22in

E2622 RR D IN 29.50 Adj skin pro w/c cus wd<22in

E2622 RR KU D IN 32.16 Adj skin pro w/c cus wd<22in

E2622 UE D IN 221.27 Adj skin pro w/c cus wd<22in

E2622 UE KU D IN 241.15 Adj skin pro w/c cus wd<22in

E2623 NU D IN 373.07 Adj skin pro wc cus wd>=22in

E2623 NU KU D IN 409.15 Adj skin pro wc cus wd>=22in

E2623 RR D IN 37.31 Adj skin pro wc cus wd>=22in

E2623 RR KU D IN 40.93 Adj skin pro wc cus wd>=22in

E2623 UE D IN 279.81 Adj skin pro wc cus wd>=22in

E2623 UE KU D IN 306.85 Adj skin pro wc cus wd>=22in

E2624 NU D IN 299.79 Adj skin pro/pos cus<22in

E2624 NU KU D IN 324.19 Adj skin pro/pos cus<22in

E2624 RR D IN 29.98 Adj skin pro/pos cus<22in

E2624 RR KU D IN 32.42 Adj skin pro/pos cus<22in

E2624 UE D IN 224.84 Adj skin pro/pos cus<22in

E2624 UE KU D IN 243.16 Adj skin pro/pos cus<22in

E2625 NU D IN 371.02 Adj skin pro/pos wc cus>=22

E2625 NU KU D IN 410.40 Adj skin pro/pos wc cus>=22

E2625 RR D IN 37.10 Adj skin pro/pos wc cus>=22

E2625 RR KU D IN 41.03 Adj skin pro/pos wc cus>=22

E2625 UE D IN 278.27 Adj skin pro/pos wc cus>=22

E2625 UE KU D IN 307.80 Adj skin pro/pos wc cus>=22

E2626 NU D IN 600.26 Seo mobile arm sup att to wc

E2626 NU KU D IN 699.08 Seo mobile arm sup att to wc

E2626 RR D IN 60.03 Seo mobile arm sup att to wc

E2626 RR KU D IN 69.88 Seo mobile arm sup att to wc

E2626 UE D IN 450.19 Seo mobile arm sup att to wc

E2626 UE KU D IN 524.24 Seo mobile arm sup att to wc

E2627 NU D IN 928.77 Arm supp att to wc rancho ty

E2627 NU KU D IN 1115.50 Arm supp att to wc rancho ty

E2627 RR D IN 92.88 Arm supp att to wc rancho ty

E2627 RR KU D IN 111.58 Arm supp att to wc rancho ty

E2627 UE D IN 696.58 Arm supp att to wc rancho ty

E2627 UE KU D IN 836.61 Arm supp att to wc rancho ty

E2628 NU D IN 725.68 Mobile arm supports reclinin

E2628 NU KU D IN 840.35 Mobile arm supports reclinin

E2628 RR D IN 72.57 Mobile arm supports reclinin

E2628 RR KU D IN 84.03 Mobile arm supports reclinin

E2628 UE D IN 544.26 Mobile arm supports reclinin

E2628 UE KU D IN 630.25 Mobile arm supports reclinin

E2629 NU D IN 916.01 Friction dampening arm supp

E2629 NU KU D IN 1063.44 Friction dampening arm supp

E2629 RR D IN 91.60 Friction dampening arm supp

E2629 RR KU D IN 106.33 Friction dampening arm supp




E2629 UE D IN 687.01 Friction dampening arm supp

E2629 UE KU D IN 797.57 Friction dampening arm supp

E2630 NU D IN 617.53 Monosuspension arm/hand supp

E2630 NU KU D IN 632.11 Monosuspension arm/hand supp

E2630 RR D IN 61.75 Monosuspension arm/hand supp

E2630 RR KU D IN 63.21 Monosuspension arm/hand supp

E2630 UE D IN 463.15 Monosuspension arm/hand supp

E2630 UE KU D IN 474.08 Monosuspension arm/hand supp

E2631 NU D IN 269.34 Elevat proximal arm support

E2631 NU KU D IN 297.49 Elevat proximal arm support

E2631 RR D IN 26.93 Elevat proximal arm support

E2631 RR KU D IN 29.74 Elevat proximal arm support

E2631 UE D IN 202.00 Elevat proximal arm support

E2631 UE KU D IN 223.10 Elevat proximal arm support

E2632 NU D IN 161.98 Offset/lat rocker arm w/ela

E2632 NU KU D IN 187.41 Offset/lat rocker arm w/ela

E2632 RR D IN 16.20 Offset/lat rocker arm w/ela

E2632 RR KU D IN 18.73 Offset/lat rocker arm w/ela

E2632 UE D IN 121.49 Offset/lat rocker arm w/ela

E2632 UE KU D IN 140.56 Offset/lat rocker arm w/ela

E2633 NU D IN 131.23 Mobile arm support supinator

E2633 NU KU D IN 156.17 Mobile arm support supinator

E2633 RR D IN 13.12 Mobile arm support supinator

E2633 RR KU D IN 15.66 Mobile arm support supinator

E2633 UE D IN 98.43 Mobile arm support supinator

E2633 UE KU D IN 117.11 Mobile arm support supinator

K0001 RR D CR 24.26 Standard wheelchair

K0002 RR D CR 42.27 Stnd hemi (low seat) whlchr

K0003 RR D CR 36.70 Lightweight wheelchair

K0004 RR D CR 45.25 High strength ltwt whlchr

K0005 NU D IN 2080.78 Ultralightweight wheelchair

K0005 RR D IN 208.05 Ultralightweight wheelchair

K0005 UE D IN 1560.54 Ultralightweight wheelchair

K0006 RR D CR 66.91 Heavy duty wheelchair

K0007 RR D CR 94.32 Extra heavy duty wheelchair

K0009 RR D CR 83.69 Other manual wheelchair/base

K0010 RR D CR 407.53 Stnd wt frame power whlchr

K0011 RR D CR 558.85 Stnd wt pwr whlchr w control

K0011 RR KF D CR 620.45 Stnd wt pwr whlchr w control

K0012 RR D CR 342.81 Ltwt portbl power whlchr

K0015 RR D CR 13.70 Detach non-adj ht armrst rep

K0015 RR KU D CR 17.62 Detach non-adj ht armrst rep

K0017 NU D IN 44.77 Detach adjust armrest base

K0017 NU KU D IN 49.57 Detach adjust armrest base

K0017 RR D IN 4.48 Detach adjust armrest base

K0017 RR KU D IN 4.95 Detach adjust armrest base




K0017 UE D IN 33.58 Detach adjust armrest base

K0017 UE KU D IN 37.18 Detach adjust armrest base

K0018 NU D IN 25.31 Detach adjust armrst upper

K0018 NU KU D IN 27.69 Detach adjust armrst upper

K0018 RR D IN 2.53 Detach adjust armrst upper

K0018 RR KU D IN 2.76 Detach adjust armrst upper

K0018 UE D IN 18.99 Detach adjust armrst upper

K0018 UE KU D IN 20.78 Detach adjust armrst upper

K0019 NU D IN 12.31 Arm pad repl, each

K0019 NU KU D IN 16.70 Arm pad repl, each

K0019 RR D IN 1.23 Arm pad repl, each

K0019 RR KU D IN 1.67 Arm pad repl, each

K0019 UE D IN 9.23 Arm pad repl, each

K0019 UE KU D IN 12.55 Arm pad repl, each

K0020 NU D IN 43.87 Fixed adjust armrest pair

K0020 NU KU D IN 45.07 Fixed adjust armrest pair

K0020 RR D IN 4.39 Fixed adjust armrest pair

K0020 RR KU D IN 4.51 Fixed adjust armrest pair

K0020 UE D IN 32.90 Fixed adjust armrest pair

K0020 UE KU D IN 33.80 Fixed adjust armrest pair

K0037 NU D IN 42.12 Hi mount flip-up ftrest repl

K0037 NU KU D IN 44.47 Hi mount flip-up ftrest repl

K0037 RR D IN 4.17 Hi mount flip-up ftrest repl

K0037 RR KU D IN 4.17 Hi mount flip-up ftrest repl

K0037 UE D IN 31.60 Hi mount flip-up ftrest repl

K0037 UE KU D IN 33.35 Hi mount flip-up ftrest repl

K0038 NU D IN 22.38 Leg strap each

K0038 NU KU D IN 23.55 Leg strap each

K0038 RR D IN 2.24 Leg strap each

K0038 RR KU D IN 2.36 Leg strap each

K0038 UE D IN 16.78 Leg strap each

K0038 UE KU D IN 17.64 Leg strap each

K0039 NU D IN 48.05 Leg strap h style each

K0039 NU KU D IN 52.26 Leg strap h style each

K0039 RR D IN 4.81 Leg strap h style each

K0039 RR KU D IN 5.26 Leg strap h style each

K0039 UE D IN 36.04 Leg strap h style each

K0039 UE KU D IN 39.21 Leg strap h style each

K0040 NU D IN 51.12 Adjustable angle footplate

K0040 NU KU D IN 72.44 Adjustable angle footplate

K0040 RR D IN 5.11 Adjustable angle footplate

K0040 RR KU D IN 7.23 Adjustable angle footplate

K0040 UE D IN 38.34 Adjustable angle footplate

K0040 UE KU D IN 54.30 Adjustable angle footplate

K0041 NU D IN 45.92 Large size footplate each

K0041 NU KU D IN 51.33 Large size footplate each




K0041 RR D IN 4.59 Large size footplate each

K0041 RR KU D IN 5.18 Large size footplate each

K0041 UE D IN 34.44 Large size footplate each

K0041 UE KU D IN 38.49 Large size footplate each

K0042 NU D IN 29.49 Standard size ftplate rep ea

K0042 NU KU D IN 35.34 Standard size ftplate rep ea

K0042 RR D IN 2.95 Standard size ftplate rep ea

K0042 RR KU D IN 3.53 Standard size ftplate rep ea

K0042 UE D IN 22.12 Standard size ftplate rep ea

K0042 UE KU D IN 26.50 Standard size ftplate rep ea

K0043 NU D IN 18.20 Ftrst lowr exten tube rep ea

K0043 NU KU D IN 18.94 Ftrst lowr exten tube rep ea

K0043 RR D IN 1.82 Ftrst lowr exten tube rep ea

K0043 RR KU D IN 1.88 Ftrst lowr exten tube rep ea

K0043 UE D IN 13.65 Ftrst lowr exten tube rep ea

K0043 UE KU D IN 14.23 Ftrst lowr exten tube rep ea

K0044 NU D IN 15.84 Ftrst upr hanger brac rep ea

K0044 NU KU D IN 16.15 Ftrst upr hanger brac rep ea

K0044 RR D IN 1.59 Ftrst upr hanger brac rep ea

K0044 RR KU D IN 1.62 Ftrst upr hanger brac rep ea

K0044 UE D IN 11.88 Ftrst upr hanger brac rep ea

K0044 UE KU D IN 12.10 Ftrst upr hanger brac rep ea

K0045 NU D IN 52.10 Ftrst compl assembly repl ea

K0045 NU KU D IN 54.93 Ftrst compl assembly repl ea

K0045 RR D IN 5.21 Ftrst compl assembly repl ea

K0045 RR KU D IN 5.66 Ftrst compl assembly repl ea

K0045 UE D IN 39.08 Ftrst compl assembly repl ea

K0045 UE KU D IN 41.20 Ftrst compl assembly repl ea

K0046 NU D IN 18.33 Elev lgrst lwr exten repl ea

K0046 NU KU D IN 18.94 Elev lgrst lwr exten repl ea

K0046 RR D IN 1.83 Elev lgrst lwr exten repl ea

K0046 RR KU D IN 1.88 Elev lgrst lwr exten repl ea

K0046 UE D IN 13.75 Elev lgrst lwr exten repl ea

K0046 UE KU D IN 14.23 Elev lgrst lwr exten repl ea

K0047 NU D IN 64.76 Elev legrst upr hangr rep ea

K0047 NU KU D IN 74.19 Elev legrst upr hangr rep ea

K0047 RR D IN 6.48 Elev legrst upr hangr rep ea

K0047 RR KU D IN 7.44 Elev legrst upr hangr rep ea

K0047 UE D IN 48.57 Elev legrst upr hangr rep ea

K0047 UE KU D IN 55.62 Elev legrst upr hangr rep ea

K0050 NU D IN 30.04 Ratchet assembly replacement

K0050 RR D IN 3.00 Ratchet assembly replacement

K0050 UE D IN 22.54 Ratchet assembly replacement

K0051 NU D IN 47.53 Cam rel asm ft/legrst rep ea

K0051 NU KU D IN 51.03 Cam rel asm ft/legrst rep ea

K0051 RR D IN 4.75 Cam rel asm ft/legrst rep ea




K0051 RR KU D IN 5.14 Cam rel asm ft/legrst rep ea

K0051 UE D IN 35.65 Cam rel asm ft/legrst rep ea

K0051 UE KU D IN 38.26 Cam rel asm ft/legrst rep ea

K0052 NU D IN 68.86 Swingaway detach ftrest repl

K0052 NU KU D IN 89.69 Swingaway detach ftrest repl

K0052 RR D IN 6.89 Swingaway detach ftrest repl

K0052 RR KU D IN 8.96 Swingaway detach ftrest repl

K0052 UE D IN 51.65 Swingaway detach ftrest repl

K0052 UE KU D IN 67.23 Swingaway detach ftrest repl

K0053 NU D IN 79.93 Elevate footrest articulate

K0053 NU KU D IN 98.96 Elevate footrest articulate

K0053 RR D IN 7.99 Elevate footrest articulate

K0053 RR KU D IN 9.89 Elevate footrest articulate

K0053 UE D IN 59.95 Elevate footrest articulate

K0053 UE KU D IN 74.22 Elevate footrest articulate

K0056 NU D IN 91.39 Seat ht <17 or >=21 ltwt wc

K0056 NU KU D IN 107.04 Seat ht <17 or >=21 ltwt wc

K0056 RR D IN 9.14 Seat ht <17 or >=21 ltwt wc

K0056 RR KU D IN 10.71 Seat ht <17 or >=21 ltwt wc

K0056 UE D IN 68.54 Seat ht <17 or >=21 ltwt wc

K0056 UE KU D IN 80.29 Seat ht <17 or >=21 ltwt wc

K0065 NU D IN 43.51 Spoke protectors

K0065 NU KU D IN 50.02 Spoke protectors

K0065 RR D IN 4.35 Spoke protectors

K0065 RR KU D IN 5.00 Spoke protectors

K0065 UE D IN 32.63 Spoke protectors

K0065 UE KU D IN 37.53 Spoke protectors

K0069 NU D IN 90.37 Rr whl compl sol tire rep ea

K0069 NU KU D IN 112.47 Rr whl compl sol tire rep ea

K0069 RR D IN 9.04 Rr whl compl sol tire rep ea

K0069 RR KU D IN 11.71 Rr whl compl sol tire rep ea

K0069 UE D IN 67.78 Rr whl compl sol tire rep ea

K0069 UE KU D IN 84.35 Rr whl compl sol tire rep ea

K0070 RR D CR 15.91 Rr whl compl pne tire rep ea

K0070 RR KU D CR 20.63 Rr whl compl pne tire rep ea

K0071 NU D IN 102.72 Fr cstr comp pne tire rep ea

K0071 NU KU D IN 122.96 Fr cstr comp pne tire rep ea

K0071 RR D IN 10.27 Fr cstr comp pne tire rep ea

K0071 RR KU D IN 12.30 Fr cstr comp pne tire rep ea

K0071 UE D IN 77.05 Fr cstr comp pne tire rep ea

K0071 UE KU D IN 92.19 Fr cstr comp pne tire rep ea

K0072 NU D IN 64.39 Fr cstr semi-pne tire rep ea

K0072 NU KU D IN 74.03 Fr cstr semi-pne tire rep ea

K0072 RR D IN 6.44 Fr cstr semi-pne tire rep ea

K0072 RR KU D IN 7.40 Fr cstr semi-pne tire rep ea

K0072 UE D IN 48.30 Fr cstr semi-pne tire rep ea




K0072 UE KU D IN 55.50 Fr cstr semi-pne tire rep ea

K0073 NU D IN 33.53 Caster pin lock each

K0073 NU KU D IN 39.18 Caster pin lock each

K0073 RR D IN 3.35 Caster pin lock each

K0073 RR KU D IN 3.92 Caster pin lock each

K0073 UE D IN 25.15 Caster pin lock each

K0073 UE KU D IN 29.37 Caster pin lock each

K0077 NU D IN 52.38 Fr cstr asmb sol tire rep ea

K0077 NU KU D IN 66.25 Fr cstr asmb sol tire rep ea

K0077 RR D IN 5.24 Fr cstr asmb sol tire rep ea

K0077 RR KU D IN 6.61 Fr cstr asmb sol tire rep ea

K0077 UE D IN 39.29 Fr cstr asmb sol tire rep ea

K0077 UE KU D IN 49.66 Fr cstr asmb sol tire rep ea

K0098 NU D IN 22.65 Drive belt for pwc, repl

K0098 NU KU D IN 26.40 Drive belt for pwc, repl

K0098 RR D IN 2.27 Drive belt for pwc, repl

K0098 RR KU D IN 2.65 Drive belt for pwc, repl

K0098 UE D IN 16.99 Drive belt for pwc, repl

K0098 UE KU D IN 19.78 Drive belt for pwc, repl

K0105 NU D IN 94.57 Iv hanger

K0105 NU KU D IN 111.91 Iv hanger

K0105 RR D IN 9.46 Iv hanger

K0105 RR KU D IN 11.19 Iv hanger

K0105 UE D IN 70.93 Iv hanger

K0105 UE KU D IN 83.93 Iv hanger

K0195 RR D CR 10.62 Elevating whlchair leg rests

K0455 RR D FS 298.10 Pump uninterrupted infusion

K0552 D SU 2.64 Sup/ext non-ins inf pump syr

K0553 D SU 251.11 Ther cgm supply allowance

K0554 NU D IN 264.16 Ther cgm receiver/monitor

K0554 RR D IN 26.42 Ther cgm receiver/monitor

K0554 UE D IN 198.13 Ther cgm receiver/monitor

K0601 NU D IN 1.20 Repl batt silver oxide 1.5 v

K0602 NU D IN 6.76 Repl batt silver oxide 3 v

K0603 NU D IN 0.61 Repl batt alkaline 1.5 v

K0604 NU D IN 6.52 Repl batt lithium 3.6 v

K0605 NU D IN 15.58 Repl batt lithium 4.5 v

K0606 RR KF D CR 2834.31 Aed garment w elec analysis

K0607 RR D CR 21.87 Repl batt for aed

K0607 RR KF D CR 24.27 Repl batt for aed

K0608 NU D IN 136.41 Repl garment for aed

K0608 NU KF D IN 151.48 Repl garment for aed

K0608 RR D IN 13.67 Repl garment for aed

K0608 RR KF D IN 15.17 Repl garment for aed

K0608 UE D IN 102.31 Repl garment for aed

K0608 UE KF D IN 113.60 Repl garment for aed




K0609 D SU 907.24 Repl electrode for aed

K0609 KF D SU 1007.28 Repl electrode for aed

K0672 D PO 82.75 Removable soft interface le

K0730 RR D CR 194.03 Ctrl dose inh drug deliv sys

K0733 NU D IN 26.77 12-24hr sealed lead acid

K0733 NU KU D IN 29.30 12-24hr sealed lead acid

K0733 RR D IN 2.68 12-24hr sealed lead acid

K0733 RR KU D IN 2.95 12-24hr sealed lead acid

K0733 UE D IN 20.08 12-24hr sealed lead acid

K0733 UE KU D IN 21.99 12-24hr sealed lead acid

K0738 RR D OX 37.44 Portable gas oxygen system

K0738 RR QB D OX 37.44 Portable gas oxygen system

K0738 RR QF D OX 37.44 Portable gas oxygen system

K0800 NU D IN 826.39 Pov group 1 std up to 300lbs

K0800 RR D IN 82.64 Pov group 1 std up to 300lbs

K0800 UE D IN 619.80 Pov group 1 std up to 300lbs

K0801 NU D IN 1485.28 Pov group 1 hd 301-450 lbs

K0801 RR D IN 148.53 Pov group 1 hd 301-450 lbs

K0801 UE D IN 1113.96 Pov group 1 hd 301-450 lbs

K0802 NU D IN 1965.10 Pov group 1 vhd 451-600 lbs

K0802 RR D IN 196.51 Pov group 1 vhd 451-600 lbs

K0802 UE D IN 1473.83 Pov group 1 vhd 451-600 lbs

K0806 NU D IN 1327.19 Pov group 2 std up to 300lbs

K0806 RR D IN 132.72 Pov group 2 std up to 300lbs

K0806 UE D IN 995.39 Pov group 2 std up to 300lbs

K0807 NU D IN 2056.81 Pov group 2 hd 301-450 lbs

K0807 RR D IN 205.68 Pov group 2 hd 301-450 lbs

K0807 UE D IN 1542.61 Pov group 2 hd 301-450 lbs

K0808 NU D IN 3179.48 Pov group 2 vhd 451-600 lbs

K0808 RR D IN 317.95 Pov group 2 vhd 451-600 lbs

K0808 UE D IN 2384.62 Pov group 2 vhd 451-600 lbs

K0813 RR D CR 251.19 Pwc gp 1 std port seat/back

K0814 RR D CR 263.25 Pwc gp 1 std port cap chair

K0815 RR D CR 292.50 Pwc gp 1 std seat/back

K0816 RR D CR 273.16 Pwc gp 1 std cap chair

K0820 RR D CR 256.91 Pwc gp 2 std port seat/back

K0821 RR D CR 273.43 Pwc gp 2 std port cap chair



K0824 RR D CR 426.57 Pwc gp 2 hd seat/back

K0825 RR D CR 386.25 Pwc gp 2 hd cap chair

K0826 RR D CR 712.90 Pwc gp 2 vhd seat/back

K0827 RR D CR 627.61 Pwc gp vhd cap chair

K0828 RR D CR 831.06 Pwc gp 2 xtra hd seat/back

K0829 RR D CR 833.59 Pwc gp 2 xtra hd cap chair

K0835 RR D CR 341.01 Pwc gp2 std sing pow opt s/b




K0836 RR D CR 353.70 Pwc gp2 std sing pow opt cap

K0837 RR D CR 437.38 Pwc gp 2 hd sing pow opt s/b

K0838 RR D CR 387.67 Pwc gp 2 hd sing pow opt cap

K0839 RR D CR 580.99 Pwc gp2 vhd sing pow opt s/b

K0840 RR D CR 892.02 Pwc gp2 xhd sing pow opt s/b

K0841 RR D CR 384.29 Pwc gp2 std mult pow opt s/b

K0842 RR D CR 383.73 Pwc gp2 std mult pow opt cap

K0843 RR D CR 455.54 Pwc gp2 hd mult pow opt s/b



K0850 RR D CR 891.93 Pwc gp 3 hd seat/back

K0851 RR D CR 857.60 Pwc gp 3 hd cap chair

K0852 RR D CR 1030.57 Pwc gp 3 vhd seat/back

K0853 RR D CR 1058.66 Pwc gp 3 vhd cap chair

K0854 RR D CR 1402.49 Pwc gp 3 xhd seat/back

K0855 RR D CR 1324.86 Pwc gp 3 xhd cap chair

K0856 RR D CR 825.36 Pwc gp3 std sing pow opt s/b

K0857 RR D CR 841.91 Pwc gp3 std sing pow opt cap

K0858 RR D CR 1024.04 Pwc gp3 hd sing pow opt s/b

K0859 RR D CR 976.62 Pwc gp3 hd sing pow opt cap

K0860 RR D CR 1462.97 Pwc gp3 vhd sing pow opt s/b

K0861 RR D CR 826.68 Pwc gp3 std mult pow opt s/b

K0862 RR D CR 1024.04 Pwc gp3 hd mult pow opt s/b

K0863 RR D CR 1462.97 Pwc gp3 vhd mult pow opt s/b

K0864 RR D CR 1740.94 Pwc gp3 xhd mult pow opt s/b

K0903 D TS 43.56

L0112 D PO 1365.78 Cranial cervical orthosis

L0113 D PO 278.29 Cranial cervical torticollis

L0120 D PO 27.30 Cerv flex n/adj foam pre ots

L0130 D PO 197.41 Flex thermoplastic collar mo

L0140 D PO 68.12 Cervical semi-rigid adjustab

L0150 D PO 113.60 Cerv semi-rig adj molded chn

L0160 D PO 161.74 Cerv sr wire occ/man pre ots

L0170 D PO 684.44 Cervical collar molded to pt

L0172 D PO 138.77 Cerv col sr foam 2pc pre ots

L0174 D PO 249.30 Cerv sr 2pc thor ext pre ots

L0180 D PO 339.04 Cer post col occ/man sup adj

L0190 D PO 510.38 Cerv collar supp adj cerv ba

L0200 D PO 468.64 Cerv col supp adj bar & thor

L0220 D PO 111.14 Thor rib belt custom fabrica

L0450 D PO 183.49 Tlso flex trunk/thor pre ots

L0452 D PO 0.00 Tlso flex custom fab thoraci

L0454 D PO 338.43 Tlso trnk sj-t9 pre cst

L0455 D PO 338.43 Tlso flex trnk sj-t9 pre ots

L0456 D PO 970.53 Tlso flex trnk sj-ss pre cst

L0457 D PO 970.53 Tlso flex trnk sj-ss pre ots




L0458 D PO 870.27 Tlso 2mod symphis-xipho pre

L0460 D PO 979.58 Tlso 2 shl symphys-stern cst

L0462 D PO 1218.41 Tlso 3mod sacro-scap pre

L0464 D PO 1450.49 Tlso 4mod sacro-scap pre

L0466 D PO 372.98 Tlso r fram soft ant pre cst

L0467 D PO 372.98 Tlso r fram soft pre ots

L0468 D PO 467.63 Tlso rig fram pelvic pre cst

L0469 D PO 467.63 Tlso rig fram pelvic pre ots

L0470 D PO 665.76 Tlso rigid frame pre subclav

L0472 D PO 417.90 Tlso rigid frame hyperex pre

L0480 D PO 1292.24 Tlso rigid plastic custom fa

L0482 D PO 1481.39 Tlso rigid lined custom fab

L0484 D PO 1727.26 Tlso rigid plastic cust fab

L0486 D PO 1711.06 Tlso rigidlined cust fab two

L0488 D PO 979.58 Tlso rigid lined pre one pie

L0490 D PO 276.03 Tlso rigid plastic pre one

L0491 D PO 749.40 Tlso 2 piece rigid shell

L0492 D PO 485.69 Tlso 3 piece rigid shell

L0621 D PO 87.02 Sio flex pelvic/sacr pre ots

L0622 D PO 235.94 Sio flex pelvisacral custom

L0623 D PO 0.00 Sio rig pnl pelv/sac pre ots

L0624 D PO 0.00 Sio panel custom

L0625 D PO 53.78 Lo flex l1-below l5 pre ots

L0626 D PO 76.07 Lo sag rig pnl stays pre cst

L0627 D PO 401.13 Lo sag ri an/pos pnl pre cst

L0628 D PO 81.84 Lso flex no ri stays pre ots

L0629 D PO 0.00 Lso flex w/rigid stays cust

L0630 D PO 158.02 Lso r post pnl sj-t9 pre cst

L0631 D PO 1001.76 Lso sag r an/pos pnl pre cst

L0632 D PO 0.00 Lso sag rigid frame cust

L0633 D PO 279.82 Lso sc r pos/lat pnl pre cst

L0634 D PO 0.00 Lso flexion control custom

L0635 D PO 1037.65 Lso sagit rigid panel prefab

L0636 D PO 1531.12 Lso sagittal rigid panel cus

L0637 D PO 1328.44 Lso sc r ant/pos pnl pre cst

L0638 D PO 1287.02 Lso sag-coronal panel custom

L0639 D PO 1328.44 Lso s/c shell/panel prefab

L0640 D PO 1021.10 Lso s/c shell/panel custom

L0641 D PO 76.07 Lo rig pos pnl l1-l5 pre ots

L0642 D PO 401.13 Lo sag ri an/pos pnl pre ots

L0643 D PO 158.02 Lso sag ctr rigi pos pre ots

L0648 D PO 1001.76 Lso sag r an/pos pnl pre ots

L0649 D PO 279.82 Lso sc r pos/lat pnl pre ots

L0650 D PO 1328.44 Lso sc r ant/pos pnl pre ots

L0651 D PO 1328.44 Lso sag-co shell pnl pre ots

L0700 D PO 2100.97 Ctlso a-p-l control molded




L0710 D PO 2293.34 Ctlso a-p-l control w/ inter

L0810 D PO 2436.34 Halo cervical into jckt vest

L0820 D PO 1970.89 Halo cervical into body jack

L0830 D PO 2845.76 Halo cerv into milwaukee typ

L0859 D PO 1105.56 Mri compatible system

L0861 D PO 210.33 Halo repl liner/interface

L0970 D PO 103.72 Tlso corset front

L0972 D PO 106.02 Lso corset front

L0974 D PO 216.63 Tlso full corset

L0976 D PO 193.48 Lso full corset

L0978 D PO 174.69 Axillary crutch extension

L0980 D PO 15.85 Peroneal straps pair pre ots

L0982 D PO 17.27 Stocking sup grips 4 pre ots

L0984 D PO 55.10 Protect body sock ea pre ots

L1000 D PO 1842.45 Ctlso milwauke initial model

L1001 D PO 0.00 Ctlso infant immobilizer

L1005 D PO 3123.27 Tension based scoliosis orth

L1010 D PO 74.20 Ctlso axilla sling

L1020 D PO 101.38 Kyphosis pad

L1025 D PO 115.22 Kyphosis pad floating

L1030 D PO 76.97 Lumbar bolster pad

L1040 D PO 92.65 Lumbar or lumbar rib pad

L1050 D PO 80.21 Sternal pad

L1060 D PO 90.48 Thoracic pad

L1070 D PO 92.52 Trapezius sling

L1080 D PO 64.11 Outrigger

L1085 D PO 178.08 Outrigger bil w/ vert extens

L1090 D PO 83.18 Lumbar sling

L1100 D PO 146.84 Ring flange plastic/leather

L1110 D PO 248.72 Ring flange plas/leather mol

L1120 D PO 39.62 Covers for upright each

L1200 D PO 1577.14 Furnsh initial orthosis only

L1210 D PO 237.46 Lateral thoracic extension

L1220 D PO 201.05 Anterior thoracic extension

L1230 D PO 515.87 Milwaukee type superstructur

L1240 D PO 88.78 Lumbar derotation pad

L1250 D PO 87.42 Anterior asis pad

L1260 D PO 89.84 Anterior thoracic derotation

L1270 D PO 89.74 Abdominal pad

L1280 D PO 79.98 Rib gusset (elastic) each

L1290 D PO 90.68 Lateral trochanteric pad

L1300 D PO 1515.93 Body jacket mold to patient

L1310 D PO 1559.89 Post-operative body jacket

L1600 D PO 116.94 Ho flex frejka w/cov pre cst

L1610 D PO 39.84 Ho frejka cov only pre cst

L1620 D PO 131.19 Ho flex pavlik harns pre cst




L1630 D PO 156.56 Abduct control hip semi-flex

L1640 D PO 418.75 Pelv band/spread bar thigh c

L1650 D PO 222.08 Ho abduction hip adjustable

L1652 D PO 347.86 Ho bi thighcuffs w sprdr bar

L1660 D PO 155.31 Ho abduction static plastic

L1680 D PO 1276.85 Pelvic & hip control thigh c

L1685 D PO 1347.30 Post-op hip abduct custom fa

L1686 D PO 903.85 Ho post-op hip abduction

L1690 D PO 1887.00 Combination bilateral ho

L1700 D PO 1569.86 Leg perthes orth toronto typ

L1710 D PO 1845.28 Legg perthes orth newington

L1720 D PO 1363.11 Legg perthes orthosis trilat

L1730 D PO 1028.43 Legg perthes orth scottish r

L1755 D PO 1496.91 Legg perthes patten bottom t

L1810 D PO 118.14 Ko elastic with joints

L1812 D PO 118.14 Ko elastic w/joints pre ots

L1820 D PO 117.67 Ko elas w/ condyle pads & jo

L1830 D PO 98.43 Ko immob canvas long pre ots

L1831 D PO 287.18 Knee orth pos locking joint

L1832 D PO 735.65 Ko adj jnt pos r sup pre cst

L1833 D PO 735.65 Ko adj jnt pos r sup pre ots

L1834 D PO 865.48 Ko w/0 joint rigid molded to

L1836 D PO 130.20 Ko rigid w/o joints pre ots

L1840 D PO 909.77 Ko derot ant cruciate custom

L1843 D PO 875.56 Ko single upright pre cst

L1844 D PO 1517.15 Ko w/adj jt rot cntrl molded

L1845 D PO 914.00 Ko double upright pre cst

L1846 D PO 1159.72 Ko w adj flex/ext rotat mold

L1847 D PO 561.28 Ko dbl upright w/air pre cst

L1848 D PO 561.28 Ko dbl upright w/air pre ots

L1850 D PO 261.22 Ko swedish type pre ots

L1851 D PO 875.56 Ko single upright prefab ots

L1852 D PO 914.00 Ko double upright prefab ots

L1860 D PO 1013.17 Ko supracondylar socket mold

L1900 D PO 274.48 Afo sprng wir drsflx calf bd

L1902 D PO 74.55 Afo ankle gauntlet pre ots

L1904 D PO 426.75 Afo molded ankle gauntlet

L1906 D PO 124.71 Afo multilig ank sup pre ots

L1907 D PO 549.08 Afo supramalleolar custom

L1910 D PO 242.69 Afo sing bar clasp attach sh

L1920 D PO 317.27 Afo sing upright w/ adjust s

L1930 D PO 214.68 Afo plastic

L1932 D PO 870.78 Afo rig ant tib prefab tcf/=

L1940 D PO 485.16 Afo molded to patient plasti

L1945 D PO 890.95 Afo molded plas rig ant tib

L1950 D PO 675.96 Afo spiral molded to pt plas




L1951 D PO 819.52 Afo spiral prefabricated

L1960 D PO 503.02 Afo pos solid ank plastic mo

L1970 D PO 744.01 Afo plastic molded w/ankle j

L1971 D PO 457.39 Afo w/ankle joint, prefab

L1980 D PO 333.06 Afo sing solid stirrup calf

L1990 D PO 427.94 Afo doub solid stirrup calf

L2000 D PO 920.48 Kafo sing fre stirr thi/calf

L2005 D PO 3998.66 Kafo sng/dbl mechanical act

L2010 D PO 839.10 Kafo sng solid stirrup w/o j

L2020 D PO 1059.66 Kafo dbl solid stirrup band/

L2030 D PO 919.35 Kafo dbl solid stirrup w/o j

L2034 D PO 2003.67 Kafo pla sin up w/wo k/a cus

L2035 D PO 169.04 Kafo plastic pediatric size

L2036 D PO 1683.72 Kafo plas doub free knee mol

L2037 D PO 1551.65 Kafo plas sing free knee mol

L2038 D PO 1297.50 Kafo w/o joint multi-axis an

L2040 D PO 165.74 Hkafo torsion bil rot straps

L2050 D PO 441.37 Hkafo torsion cable hip pelv

L2060 D PO 566.47 Hkafo torsion ball bearing j

L2070 D PO 162.73 Hkafo torsion unilat rot str

L2080 D PO 347.04 Hkafo unilat torsion cable

L2090 D PO 427.75 Hkafo unilat torsion ball br

L2106 D PO 617.03 Afo tib fx cast plaster mold

L2108 D PO 969.63 Afo tib fx cast molded to pt

L2112 D PO 460.40 Afo tibial fracture soft

L2114 D PO 526.75 Afo tib fx semi-rigid

L2116 D PO 694.00 Afo tibial fracture rigid

L2126 D PO 1234.82 Kafo fem fx cast thermoplas

L2128 D PO 1556.14 Kafo fem fx cast molded to p

L2132 D PO 732.08 Kafo femoral fx cast soft

L2134 D PO 877.72 Kafo fem fx cast semi-rigid

L2136 D PO 1073.22 Kafo femoral fx cast rigid

L2180 D PO 106.28 Plas shoe insert w ank joint

L2182 D PO 83.18 Drop lock knee

L2184 D PO 149.89 Limited motion knee joint

L2186 D PO 166.10 Adj motion knee jnt lerman t

L2188 D PO 362.39 Quadrilateral brim

L2190 D PO 94.13 Waist belt

L2192 D PO 323.58 Pelvic band & belt thigh fla

L2200 D PO 43.15 Limited ankle motion ea jnt

L2210 D PO 70.01 Dorsiflexion assist each joi

L2220 D PO 80.38 Dorsi & plantar flex ass/res

L2230 D PO 69.63 Split flat caliper stirr & p

L2232 D PO 94.28 Rocker bottom, contact afo

L2240 D PO 75.90 Round caliper and plate atta

L2250 D PO 322.46 Foot plate molded stirrup at




L2260 D PO 181.92 Reinforced solid stirrup

L2265 D PO 106.88 Long tongue stirrup

L2270 D PO 48.74 Varus/valgus strap padded/li

L2275 D PO 118.59 Plastic mod low ext pad/line

L2280 D PO 440.54 Molded inner boot

L2300 D PO 248.68 Abduction bar jointed adjust

L2310 D PO 111.65 Abduction bar-straight

L2320 D PO 186.72 Non-molded lacer

L2330 D PO 356.34 Lacer molded to patient mode

L2335 D PO 209.63 Anterior swing band

L2340 D PO 494.67 Pre-tibial shell molded to p

L2350 D PO 808.64 Prosthetic type socket molde

L2360 D PO 46.95 Extended steel shank

L2370 D PO 232.96 Patten bottom

L2375 D PO 102.54 Torsion ank & half solid sti

L2380 D PO 111.73 Torsion straight knee joint

L2385 D PO 121.55 Straight knee joint heavy du

L2387 D PO 164.96 Add le poly knee custom kafo

L2390 D PO 99.34 Offset knee joint each

L2395 D PO 151.67 Offset knee joint heavy duty

L2397 D PO 106.36 Suspension sleeve lower ext

L2405 D PO 85.08 Knee joint drop lock ea jnt

L2415 D PO 118.55 Knee joint cam lock each joi

L2425 D PO 139.87 Knee disc/dial lock/adj flex

L2430 D PO 139.87 Knee jnt ratchet lock ea jnt

L2492 D PO 92.54 Knee lift loop drop lock rin

L2500 D PO 286.30 Thi/glut/ischia wgt bearing

L2510 D PO 766.53 Th/wght bear quad-lat brim m

L2520 D PO 418.07 Th/wght bear quad-lat brim c

L2525 D PO 1434.31 Th/wght bear nar m-l brim mo

L2526 D PO 773.11 Th/wght bear nar m-l brim cu

L2530 D PO 213.23 Thigh/wght bear lacer non-mo

L2540 D PO 383.68 Thigh/wght bear lacer molded

L2550 D PO 260.64 Thigh/wght bear high roll cu

L2570 D PO 576.34 Hip clevis type 2 posit jnt

L2580 D PO 546.33 Pelvic control pelvic sling

L2600 D PO 186.38 Hip clevis/thrust bearing fr

L2610 D PO 220.39 Hip clevis/thrust bearing lo

L2620 D PO 242.65 Pelvic control hip heavy dut

L2622 D PO 278.30 Hip joint adjustable flexion

L2624 D PO 378.34 Hip adj flex ext abduct cont

L2627 D PO 1558.73 Plastic mold recipro hip & c

L2628 D PO 1831.01 Metal frame recipro hip & ca

L2630 D PO 224.72 Pelvic control band & belt u

L2640 D PO 304.97 Pelvic control band & belt b

L2650 D PO 108.90 Pelv & thor control gluteal




L2660 D PO 169.14 Thoracic control thoracic ba

L2670 D PO 154.80 Thorac cont paraspinal uprig

L2680 D PO 142.01 Thorac cont lat support upri

L2750 D PO 75.85 Plating chrome/nickel pr bar

L2755 D PO 127.54 Carbon graphite lamination

L2760 D PO 55.14 Extension per extension per

L2768 D PO 127.15 Ortho sidebar disconnect

L2780 D PO 65.23 Non-corrosive finish

L2785 D PO 38.35 Drop lock retainer each

L2795 D PO 77.11 Knee control full kneecap

L2800 D PO 96.80 Knee cap medial or lateral p

L2810 D PO 70.88 Knee control condylar pad

L2820 D PO 78.81 Soft interface below knee se

L2830 D PO 88.62 Soft interface above knee se

L2840 D PO 49.46 Tibial length sock fx or equ

L2850 D PO 56.19 Femoral lgth sock fx or equa

L3000 D PO 306.55 Ft insert ucb berkeley shell

L3001 D PO 129.05 Foot insert remov molded spe

L3002 D PO 157.60 Foot insert plastazote or eq

L3003 D PO 170.02 Foot insert silicone gel eac

L3010 D PO 170.02 Foot longitudinal arch suppo

L3020 D PO 193.61 Foot longitud/metatarsal sup

L3030 D PO 74.48 Foot arch support remov prem

L3031 D PO 119.50 Foot lamin/prepreg composite

L3040 D PO 45.93 Ft arch suprt premold longit

L3050 D PO 45.93 Foot arch supp premold metat

L3060 D PO 71.97 Foot arch supp longitud/meta

L3070 D PO 31.03 Arch suprt att to sho longit

L3080 D PO 31.03 Arch supp att to shoe metata

L3090 D PO 39.72 Arch supp att to shoe long/m

L3100 D PO 42.17 Hallus-valgus nt dyn pre ots

L3140 D PO 86.89 Abduction rotation bar shoe

L3150 D PO 79.44 Abduct rotation bar w/o shoe

L3170 D PO 49.65 Foot plas heel stabi pre ots

L3224 D PO 53.37 Woman's shoe oxford brace

L3225 D PO 61.39 Man's shoe oxford brace

L3300 D PO 50.87 Sho lift taper to metatarsal

L3310 D PO 79.44 Shoe lift elev heel/sole neo

L3330 D PO 552.25 Lifts elevation metal extens

L3332 D PO 71.97 Shoe lifts tapered to one-ha

L3334 D PO 37.23 Shoe lifts elevation heel /i

L3340 D PO 83.17 Shoe wedge sach

L3350 D PO 22.31 Shoe heel wedge

L3360 D PO 34.75 Shoe sole wedge outside sole

L3370 D PO 48.41 Shoe sole wedge between sole

L3380 D PO 48.41 Shoe clubfoot wedge




L3390 D PO 48.41 Shoe outflare wedge

L3400 D PO 39.72 Shoe metatarsal bar wedge ro

L3410 D PO 90.62 Shoe metatarsal bar between

L3420 D PO 53.35 Full sole/heel wedge btween

L3430 D PO 156.37 Sho heel count plast reinfor

L3440 D PO 74.48 Heel leather reinforced

L3450 D PO 102.98 Shoe heel sach cushion type

L3455 D PO 39.72 Shoe heel new leather standa

L3460 D PO 33.49 Shoe heel new rubber standar

L3465 D PO 57.08 Shoe heel thomas with wedge

L3470 D PO 60.79 Shoe heel thomas extend to b

L3480 D PO 60.79 Shoe heel pad & depress for

L3500 D PO 28.57 Ortho shoe add leather insol

L3510 D PO 28.57 Orthopedic shoe add rub insl

L3520 D PO 31.03 O shoe add felt w leath insl

L3530 D PO 31.03 Ortho shoe add half sole

L3540 D PO 49.65 Ortho shoe add full sole

L3550 D PO 8.70 O shoe add standard toe tap

L3560 D PO 22.31 O shoe add horseshoe toe tap

L3570 D PO 83.17 O shoe add instep extension

L3580 D PO 63.29 O shoe add instep velcro clo

L3590 D PO 52.13 O shoe convert to sof counte

L3595 D PO 40.95 Ortho shoe add march bar

L3600 D PO 74.48 Trans shoe calip plate exist

L3610 D PO 98.04 Trans shoe caliper plate new

L3620 D PO 74.48 Trans shoe solid stirrup exi

L3630 D PO 98.04 Trans shoe solid stirrup new

L3640 D PO 42.17 Shoe dennis browne splint bo

L3650 D PO 53.16 So 8 abd restraint pre ots

L3660 D PO 91.27 So 8 ab rstr can/web pre ots

L3670 D PO 127.21 So acro/clav can web pre ots

L3671 D PO 800.20 So cap design w/o jnts cf

L3674 D PO 1049.75 So airplane w/wo joint cf

L3675 D PO 155.86 So vest canvas/web pre ots

L3702 D PO 256.44 Eo w/o joints cf

L3710 D PO 128.76 Eo elas w/metal jnts pre ots

L3720 D PO 642.39 Forearm/arm cuffs free motio

L3730 D PO 845.61 Forearm/arm cuffs ext/flex a

L3740 D PO 950.34 Cuffs adj lock w/ active con

L3760 D PO 444.11 Eo adj jt prefab custom fit

L3761 D PO 444.11 Eo, adj lock joint prefab ot

L3762 D PO 95.50 Eo rigid w/o joints pre ots

L3763 D PO 705.09 Ewho rigid w/o jnts cf

L3764 D PO 703.18 Ewho w/joint(s) cf

L3765 D PO 1138.74 Ewhfo rigid w/o jnts cf

L3766 D PO 1205.85 Ewhfo w/joint(s) cf




L3806 D PO 403.40 Whfo w/joint(s) custom fab

L3807 D PO 222.08 Whfo w/o joints pre cst

L3808 D PO 296.63 Whfo, rigid w/o joints

L3809 D PO 222.08 Whfo w/o joints pre ots

L3900 D PO 1387.34 Hinge extension/flex wrist/f

L3901 D PO 1555.58 Hinge ext/flex wrist finger

L3904 D PO 3166.71 Whfo electric custom fitted

L3905 D PO 880.71 Who w/nontorsion jnt(s) cf

L3906 D PO 374.64 Who w/o joints cf

L3908 D PO 53.20 Who cock-up nonmolde pre ots

L3912 D PO 85.35 Hfo flexion glove pre ots

L3913 D PO 240.54 Hfo w/o joints cf

L3915 D PO 472.09 Who nontorsion jnts pre cst

L3916 D PO 472.09 Who nontorsion jnts pre ots

L3917 D PO 93.82 Metacarp fx orthosis pre cst

L3918 D PO 93.82 Metacarp fx orthosis pre ots

L3919 D PO 240.54 Ho w/o joints cf

L3921 D PO 285.23 Hfo w/joint(s) cf

L3923 D PO 77.25 Hfo without joints pre cst

L3924 D PO 77.25 Hfo without joints pre ots

L3925 D PO 46.91 Fo pip dip jnt/sprng pre ots

L3927 D PO 31.08 Fo pip dip no jt spr pre ots

L3929 D PO 74.76 Hfo nontorsion jnts pre cst

L3930 D PO 74.76 Hfo nontorsion jnts pre ots

L3931 D PO 180.86 Whfo nontorsion joint prefab

L3933 D PO 189.49 Fo w/o joints cf

L3935 D PO 196.22 Fo nontorsion joint cf

L3956 D PO 0.00 Add joint upper ext orthosis

L3960 D PO 732.02 Sewho airplan desig abdu pos

L3961 D PO 1492.08 Sewho cap design w/o jnts cf

L3962 D PO 762.20 Sewho erbs palsey design abd

L3967 D PO 1761.64 Sewho airplane w/o jnts cf

L3971 D PO 1672.18 Sewho cap design w/jnt(s) cf

L3973 D PO 1761.64 Sewho airplane w/jnt(s) cf

L3975 D PO 1492.08 Sewhfo cap design w/o jnt cf

L3976 D PO 1492.08 Sewhfo airplane w/o jnts cf

L3977 D PO 1672.18 Sewhfo cap desgn w/jnt(s) cf

L3978 D PO 1761.64 Sewhfo airplane w/jnt(s) cf

L3980 D PO 274.53 Up ext fx orthos humeral nos

L3981 D PO 893.91 Ue fx orth shoul cap forearm

L3982 D PO 339.18 Upper ext fx orthosis rad/ul

L3984 D PO 362.05 Upper ext fx orthosis wrist

L3995 D PO 30.38 Sock fracture or equal each

L4000 D PO 1183.88 Repl girdle milwaukee orth

L4002 D PO 0.00 Replace strap, any orthosis

L4010 D PO 666.22 Replace trilateral socket br




L4020 D PO 832.16 Replace quadlat socket brim

L4030 D PO 458.19 Replace socket brim cust fit

L4040 D PO 370.44 Replace molded thigh lacer

L4045 D PO 297.69 Replace non-molded thigh lac

L4050 D PO 374.66 Replace molded calf lacer

L4055 D PO 242.60 Replace non-molded calf lace

L4060 D PO 288.41 Replace high roll cuff

L4070 D PO 275.15 Replace prox & dist upright

L4080 D PO 97.01 Repl met band kafo-afo prox

L4090 D PO 85.86 Repl met band kafo-afo calf/

L4100 D PO 96.84 Repl leath cuff kafo prox th

L4110 D PO 76.96 Repl leath cuff kafo-afo cal

L4130 D PO 529.67 Replace pretibial shell

L4350 D PO 95.43 Ankle control ortho pre ots

L4360 D PO 266.98 Pneumat walking boot pre cst

L4361 D PO 266.98 Pneuma/vac walk boot pre ots

L4370 D PO 171.33 Pneum full leg splnt pre ots

L4386 D PO 154.71 Non-pneum walk boot pre cst

L4387 D PO 154.71 Non-pneum walk boot pre ots

L4392 D PO 22.98 Replace afo soft interface

L4394 D PO 16.77 Replace foot drop spint

L4396 D PO 163.79 Static or dynami afo pre cst

L4397 D PO 163.79 Static or dynami afo pre ots

L4398 D PO 75.38 Foot drop splint pre ots

L4631 D PO 1456.23 Afo, walk boot type, cus fab

L5000 D PO 511.67 Sho insert w arch toe filler

L5010 D PO 1235.81 Mold socket ank hgt w/ toe f

L5020 D PO 2098.67 Tibial tubercle hgt w/ toe f

L5050 D PO 2321.51 Ank symes mold sckt sach ft

L5060 D PO 2670.42 Symes met fr leath socket ar

L5100 D PO 2326.64 Molded socket shin sach foot

L5105 D PO 3358.76 Plast socket jts/thgh lacer

L5150 D PO 3395.24 Mold sckt ext knee shin sach

L5160 D PO 3692.93 Mold socket bent knee shin s

L5200 D PO 3536.51 Kne sing axis fric shin sach

L5210 D PO 2346.12 No knee/ankle joints w/ ft b

L5220 D PO 2666.79 No knee joint with artic ali

L5230 D PO 3678.02 Fem focal defic constant fri

L5250 D PO 5016.50 Hip canad sing axi cons fric

L5270 D PO 4994.24 Tilt table locking hip sing

L5280 D PO 4956.00 Hemipelvect canad sing axis

L5301 D PO 2659.50 Bk mold socket sach ft endo

L5312 D PO 3806.89 Knee disart, sach ft, endo

L5321 D PO 3855.01 Ak open end sach

L5331 D PO 4912.05 Hip disart canadian sach ft

L5341 D PO 5113.48 Hemipelvectomy canadian sach




L5400 D PO 1316.68 Postop dress & 1 cast chg bk

L5410 D PO 403.96 Postop dsg bk ea add cast ch

L5420 D PO 1613.54 Postop dsg & 1 cast chg ak/d

L5430 D PO 486.53 Postop dsg ak ea add cast ch

L5450 D PO 395.81 Postop app non-wgt bear dsg

L5460 D PO 527.35 Postop app non-wgt bear dsg

L5500 D PO 1241.74 Init bk ptb plaster direct

L5505 D PO 1717.37 Init ak ischal plstr direct

L5510 D PO 1407.59 Prep bk ptb plaster molded

L5520 D PO 1390.37 Perp bk ptb thermopls direct

L5530 D PO 1669.96 Prep bk ptb thermopls molded

L5535 D PO 1639.58 Prep bk ptb open end socket

L5540 D PO 1749.94 Prep bk ptb laminated socket

L5560 D PO 1879.13 Prep ak ischial plast molded

L5570 D PO 1953.63 Prep ak ischial direct form

L5580 D PO 2280.73 Prep ak ischial thermo mold

L5585 D PO 2806.81 Prep ak ischial open end

L5590 D PO 2324.22 Prep ak ischial laminated

L5595 D PO 4106.05 Hip disartic sach thermopls

L5600 D PO 4413.81 Hip disart sach laminat mold

L5610 D PO 2001.73 Above knee hydracadence

L5611 D PO 1557.75 Ak 4 bar link w/fric swing

L5613 D PO 2435.49 Ak 4 bar ling w/hydraul swig

L5614 D PO 1649.87 4-bar link above knee w/swng

L5616 D PO 1316.12 Ak univ multiplex sys frict

L5617 D PO 547.04 Ak/bk self-aligning unit ea

L5618 D PO 289.40 Test socket symes

L5620 D PO 268.80 Test socket below knee

L5622 D PO 350.51 Test socket knee disarticula

L5624 D PO 351.50 Test socket above knee

L5626 D PO 460.97 Test socket hip disarticulat

L5628 D PO 492.90 Test socket hemipelvectomy

L5629 D PO 307.26 Below knee acrylic socket

L5630 D PO 433.91 Syme typ expandabl wall sckt

L5631 D PO 424.81 Ak/knee disartic acrylic soc

L5632 D PO 237.09 Symes type ptb brim design s

L5634 D PO 294.10 Symes type poster opening so

L5636 D PO 246.35 Symes type medial opening so

L5637 D PO 279.31 Below knee total contact

L5638 D PO 486.55 Below knee leather socket

L5639 D PO 1084.00 Below knee wood socket

L5640 D PO 618.23 Knee disarticulat leather so

L5642 D PO 599.02 Above knee leather socket

L5643 D PO 1504.83 Hip flex inner socket ext fr

L5644 D PO 571.06 Above knee wood socket

L5645 D PO 771.44 Bk flex inner socket ext fra




L5646 D PO 529.74 Below knee cushion socket

L5647 D PO 769.08 Below knee suction socket

L5648 D PO 636.54 Above knee cushion socket

L5649 D PO 2306.56 Isch containmt/narrow m-l so

L5650 D PO 472.00 Tot contact ak/knee disart s

L5651 D PO 1161.10 Ak flex inner socket ext fra

L5652 D PO 421.52 Suction susp ak/knee disart

L5653 D PO 562.70 Knee disart expand wall sock

L5654 D PO 320.65 Socket insert symes

L5655 D PO 271.73 Socket insert below knee

L5656 D PO 364.52 Socket insert knee articulat

L5658 D PO 351.54 Socket insert above knee

L5661 D PO 588.37 Multi-durometer symes

L5665 D PO 495.05 Multi-durometer below knee

L5666 D PO 67.68 Below knee cuff suspension

L5668 D PO 109.16 Bk molded distal cushion

L5670 D PO 262.35 Bk molded supracondylar susp

L5671 D PO 555.95 Bk/ak locking mechanism

L5672 D PO 288.30 Bk removable medial brim sus

L5673 D PO 687.48 Socket insert w lock mech

L5676 D PO 350.35 Bk knee joints single axis p

L5677 D PO 476.71 Bk knee joints polycentric p

L5678 D PO 38.39 Bk joint covers pair

L5679 D PO 572.87 Socket insert w/o lock mech

L5680 D PO 320.46 Bk thigh lacer non-molded

L5681 D PO 1286.10 Intl custm cong/latyp insert

L5682 D PO 604.65 Bk thigh lacer glut/ischia m

L5683 D PO 1286.10 Initial custom socket insert

L5684 D PO 46.53 Bk fork strap

L5685 D PO 125.23 Below knee sus/seal sleeve

L5686 D PO 49.39 Bk back check

L5688 D PO 59.06 Bk waist belt webbing

L5690 D PO 94.61 Bk waist belt padded and lin

L5692 D PO 128.47 Ak pelvic control belt light

L5694 D PO 175.40 Ak pelvic control belt pad/l

L5695 D PO 161.92 Ak sleeve susp neoprene/equa

L5696 D PO 178.89 Ak/knee disartic pelvic join

L5697 D PO 77.62 Ak/knee disartic pelvic band

L5698 D PO 126.92 Ak/knee disartic silesian ba

L5699 D PO 228.64 Shoulder harness

L5700 D PO 2770.18 Replace socket below knee

L5701 D PO 3326.78 Replace socket above knee

L5702 D PO 4208.86 Replace socket hip

L5703 D PO 2178.13 Symes ankle w/o (sach) foot

L5704 D PO 518.24 Custom shape cover bk

L5705 D PO 926.01 Custom shape cover ak




L5706 D PO 907.72 Custom shape cvr knee disart

L5707 D PO 1196.69 Custom shape cvr hip disart

L5710 D PO 361.58 Kne-shin exo sng axi mnl loc

L5711 D PO 505.35 Knee-shin exo mnl lock ultra

L5712 D PO 423.43 Knee-shin exo frict swg & st

L5714 D PO 434.93 Knee-shin exo variable frict

L5716 D PO 704.67 Knee-shin exo mech stance ph

L5718 D PO 880.76 Knee-shin exo frct swg & sta

L5722 D PO 930.49 Knee-shin pneum swg frct exo

L5724 D PO 1459.36 Knee-shin exo fluid swing ph

L5726 D PO 1681.88 Knee-shin ext jnts fld swg e

L5728 D PO 2300.59 Knee-shin fluid swg & stance

L5780 D PO 1106.95 Knee-shin pneum/hydra pneum

L5781 D PO 3912.05 Lower limb pros vacuum pump

L5782 D PO 4124.20 Hd low limb pros vacuum pump

L5785 D PO 622.24 Exoskeletal bk ultralt mater

L5790 D PO 695.18 Exoskeletal ak ultra-light m

L5795 D PO 1384.11 Exoskel hip ultra-light mate

L5810 D PO 470.72 Endoskel knee-shin mnl lock

L5811 D PO 705.13 Endo knee-shin mnl lck ultra

L5812 D PO 546.55 Endo knee-shin frct swg & st

L5814 D PO 3631.15 Endo knee-shin hydral swg ph

L5816 D PO 827.20 Endo knee-shin polyc mch sta

L5818 D PO 928.48 Endo knee-shin frct swg & st

L5822 D PO 1646.43 Endo knee-shin pneum swg frc

L5824 D PO 1482.71 Endo knee-shin fluid swing p

L5826 D PO 3053.32 Miniature knee joint

L5828 D PO 2730.29 Endo knee-shin fluid swg/sta

L5830 D PO 1834.61 Endo knee-shin pneum/swg pha

L5840 D PO 3392.21 Multi-axial knee/shin system

L5845 D PO 1752.47 Knee-shin sys stance flexion

L5848 D PO 1051.35 Knee-shin sys hydraul stance

L5850 D PO 123.68 Endo ak/hip knee extens assi

L5855 D PO 332.35 Mech hip extension assist

L5856 D PO 23471.14 Elec knee-shin swing/stance

L5857 D PO 8328.42 Elec knee-shin swing only

L5858 D PO 18171.24 Stance phase only

L5859 D PO 14186.14 Knee-shin pro flex/ext cont

L5910 D PO 350.17 Endo below knee alignable sy

L5920 D PO 513.00 Endo ak/hip alignable system

L5925 D PO 433.16 Above knee manual lock

L5930 D PO 3290.92 High activity knee frame

L5940 D PO 484.97 Endo bk ultra-light material

L5950 D PO 758.29 Endo ak ultra-light material

L5960 D PO 932.07 Endo hip ultra-light materia

L5961 D PO 4444.51 Endo poly hip, pneu/hyd/rot




L5962 D PO 613.40 Below knee flex cover system

L5964 D PO 905.47 Above knee flex cover system

L5966 D PO 1153.79 Hip flexible cover system

L5968 D PO 3552.99 Multiaxial ankle w dorsiflex

L5970 D PO 196.36 Foot external keel sach foot

L5971 D PO 196.36 Sach foot, replacement

L5972 D PO 366.77 Flexible keel foot

L5973 D PO 16821.46 Ank-foot sys dors-plant flex

L5974 D PO 225.31 Foot single axis ankle/foot

L5975 D PO 453.29 Combo ankle/foot prosthesis

L5976 D PO 541.46 Energy storing foot

L5978 D PO 282.15 Ft prosth multiaxial ankl/ft

L5979 D PO 2206.10 Multi-axial ankle/ft prosth

L5980 D PO 3584.76 Flex foot system

L5981 D PO 2896.00 Flex-walk sys low ext prosth

L5982 D PO 558.94 Exoskeletal axial rotation u

L5984 D PO 550.78 Endoskeletal axial rotation

L5985 D PO 276.09 Lwr ext dynamic prosth pylon

L5986 D PO 612.67 Multi-axial rotation unit

L5987 D PO 7033.51 Shank ft w vert load pylon

L5988 D PO 1953.20 Vertical shock reducing pylo

L5990 D PO 1773.80 User adjustable heel height

L6000 D PO 1284.63 Part hand thumb rem

L6010 D PO 1429.58 Part hand little/ring

L6020 D PO 1332.86 Part hand no fingers

L6026 D PO 4833.16 Part hand myo exclu term dev

L6050 D PO 1836.63 Wrst mld sck flx hng tri pad

L6055 D PO 2559.79 Wrst mold sock w/exp interfa

L6100 D PO 1860.79 Elb mold sock flex hinge pad

L6110 D PO 1973.68 Elbow mold sock suspension t

L6120 D PO 2300.04 Elbow mold doub splt soc ste

L6130 D PO 2502.87 Elbow stump activated lock h

L6200 D PO 2637.62 Elbow mold outsid lock hinge

L6205 D PO 3520.81 Elbow molded w/ expand inter

L6250 D PO 2763.62 Elbow inter loc elbow forarm

L6300 D PO 3602.09 Shlder disart int lock elbow

L6310 D PO 3110.24 Shoulder passive restor comp

L6320 D PO 1699.05 Shoulder passive restor cap

L6350 D PO 3787.04 Thoracic intern lock elbow

L6360 D PO 3405.85 Thoracic passive restor comp

L6370 D PO 2037.95 Thoracic passive restor cap

L6380 D PO 1180.95 Postop dsg cast chg wrst/elb

L6382 D PO 1776.68 Postop dsg cast chg elb dis/

L6384 D PO 2457.85 Postop dsg cast chg shlder/t

L6386 D PO 388.27 Postop ea cast chg & realign

L6388 D PO 425.04 Postop applicat rigid dsg on




L6400 D PO 2243.45 Below elbow prosth tiss shap

L6450 D PO 2997.19 Elb disart prosth tiss shap

L6500 D PO 3135.69 Above elbow prosth tiss shap

L6550 D PO 3769.15 Shldr disar prosth tiss shap

L6570 D PO 4231.74 Scap thorac prosth tiss shap

L6580 D PO 1615.59 Wrist/elbow bowden cable mol

L6582 D PO 1463.29 Wrist/elbow bowden cbl dir f

L6584 D PO 2294.82 Elbow fair lead cable molded

L6586 D PO 2147.59 Elbow fair lead cable dir fo

L6588 D PO 2821.87 Shdr fair lead cable molded

L6590 D PO 2680.33 Shdr fair lead cable direct

L6600 D PO 181.35 Polycentric hinge pair

L6605 D PO 179.07 Single pivot hinge pair

L6610 D PO 171.96 Flexible metal hinge pair

L6611 D PO 402.53 Additional switch, ext power

L6615 D PO 185.29 Disconnect locking wrist uni

L6616 D PO 68.66 Disconnect insert locking wr

L6620 D PO 296.45 Flexion/extension wrist unit

L6621 D PO 2236.32 Flex/ext wrist w/wo friction

L6623 D PO 826.92 Spring-ass rot wrst w/ latch

L6624 D PO 3682.17 Flex/ext/rotation wrist unit

L6625 D PO 587.54 Rotation wrst w/ cable lock

L6628 D PO 463.16 Quick disconn hook adapter o

L6629 D PO 141.45 Lamination collar w/ couplin

L6630 D PO 208.37 Stainless steel any wrist

L6632 D PO 72.37 Latex suspension sleeve each

L6635 D PO 170.29 Lift assist for elbow

L6637 D PO 363.22 Nudge control elbow lock

L6638 D PO 2445.02 Elec lock on manual pw elbow

L6640 D PO 322.68 Shoulder abduction joint pai

L6641 D PO 155.10 Excursion amplifier pulley t

L6642 D PO 210.23 Excursion amplifier lever ty

L6645 D PO 388.06 Shoulder flexion-abduction j

L6646 D PO 3083.74 Multipo locking shoulder jnt

L6647 D PO 507.67 Shoulder lock actuator

L6648 D PO 3180.42 Ext pwrd shlder lock/unlock

L6650 D PO 402.90 Shoulder universal joint

L6655 D PO 79.18 Standard control cable extra

L6660 D PO 88.74 Heavy duty control cable

L6665 D PO 44.53 Teflon or equal cable lining

L6670 D PO 49.24 Hook to hand cable adapter

L6672 D PO 195.38 Harness chest/shlder saddle

L6675 D PO 116.11 Harness figure of 8 sing con

L6676 D PO 134.21 Harness figure of 8 dual con

L6677 D PO 290.08 Ue triple control harness

L6680 D PO 224.31 Test sock wrist disart/bel e




L6682 D PO 248.01 Test sock elbw disart/above

L6684 D PO 337.01 Test socket shldr disart/tho

L6686 D PO 761.05 Suction socket

L6687 D PO 557.68 Frame typ socket bel elbow/w

L6688 D PO 554.32 Frame typ sock above elb/dis

L6689 D PO 664.15 Frame typ socket shoulder di

L6690 D PO 723.73 Frame typ sock interscap-tho

L6691 D PO 334.97 Removable insert each

L6692 D PO 540.69 Silicone gel insert or equal

L6693 D PO 2775.74 Lockingelbow forearm cntrbal

L6694 D PO 687.48 Elbow socket ins use w/lock

L6695 D PO 572.87 Elbow socket ins use w/o lck

L6696 D PO 1286.10 Cus elbo skt in for con/atyp

L6697 D PO 1286.10 Cus elbo skt in not con/atyp

L6698 D PO 555.95 Below/above elbow lock mech

L6703 D PO 351.48 Term dev, passive hand mitt

L6704 D PO 566.22 Term dev, sport/rec/work att

L6706 D PO 337.35 Term dev mech hook vol open

L6707 D PO 1243.42 Term dev mech hook vol close

L6708 D PO 812.86 Term dev mech hand vol open

L6709 D PO 1171.36 Term dev mech hand vol close

L6711 D PO 657.33 Ped term dev, hook, vol open

L6712 D PO 1210.30 Ped term dev, hook, vol clos

L6713 D PO 1527.48 Ped term dev, hand, vol open

L6714 D PO 1293.81 Ped term dev, hand, vol clos

L6715 D PO 3086.83 Term device, multi art digit

L6721 D PO 2299.59 Hook/hand, hvy dty, vol open

L6722 D PO 1982.40 Hook/hand, hvy dty, vol clos

L6805 D PO 328.95 Term dev modifier wrist unit

L6810 D PO 186.45 Term dev precision pinch dev

L6880 D PO 23360.33 Elec hand ind art digits

L6881 D PO 3997.16 Term dev auto grasp feature

L6882 D PO 3032.07 Microprocessor control uplmb

L6883 D PO 1534.26 Replc sockt below e/w disa

L6884 D PO 2277.17 Replc sockt above elbow disa

L6885 D PO 3405.85 Replc sockt shldr dis/interc

L6890 D PO 164.45 Prefab glove for term device

L6895 D PO 604.96 Custom glove for term device

L6900 D PO 1726.40 Hand restorat thumb/1 finger

L6905 D PO 1716.59 Hand restoration multiple fi

L6910 D PO 1467.85 Hand restoration no fingers

L6915 D PO 740.07 Hand restoration replacmnt g

L6920 D PO 6452.43 Wrist disarticul switch ctrl

L6925 D PO 8686.09 Wrist disart myoelectronic c

L6930 D PO 6492.44 Below elbow switch control

L6935 D PO 8820.88 Below elbow myoelectronic ct




L6940 D PO 8482.79 Elbow disarticulation switch

L6945 D PO 10364.96 Elbow disart myoelectronic c

L6950 D PO 9641.89 Above elbow switch control

L6955 D PO 11547.48 Above elbow myoelectronic ct

L6960 D PO 13080.42 Shldr disartic switch contro

L6965 D PO 13950.74 Shldr disartic myoelectronic

L6970 D PO 14536.90 Interscapular-thor switch ct

L6975 D PO 15898.67 Interscap-thor myoelectronic

L7007 D PO 3326.96 Adult electric hand

L7008 D PO 5236.28 Pediatric electric hand

L7009 D PO 3394.55 Adult electric hook

L7040 D PO 2725.69 Prehensile actuator

L7045 D PO 1562.73 Pediatric electric hook

L7170 D PO 7195.42 Electronic elbow hosmer swit

L7180 D PO 31583.87 Electronic elbow sequential

L7181 D PO 39175.54 Electronic elbo simultaneous

L7185 D PO 7105.57 Electron elbow adolescent sw

L7186 D PO 8552.24 Electron elbow child switch

L7190 D PO 7463.27 Elbow adolescent myoelectron

L7191 D PO 8936.58 Elbow child myoelectronic ct

L7259 D PO 3089.94 Electronic wrist rotator any

L7360 D PO 230.70 Six volt bat otto bock/eq ea

L7362 D PO 242.24 Battery chrgr six volt otto

L7364 D PO 385.26 Twelve volt battery utah/equ

L7366 D PO 518.96 Battery chrgr 12 volt utah/e

L7367 D PO 380.64 Replacemnt lithium ionbatter

L7368 D PO 493.45 Lithium ion battery charger

L7400 D PO 299.67 Add ue prost be/wd, ultlite

L7401 D PO 335.48 Add ue prost a/e ultlite mat

L7402 D PO 362.25 Add ue prost s/d ultlite mat

L7403 D PO 360.08 Add ue prost b/e acrylic

L7404 D PO 543.41 Add ue prost a/e acrylic

L7405 D PO 710.72 Add ue prost s/d acrylic

L7700 D PO 109.12 Pros soc insert gasket/seal

L8000 D PO 42.52 Mastectomy bra

L8001 D PO 122.63 Breast prosthesis bra & form

L8002 D PO 161.32 Brst prsth bra & bilat form

L8015 D PO 58.60 Ext breastprosthesis garment

L8020 D PO 220.42 Mastectomy form

L8030 D PO 318.83 Breast prosthes w/o adhesive

L8031 D PO 318.83 Breast prosthesis w adhesive

L8032 D PO 38.30 Reusable nipple prosthesis

L8035 D PO 3582.02 Custom breast prosthesis

L8040 D PO 2363.33 Nasal prosthesis

L8040 KM D PO 2245.17 Nasal prosthesis

L8040 KN D PO 945.35 Nasal prosthesis




L8041 D PO 2848.55 Midfacial prosthesis

L8041 KM D PO 2706.11 Midfacial prosthesis

L8041 KN D PO 1139.43 Midfacial prosthesis

L8042 D PO 3200.60 Orbital prosthesis

L8042 KM D PO 3040.57 Orbital prosthesis

L8042 KN D PO 1280.23 Orbital prosthesis

L8043 D PO 3584.68 Upper facial prosthesis

L8043 KM D PO 3405.42 Upper facial prosthesis

L8043 KN D PO 1433.86 Upper facial prosthesis

L8044 D PO 3968.74 Hemi-facial prosthesis

L8044 KM D PO 3770.32 Hemi-facial prosthesis

L8044 KN D PO 1587.52 Hemi-facial prosthesis

L8045 D PO 2485.34 Auricular prosthesis

L8045 KM D PO 2361.06 Auricular prosthesis

L8045 KN D PO 994.14 Auricular prosthesis

L8046 D PO 2560.49 Partial facial prosthesis

L8046 KM D PO 2432.45 Partial facial prosthesis

L8046 KN D PO 1024.17 Partial facial prosthesis

L8047 D PO 1312.23 Nasal septal prosthesis

L8047 KM D PO 1246.62 Nasal septal prosthesis

L8047 KN D PO 524.90 Nasal septal prosthesis

L8300 D PO 94.16 Truss single w/ standard pad

L8310 D PO 144.79 Truss double w/ standard pad

L8320 D PO 63.24 Truss addition to std pad wa

L8330 D PO 62.68 Truss add to std pad scrotal

L8400 D PO 18.33 Sheath below knee

L8410 D PO 20.85 Sheath above knee

L8415 D PO 20.72 Sheath upper limb

L8417 D PO 73.52 Pros sheath/sock w gel cushn

L8420 D PO 24.23 Prosthetic sock multi ply bk

L8430 D PO 26.64 Prosthetic sock multi ply ak

L8435 D PO 23.91 Pros sock multi ply upper lm

L8440 D PO 50.69 Shrinker below knee

L8460 D PO 70.55 Shrinker above knee

L8465 D PO 62.88 Shrinker upper limb

L8470 D PO 6.45 Pros sock single ply bk

L8480 D PO 8.90 Pros sock single ply ak

L8485 D PO 10.75 Pros sock single ply upper l

L8500 D PO 638.07 Artificial larynx

L8501 D PO 141.71 Tracheostomy speaking valve

L8507 D PO 40.96 Trach-esoph voice pros pt in

L8509 L PO 106.79 Trach-esoph voice pros md in

L8510 D PO 247.09 Voice amplifier

L8511 J PO 71.11 Indwelling trach insert

L8512 J PO 2.14 Gel cap for trach voice pros

L8513 J PO 5.10 Trach pros cleaning device




L8514 J PO 92.20 Repl trach puncture dilator

L8515 J PO 61.70 Gel cap app device for trach

L8600 L PO 603.74 Implant breast silicone/eq

L8603 L PO 424.01 Collagen imp urinary 2.5 ml

L8605 L PO 700.28 Inj bulking agent anal canal

L8606 L PO 222.57 Synthetic implnt urinary 1ml

L8607 L PO 41.95 Inj vocal cord bulking agent

L8609 L PO 6370.32 Artificial cornea

L8610 L PO 619.30 Ocular implant

L8612 L PO 653.17 Aqueous shunt prosthesis

L8613 L PO 292.43 Ossicular implant

L8614 L PO 18509.89 Cochlear device

L8615 L PO 440.97 Coch implant headset replace

L8616 L PO 102.71 Coch implant microphone repl

L8617 L PO 89.74 Coch implant trans coil repl

L8618 L PO 25.63 Coch implant tran cable repl

L8619 L PO 7940.05 Coch imp ext proc/contr rplc

L8621 L PO 0.60 Repl zinc air battery

L8622 L PO 0.31 Repl alkaline battery

L8623 L PO 63.24 Lith ion batt cid,non-earlvl

L8624 L PO 157.64 Lith ion batt cid, ear level

L8625 L PO 184.66 Charger coch impl/aoi battry

L8627 L PO 6730.53 Cid ext speech process repl

L8628 L PO 1209.54 Cid ext controller repl

L8629 L PO 175.06 Cid transmit coil and cable

L8630 L PO 325.73 Metacarpophalangeal implant

L8631 L PO 2186.02 Mcp joint repl 2 pc or more

L8641 L PO 353.54 Metatarsal joint implant

L8642 L PO 290.21 Hallux implant

L8658 L PO 303.29 Interphalangeal joint spacer

L8659 L PO 1886.69 Interphalangeal joint repl

L8670 L PO 538.20 Vascular graft, synthetic

L8679 L PO 8158.20 Imp neurosti pls gn any type

L8681 L PO 1104.31 Pt prgrm for implt neurostim

L8682 L PO 5828.88 Implt neurostim radiofq rec

L8683 L PO 5130.72 Radiofq trsmtr for implt neu

L8684 L PO 673.76 Radiof trsmtr implt scrl neu

L8689 L PO 1686.51 External recharg sys intern

L8690 L PO 4651.20 Aud osseo dev, int/ext comp

L8691 L PO 1683.79 Aoi snd proc repl excl actua

L8693 L PO 1482.55 Aud osseo dev, abutment

L8694 L PO 923.36 Aoi transducer/actuator repl

L8695 L PO 16.29 External recharg sys extern

L8696 L PO 211.94 Ext antenna phren nerve stim

Q0477 L PO 92.83 Pwr module pt cable lvad rpl

Q0478 L PO 179.67 Power adapter, combo vad




Q0479 L PO 11715.86 Power module combo vad, rep

Q0480 L PO 88058.40 Driver pneumatic vad, rep

Q0481 L PO 14207.21 Microprcsr cu elec vad, rep

Q0482 L PO 4449.97 Microprcsr cu combo vad, rep

Q0483 L PO 18331.84 Monitor elec vad, rep

Q0484 L PO 3559.99 Monitor elec or comb vad rep

Q0485 L PO 343.71 Monitor cable elec vad, rep

Q0486 L PO 286.06 Mon cable elec/pneum vad rep

Q0487 L PO 333.75 Leads any type vad, rep only

Q0489 L PO 15892.70 Pwr pck base combo vad, rep

Q0490 L PO 687.45 Emr pwr source elec vad, rep

Q0491 L PO 1080.71 Emr pwr source combo vad rep

Q0492 L PO 87.10 Emr pwr cbl elec vad, rep

Q0493 L PO 247.88 Emr pwr cbl combo vad, rep

Q0494 L PO 209.77 Emr hd pmp elec/combo, rep

Q0495 L PO 4084.06 Charger elec/combo vad, rep

Q0496 L PO 1465.84 Battery elec/combo vad, rep

Q0497 L PO 457.70 Bat clps elec/comb vad, rep

Q0498 L PO 502.20 Holster elec/combo vad, rep

Q0499 L PO 163.18 Belt/vest elec/combo vad rep

Q0500 L PO 29.86 Filters elec/combo vad, rep

Q0501 L PO 499.31 Shwr cov elec/combo vad, rep

Q0502 L PO 635.69 Mobility cart pneum vad, rep

Q0503 L PO 1271.40 Battery pneum vad replacemnt

Q0504 L PO 670.87 Pwr adpt pneum vad, rep veh

Q0506 L PO 835.10 Lith-ion batt elec/pneum vad

Q4001 L SC 49.26 Cast sup body cast plaster

Q4002 L SC 186.10 Cast sup body cast fiberglas

Q4003 L SC 35.36 Cast sup shoulder cast plstr

Q4004 L SC 122.43 Cast sup shoulder cast fbrgl

Q4005 L SC 13.04 Cast sup long arm adult plst

Q4006 L SC 29.38 Cast sup long arm adult fbrg

Q4007 L SC 6.52 Cast sup long arm ped plster

Q4008 L SC 14.68 Cast sup long arm ped fbrgls

Q4009 L SC 8.71 Cast sup sht arm adult plstr

Q4010 L SC 19.59 Cast sup sht arm adult fbrgl

Q4011 L SC 4.34 Cast sup sht arm ped plaster

Q4012 L SC 9.81 Cast sup sht arm ped fbrglas

Q4013 L SC 15.85 Cast sup gauntlet plaster

Q4014 L SC 26.72 Cast sup gauntlet fiberglass

Q4015 L SC 7.94 Cast sup gauntlet ped plster

Q4016 L SC 13.36 Cast sup gauntlet ped fbrgls

Q4017 L SC 9.16 Cast sup lng arm splint plst

Q4018 L SC 14.60 Cast sup lng arm splint fbrg

Q4019 L SC 4.59 Cast sup lng arm splnt ped p

Q4020 L SC 7.32 Cast sup lng arm splnt ped f




Q4021 L SC 6.78 Cast sup sht arm splint plst

Q4022 L SC 12.23 Cast sup sht arm splint fbrg

Q4023 L SC 3.41 Cast sup sht arm splnt ped p

Q4024 L SC 6.13 Cast sup sht arm splnt ped f

Q4025 L SC 38.01 Cast sup hip spica plaster

Q4026 L SC 118.71 Cast sup hip spica fiberglas

Q4027 L SC 19.02 Cast sup hip spica ped plstr

Q4028 L SC 59.39 Cast sup hip spica ped fbrgl

Q4029 L SC 29.08 Cast sup long leg plaster

Q4030 L SC 76.54 Cast sup long leg fiberglass

Q4031 L SC 14.53 Cast sup lng leg ped plaster

Q4032 L SC 38.27 Cast sup lng leg ped fbrgls

Q4033 L SC 27.13 Cast sup lng leg cylinder pl

Q4034 L SC 67.44 Cast sup lng leg cylinder fb

Q4035 L SC 13.56 Cast sup lngleg cylndr ped p

Q4036 L SC 33.74 Cast sup lngleg cylndr ped f

Q4037 L SC 16.53 Cast sup shrt leg plaster

Q4038 L SC 41.44 Cast sup shrt leg fiberglass

Q4039 L SC 8.29 Cast sup shrt leg ped plster

Q4040 L SC 20.72 Cast sup shrt leg ped fbrgls

Q4041 L SC 20.12 Cast sup lng leg splnt plstr

Q4042 L SC 34.34 Cast sup lng leg splnt fbrgl

Q4043 L SC 10.07 Cast sup lng leg splnt ped p

Q4044 L SC 17.18 Cast sup lng leg splnt ped f

Q4045 L SC 11.68 Cast sup sht leg splnt plstr

Q4046 L SC 18.78 Cast sup sht leg splnt fbrgl

Q4047 L SC 5.82 Cast sup sht leg splnt ped p

Q4048 L SC 9.39 Cast sup sht leg splnt ped f

Q4049 L SC 2.12 Finger splint, static

V2020 D PO 77.93 Vision svcs frames purchases

V2100 D PO 37.88 Lens spher single plano 4.00

V2101 D PO 39.91 Single visn sphere 4.12-7.00

V2102 D PO 56.60 Singl visn sphere 7.12-20.00

V2103 D PO 32.88 Spherocylindr 4.00d/12-2.00d

V2104 D PO 36.42 Spherocylindr 4.00d/2.12-4d

V2105 D PO 44.59 Spherocylinder 4.00d/4.25-6d

V2106 D PO 45.25 Spherocylinder 4.00d/>6.00d

V2107 D PO 47.56 Spherocylinder 4.25d/12-2d



V2110 D PO 61.89 Spherocylinder 4.25d/over 6d

V2111 D PO 54.55 Spherocylindr 7.25d/.25-2.25



V2114 D PO 65.78 Spherocylinder over 12.00d

V2115 D PO 71.52 Lens lenticular bifocal




V2118 D PO 70.90 Lens aniseikonic single

V2121 D PO 73.20 Lenticular lens, single

V2200 D PO 49.57 Lens spher bifoc plano 4.00d

V2201 D PO 54.02 Lens sphere bifocal 4.12-7.0

V2202 D PO 63.57 Lens sphere bifocal 7.12-20.

V2203 D PO 50.01 Lens sphcyl bifocal 4.00d/.1

V2204 D PO 54.22 Lens sphcy bifocal 4.00d/2.1

V2205 D PO 59.49 Lens sphcy bifocal 4.00d/4.2

V2206 D PO 72.43 Lens sphcy bifocal 4.00d/ove

V2207 D PO 60.46 Lens sphcy bifocal 4.25-7d/.

V2208 D PO 61.20 Lens sphcy bifocal 4.25-7/2.

V2209 D PO 67.31 Lens sphcy bifocal 4.25-7/4.

V2210 D PO 86.61 Lens sphcy bifocal 4.25-7/ov

V2211 D PO 73.85 Lens sphcy bifo 7.25-12/.25-

V2212 D PO 80.36 Lens sphcyl bifo 7.25-12/2.2

V2213 D PO 82.41 Lens sphcyl bifo 7.25-12/4.2

V2214 D PO 88.34 Lens sphcyl bifocal over 12.

V2215 D PO 95.59 Lens lenticular bifocal

V2218 D PO 97.80 Lens aniseikonic bifocal

V2219 D PO 43.05 Lens bifocal seg width over

V2220 D PO 34.91 Lens bifocal add over 3.25d

V2221 D PO 93.27 Lenticular lens, bifocal

V2300 D PO 64.37 Lens sphere trifocal 4.00d

V2301 D PO 74.65 Lens sphere trifocal 4.12-7.

V2302 D PO 81.78 Lens sphere trifocal 7.12-20

V2303 D PO 67.76 Lens sphcy trifocal 4.0/.12-

V2304 D PO 70.90 Lens sphcy trifocal 4.0/2.25

V2305 D PO 86.95 Lens sphcy trifocal 4.0/4.25

V2306 D PO 81.07 Lens sphcyl trifocal 4.00/>6

V2307 D PO 80.38 Lens sphcy trifocal 4.25-7/.

V2308 D PO 85.78 Lens sphc trifocal 4.25-7/2.

V2309 D PO 100.35 Lens sphc trifocal 4.25-7/4.

V2310 D PO 110.39 Lens sphc trifocal 4.25-7/>6

V2311 D PO 105.12 Lens sphc trifo 7.25-12/.25-

V2312 D PO 92.67 Lens sphc trifo 7.25-12/2.25

V2313 D PO 126.49 Lens sphc trifo 7.25-12/4.25

V2314 D PO 138.55 Lens sphcyl trifocal over 12

V2315 D PO 153.82 Lens lenticular trifocal

V2318 D PO 141.82 Lens aniseikonic trifocal

V2319 D PO 48.02 Lens trifocal seg width > 28

V2320 D PO 50.65 Lens trifocal add over 3.25d

V2321 D PO 151.61 Lenticular lens, trifocal

V2410 D PO 86.69 Lens variab asphericity sing

V2430 D PO 112.86 Lens variable asphericity bi

V2500 D PO 78.58 Contact lens pmma spherical

V2501 D PO 119.70 Cntct lens pmma-toric/prism




V2502 D PO 147.47 Contact lens pmma bifocal

V2503 D PO 141.10 Cntct lens pmma color vision

V2510 D PO 107.28 Cntct gas permeable sphericl

V2511 D PO 154.14 Cntct toric prism ballast

V2512 D PO 182.13 Cntct lens gas permbl bifocl

V2513 D PO 152.91 Contact lens extended wear

V2520 D PO 100.83 Contact lens hydrophilic

V2521 D PO 175.55 Cntct lens hydrophilic toric

V2522 D PO 170.84 Cntct lens hydrophil bifocl

V2523 D PO 145.59 Cntct lens hydrophil extend

V2530 D PO 215.64 Contact lens gas impermeable

V2531 D PO 529.39 Contact lens gas permeable

V2623 D PO 867.87 Plastic eye prosth custom

V2624 D PO 58.86 Polishing artifical eye

V2625 D PO 381.25 Enlargemnt of eye prosthesis

V2626 D PO 241.88 Reduction of eye prosthesis

V2627 D PO 1384.77 Scleral cover shell

V2628 D PO 316.61 Fabrication & fitting

V2630 L IL 115.08 Anter chamber intraocul lens

V2631 L IL 115.08 Iris support intraoclr lens

V2632 L IL 115.08 Post chmbr intraocular lens

V2700 D PO 42.36 Balance lens

V2710 D PO 61.99 Glass/plastic slab off prism

V2715 D PO 11.24 Prism lens/es

V2718 D PO 27.61 Fresnell prism press-on lens

V2730 D PO 20.39 Special base curve

V2744 D PO 21.15 Tint photochromatic lens/es

V2745 D PO 11.99 Tint, any color/solid/grad

V2750 D PO 24.61 Anti-reflective coating

V2755 D PO 17.78 Uv lens/es

V2760 D PO 15.49 Scratch resistant coating

V2762 D PO 58.29 Polarization, any lens

V2770 D PO 20.00 Occluder lens/es

V2780 D PO 16.16 Oversize lens/es

V2782 D PO 62.93 Lens, 1.54-1.65 p/1.60-1.79g

V2783 D PO 70.97 Lens, >= 1.66 p/>=1.80 g

V2784 D PO 46.15 Lens polycarb or equal

V2786 D PO 0.00 Occupational multifocal lens

hcpcs mod mod2 juris catg tn (nr) 0.43 sterile water/saline, … · 2019-03-15 · d. os: 9.86. ext...

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