From: "Saved by Internet Explorer 11"
Date: Thu, 17 Mar 2016 09:32:16 -0500

Fee Schedule #12 - MEDICAL SUPPLIES

Proc Type

Proc Code

Description

Factor
Code

Factor

Proc
Mod

1 | A4206 | SYRINGE W/ OR W/O NEEDLE,STERILE,1CC (1) | F | 00000.29 |
1 | A4207 | SYRINGE WITH NEEDLE, STERILE 2CC | F | 00000.10 |
1 | A4208 | SYRINGE W/ OR W/O NEEDLE,STERILE,3CC (1) | F | 00000.15 |
1 | A4209 | SYRINGE W/ OR W/O NEEDLE,STERILE,5CC OR | F | 00000.30 |
1 | A4210 | NEEDLE FREE INJECTION DEVICE, EACH | F | 00042.07 |
1 | A4211 | SUPPLIES FOR SELF ADMIN. INJECTIONS | M | 00000.00 |
1 | A4212 | NON CORING NEEDLE /STYLET W OR W/O CATH | F | 00002.58 |
1 | A4213 | SYRINGE, STERILE, 20 CC OR GREATER | F | 00000.96 |
1 | A4215 | NEEDLE, STERILE, ANY SIZE, EACH | F | 00000.22 |
1 | A4216 | STERILE WATER, SALINE AND/OR DEXTROSE | F | 00000.38 |
1 | A4217 | STERILE WATER/SALINE, 500 ML | F | 00001.31 |
1 | A4218 | STERILE SALINE OR WATER | F | 00000.38 |
1 | A4221 | SUPPLIES FOR MAINTENANCE DRUG INFUS CATH | F | 00021.17 |
1 | A4222 | SUPPLIES FOR EXTERNAL DRUG PUMP | F | 00042.01 |
1 | A4233 | ALKALIN BATT FOR GLUCOSE MON | F | 00000.58 |
1 | A4234 | J-CELL BATT FOR GLUCOSE MON | F | 00002.50 |
1 | A4235 | LITHIUM BATT FOR GLUCOSE MON | F | 00001.06 |
1 | A4236 | SILVR OXIDE BATT GLUCOSE MON | F | 00001.19 |
1 | A4244 | ALCOHOL OR PEROXIDE, PER PINT | F | 00002.92 |
1 | A4245 | ALCOHOL WIPES, EACH | F | 00000.05 |
1 | A4246 | BETADINE SOLUTION,PER PINT | F | 00003.40 |
1 | A4247 | BETADINE OR IODINE SWABS/WIPES, (EACH) | F | 00000.10 |
1 | A4248 | CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 M | M | 00000.00 |
1 | A4250 | URINE TEST/REAGENT STRP/TABS,100 | F | 00018.51 |
1 | A4252 | BLOOD KETONE TEST OR REAGENT STRIP, EACH | M | 00000.00 |
1 | A4253 | BLOOD GLUCOSE STRIPS/50 | F | 00010.41 |
1 | A4255 | PLATFORMS FOR HOME GLUCOSE MON. 50/BOX | F | 00001.05 |
1 | A4256 | NORMAL, LOW AND HIGH CALIRATOR SOLUTION | F | 00004.00 |
1 | A4258 | SPRING-POWERED DEVICE FOR LANCET | F | 00002.52 |
1 | A4259 | LANCETS, PER 100 | F | 00001.65 |
1 | A4261 | CERVICAL CAP FOR CONTRACEPTIVE USE | F | 00018.64 |
1 | A4265 | PARAFIN | F | 00003.21 |
1 | A4266 | DIAPHRAGM FOR CONTRACEPTIVE USE | F | 00018.64 |
1 | A4280 | ADHESIVE SKIN ATT. FOR BREAST PROTH | F | 00004.66 |
1 | A4310 | INSERTION TRAY W/O DRAINAGE BAG AND W/O | F | 00007.77 |
1 | A4311 | INSERTION TRAY W/O DRAINAGE BAD W/INDWEL | F | 00012.70 |
1 | A4312 | INSERTION TRAY WITHOUT DRAINAGE BAG W/IN | F | 00018.24 |
1 | A4313 | INSERTION TRAY W/O BAG W/INDWELLING CATH | F | 00017.61 |
1 | A4314 | INSERTION TRAY WITH/DRAINAGE BAG W/INDWE | F | 00024.05 |
1 | A4315 | INSERTION TRAY W/BAG, W/INDWELL CATH | F | 00025.08 |
1 | A4316 | INSERTION TRAY W/BAG W/CATH,FOLEY | F | 00027.01 |
1 | A4320 | IRRIGATION TRAY WITH BULB OR PISTON SYRI | F | 00004.90 |
1 | A4321 | THERAPUETIC AGENT FOR CATH IRRIGATION | F | 00009.80 |
1 | A4322 | IRRIGATION SYRINGE, BULB OR PISTON,EACH | F | 00003.27 |
1 | A4326 | MALE EXTERNAL CATHETER SPECIALTY | F | 00009.02 |
1 | A4327 | FEMALE EXTERNAL URINARY COLLECTION DEVIC | F | 00042.45 |
1 | A4328 | FEMALE EXTERNAL URINARY COLLECTION POUCH | F | 00009.93 |
1 | A4330 | PERIANAL FECAL COLLECTION POUCH EACH | F | 00006.80 |
1 | A4331 | EXT. DRAIN. TUBING,ANY TYPE | F | 00003.03 |
1 | A4332 | LUBRICANT, IND. PACKET FOR CATHETER | F | 00000.11 |
1 | A4333 | URINARY CATH, ANCHORING DEV. ADHESIVE | F | 00002.09 |
1 | A4334 | URINARY CATH, ANCHORING DEV. LEG STRAP | F | 00004.70 |
1 | A4335 | INCONTINENCE SUPPLY, MISC. | M | 00000.00 |
1 | A4336 | INCONT SUPPLY,URETH INSERT,ANY TYPE,EA | M | 00000.00 |
1 | A4337 | OSTOMY POUCH; DRAINABLE; FOR USE ON FACE | M | 00000.00 |
1 | A4338 | INDWELLING CATHETER, FOLEY TYPE 2-WAY LA | F | 00012.19 |
1 | A4340 | INDWELLING CATH.SPECIALTY EACH | F | 00028.87 |
1 | A4344 | INDWELLING CATHETER, FOLEY TYPE, TWO WAY | F | 00015.86 |
1 | A4346 | INDWELLING CATHETER, FOLEY TYPE, THREE W | F | 00019.13 |
1 | A4349 | MALE EXT CATH W/W/O ADHESIVE,DISP,EACH | F | 00002.02 |
1 | A4351 | INTERMITTENT URINARY CATHETER: STRAIGHT | F | 00001.77 |
1 | A4352 | INTERMITTENT CATHETER, COUDE | F | 00006.10 |
1 | A4353 | INTERMITTENT CATHETER W/INSERTION SUPP | F | 00006.64 |
1 | A4354 | CATHETER INSERTION TRAY,W/O CATHETER,INC | F | 00011.53 |
1 | A4355 | 3-WAY IRRIGATION SET FOR CATHETER | F | 00008.61 |
1 | A4356 | EXT URETH CLAMP/COMPRESSION DEVICE, EA | F | 00044.39 |
1 | A4357 | BEDSIDE DRAINAGE BAG DAY/NIGHT W OR W/O | F | 00008.98 |
1 | A4358 | URINARY LEG/ABDOMEN,VINYL EACH | F | 00005.88 |
1 | A4360 | DISPOS EXT URETHAL CLAMP/COMPRESS DEV | F | 00000.47 |
1 | A4361 | OSTOMY FACE PLATE (EACH) | F | 00015.45 |
1 | A4362 | OSTOMY SKIN BARRIER,4X4 OR EQUIV, EACH | F | 00003.69 |
1 | A4363 | OSTOMY CLAMP, REPLACEMENT | F | 00002.63 |
1 | A4364 | OSTOMY SKIN BOND OR CEMENT, PER OUNCE | F | 00003.21 |
1 | A4366 | OSTOMY VENT ANY TYPE EACH | F | 00001.34 |
1 | A4367 | OSTOMY BELT(EACH) | F | 00006.76 |
1 | A4368 | OSTOMY FILTER, ANY TYPE, EACH | F | 00000.26 |
1 | A4369 | OSTOMY SKIN BARRIER, LIQUID PER OZ | F | 00001.95 |
1 | A4371 | OSTOMY SKIN BARRIER, POWDER PER OZ | F | 00003.42 |
1 | A4372 | OSTOMY SKIN BARRIER, SOLID 4X4 EACH | F | 00003.96 |
1 | A4373 | OSTOMY SKIN BARRIER W/FLANGE EACH | F | 00005.96 |
1 | A4375 | OSTOMY POUCH DRAINABLE,W/FACEPLATE | F | 00016.34 |
1 | A4376 | OSTOMY POUCH W/FACEPLATE,RUBBER | F | 00045.25 |
1 | A4377 | OSTOMY POUCH W/O FACEPLATE,PLASTIC | F | 00004.08 |
1 | A4378 | OSTOMY POUCH W/O FACEPLATE RUBBER | F | 00029.24 |
1 | A4379 | OSTOMY POUCH URINARY W/FACEPLATE PLASTIC | F | 00014.30 |
1 | A4380 | OSTOMY POUCH, URINARY, W/FACEPLATE | F | 00035.51 |
1 | A4381 | OSTOMY POUCH,URINARY W/FACEPLATE PLASTIC | F | 00004.39 |
1 | A4382 | OSTOMY POUCH,URINARY W/O FACEPLATE PLAST | F | 00023.41 |
1 | A4383 | OST. POUCH URINARY W/O FACEPLATE RUBBER | F | 00026.81 |
1 | A4384 | OSTOMY FACEPLATE EQUIL. SILICONE RING | F | 00009.15 |
1 | A4385 | OST. SKIN BARRIER,4X4 EXT. WEAR EACH | F | 00004.84 |
1 | A4387 | OST. POUCH,W/STANDARD WEAR BARRIER | F | 00002.49 |
1 | A4388 | OST. POUCH W/EXT WEAR BARRIER ATTACHED | F | 00004.14 |
1 | A4389 | OST. POUCH,W/STANDARD WEAR BARRIER | F | 00005.90 |
1 | A4390 | OSTOMY POUCH,DRAINABLE,W/EXT WEAR, EACH | F | 00009.13 |
1 | A4391 | OST. POUCH URINARY W/EXT WEAR BARRIER | F | 00006.72 |
1 | A4392 | OST. POUCH URINARY W/STAND. WEAR BARRIER | F | 00006.32 |
1 | A4393 | OST. POUCH,URINARY,W/EXT WEAR BARRIER | F | 00008.72 |
1 | A4394 | OST. DEODERANT FOR USE IN POUCH, LIQUID | F | 00002.45 |
1 | A4395 | OSTOMY DEODERANT SOLID | F | 00000.05 |
1 | A4396 | OSTOMY BELT, W/PERISTOMAL HERNIA SUPPORT | F | 00038.50 |
1 | A4397 | IRRIGATION SUPPLY, SLEEVE EACH | F | 00004.38 |
1 | A4398 | OSTOMY IRRIGATION SUPPLY,BAG, EACH | F | 00013.13 |
1 | A4400 | IRRIGATION SET FOR IRRIGATION OF OSTOMY | F | 00046.09 |
1 | A4402 | OSTOMY LUBRICANT (EACH) | F | 00001.78 |
1 | A4404 | OSTOMY RING, EACH | F | 00001.42 |
1 | A4405 | OSTOMY SKIN BARRIER NON-PECTIN PASTE | F | 00003.20 |
1 | A4406 | OSTOMY SKIN BARRIER, PECTIN BASED | F | 00003.20 |
1 | A4407 | OSTOMY SKINBARRIER,W/FLANGE EXT.WEAR 4X4 | F | 00008.73 |
1 | A4408 | OSTOMY,SKIN BARRIER W/FLANGE EXT.WEAR>4" | F | 00005.96 |
1 | A4409 | OSTOMY SKIN BARR.W/FLANGE,EXT WEAR<4" | F | 00006.40 |
1 | A4410 | OSTOMY SKIN BARR.EXT.WEAR,W.OUT CONVEX | F | 00004.84 |
1 | A4411 | OST SKN BARR EXTND | F | 00005.66 |
1 | A4412 | OST POUCH DRAIN HIGH OUTPUT | F | 00003.00 |
1 | A4413 | OSTOMY POUCH,DRAINABLE,WITH FILTER | F | 00005.66 |
1 | A4414 | OSTOMY SKIN BARR.W/FLANGE,W/OUT CONV.<4" | F | 00003.81 |
1 | A4415 | OSTOMY SKIN BARR.W/FLANGE,>4X4 INCHES | F | 00004.14 |
1 | A4416 | OSTOMY POUCH,CLOSED W BARRIER, W FILTER | F | 00002.81 |
1 | A4417 | OSTOMY POUCH,CLOSED,BARRIER,CONVEXITY | F | 00003.81 |
1 | A4418 | OSTOMY POUCH,CLOSED, NO BARRIER,W FILTER | F | 00001.85 |
1 | A4419 | OSTOMY POUCH,CLOSED;USE ON BARRIER W FLA | F | 00001.78 |
1 | A4420 | OSTOMY POUCH,CLOSED; TWO PIECE | M | 00000.00 |
1 | A4421 | NOT OTHERWISE CLASSIFIED OSTOMY SUPPLIES | M | 00000.00 |
1 | A4422 | OSTOMY ABSORBANT MATERIAL TO THICKEN | F | 00000.11 |
1 | A4423 | OSTOMY POUCH, CLOSED; FOR USE ON BARRIER | F | 00001.91 |
1 | A4424 | OSTOMY POUCH,DRAINABLE,BARRIER, FILTER | F | 00004.88 |
1 | A4425 | OSTOMY POUCH, DRAINABLE WITH USE ON BARR | F | 00003.68 |
1 | A4426 | OSTOMY POUCH, BARRIER,LOCK FLANGE,EACH | F | 00002.79 |
1 | A4427 | OSTOMY POUCH,BARRIER, FLANGE W FILTER;EA | F | 00002.85 |
1 | A4428 | OSTOMY POUCH, URINARY; EACH | F | 00006.69 |
1 | A4429 | OSTOMY POUCH, URINARY, W BARRIER, FAUCET | F | 00008.49 |
1 | A4430 | OSTOMY POUCH, URINARY W EXTENDED WEAR;EA | F | 00008.75 |
1 | A4431 | OSTOMY POUCH, URINARY W BARRIER; EACH | F | 00006.40 |
1 | A4432 | OSTOMY POUCH, URINARY,NON-LOCK FLANGE;EA | F | 00003.69 |
1 | A4433 | OSTOMY POUCH, URINARY; USE ON BARRIER;EA | F | 00003.43 |
1 | A4434 | OSTOMY POUCH, URINARY;W FAUCET TAPE;EACH | F | 00003.86 |
1 | A4435 | Ostomy pouch,drainable,high output,w/ext | F | 00006.00 |
1 | A4450 | TAPE,NON-WATERPROOF,PER 18 INCHES | F | 00000.09 |
1 | A4452 | TAPE WATERPROOF, PER 18 INCHES | F | 00000.36 |
1 | A4455 | ADHESIVE REMOVER OR SOLVENT (TAPE, CEMEN | F | 00001.59 |
1 | A4456 | ADHESIVE REMOVER, WIPES, ANY TYPE, EA | F | 00000.25 |
1 | A4461 | SURGICAL DRESSING HOLDER, NON-RESUSEABLE | M | 00000.00 |
1 | A4463 | SURGICAL DRESS HOLDER REUSE | M | 00000.00 |
1 | A4465 | NON ELASTIC BINDER FOR EXTREMITY | M | 00000.00 |
1 | A4466 | GARM,BELT,SLV/OTH COVERNG,ELAST/SIMILR | M | 00000.00 |
1 | A4481 | TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE | F | 00000.36 |
1 | A4483 | MOISTURE EXCHANGER,FOR VENT | F | 00002.87 |
1 | A4490 | SURGICAL STOCKINGS ABOVE KNEE LENGTH, EA | F | 00007.47 |
1 | A4495 | SURGICAL STOCKINGS THIGH LENGTH, EACH | F | 00011.61 |
1 | A4500 | SURGICAL STOCKINGS BELOW KNEE LENGTH, EA | F | 00007.47 |
1 | A4510 | SURGICAL STOCKINGS FULL LENGTH, EACH | F | 00017.42 |
1 | A4554 | DISPOSABLE UNDERPADS, ALL SIZES, (E.G., | F | 00000.40 |
1 | A4556 | ELECTRODES, (E.G. APNEA MONITOR) | F | 00010.07 |
1 | A4557 | LEAD WIRES, (E.G. APNEA MONITOR) | F | 00017.52 |
1 | A4558 | CONDUCTIVE PASTE OR GEL | F | 00001.87 |
1 | A4559 | COUPLING GEL OR PASTE | M | 00000.00 |
1 | A4561 | PESSARY, RUBBER, ANY TYPE | F | 00018.07 |
1 | A4562 | PESSARY, NON-RUBBER ANY TYPE | F | 00044.98 |
1 | A4565 | SLINGS | F | 00006.63 |
1 | A4566 | SHOULDER SLING OR VEST DESIGN | M | 00000.00 |
1 | A4570 | SPLINT | F | 00007.19 |
1 | A4580 | CAST SUPPLIES | M | 00000.00 |
1 | A4595 | TENS SUPPLY 2 LEAD/MONTH | F | 00026.30 |
1 | A4600 | SLEEVE, INTER LIMB COMP DEV | M | 00000.00 |
1 | A4604 | TUBING WITH HEATING ELEMENT | F | 00005.16 |
1 | A4605 | TRACHEAL SUCTION CATH,CLOSE SYSTEM,EACH | F | 00014.69 |
1 | A4606 | OXYGEN PROBE FOR USE W/PT OWNED OXIMETER | M | 00000.00 |
1 | A4608 | TRANSTRACHEAL OXYGEN CATHETER | F | 00055.63 |
1 | A4611 | BATTERY,HD,REPLACEMENT FOR PT OWNED VENT | F | 00237.32 |
1 | A4612 | BATTERY CABLES;REPLACE PT. OWNED VENT | F | 00035.26 |
1 | A4613 | BATTERY CHARGER,REPLACEMENT FOR PT. VENT | F | 00137.16 |
1 | A4614 | PEAK EXP. FLOW METER, HAND HELD | F | 00026.40 |
1 | A4615 | CANNULA, NASAL | F | 00000.80 |
1 | A4616 | TUBING, OXYGEN, PER FOOT | F | 00000.07 |
1 | A4617 | MOUTHPIECE, EACH | F | 00003.36 |
1 | A4618 | BREATHING CIRCUITS | F | 00004.10 |
1 | A4619 | FACE TENT | F | 00001.21 |
1 | A4620 | VARIABLE CONCENTRATION MASK | F | 00000.70 |
1 | A4623 | TRACHEOSTOMY INNER CANNULA | F | 00005.28 |
1 | A4624 | TRACHEAL SUCTION CATHETER, ANY TYPE, EAC | F | 00002.04 |
1 | A4625 | TRACH CARE KIT FOR NEW TRACHEOSTOMY | F | 00005.60 |
1 | A4626 | TRACHEOSTOMY CLEANING BRUSH, EACH | F | 00003.04 |
1 | A4627 | SPACER, BAG OR RESERVOIR, W W/O MASK FOR | F | 00029.66 |
1 | A4628 | OROPHARYNGEAL SUCTION CATHETER, EACH | F | 00003.73 |
1 | A4629 | TRACHEOSTOMY CARE KIT FOR ESTABLISHED TR | F | 00004.25 |
1 | A4630 | REPLACEMENT BATTERIES FOR TENS UNITS OWN | F | 00005.06 |
1 | A4635 | UNDERARM PAD, CRUTCH, REPLACEMENT, EACH | F | 00002.38 |
1 | A4636 | REPLACEMENT, HANDGRIP, CANE, CRUTCH, WAL | F | 00002.38 |
1 | A4637 | REPLACEMENT, TIP CANE, CRUTCH, WALKER, E | F | 00001.95 |
1 | A4640 | REPLACEMENT PAD FOR ALT.PRESS PAD | F | 00060.23 |
1 | A4649 | MEDICAL OR SURGICAL SUPPLIES NOT ELSEWHE | M | 00000.00 |
1 | A4660 | SPHYGMOMANOMETER/BLOOD PRESS. APPARATUS | F | 00019.86 |
1 | A4670 | AUTOMATIC BLOOD PRESSURE MONTITER | F | 00049.36 |
R | A4670 | AUTOMATIC BLOOD PRESSURE MONITOR | M | 00000.00 | RR
1 | A4671 | DISPOSABLE CYCLER SET/DIALYSIS; EACH | M | 00000.00 |
1 | A4714 | TREATED WATER (DEIONIZED, DISTILLED, REV | F | 00004.59 |
1 | A4719 | Y SET FOR PERITONEAL DIALYSIS | M | 00000.00 |
1 | A4720 | DIAL. SOL.FOR PERIT. DIAL.>249<999CC | M | 00000.00 |
1 | A4721 | DIAL.SOL.FOR PERIT. DIAL.>999<1999CC | M | 00000.00 |
1 | A4722 | DIAL.SOL.FOR PERIT. DIAL.>1999<2999CC | M | 00000.00 |
1 | A4723 | DIAL.SOL FOR PERIT. DIAL >2999<3999CC | M | 00000.00 |
1 | A4724 | DIAL.SOL FOR PERIT.DIAL >3999<4999 CC | M | 00000.00 |
1 | A4725 | DIAL.SOL FOR PERIT. DIAL >4999<5999CC | M | 00000.00 |
1 | A4726 | DIAL.SOL FOR PERIT. DIAL >5999CC | M | 00000.00 |
1 | A4728 | DIALYSATE SOLUTION,NON DEX, 500 ML | M | 00000.00 |
1 | A4736 | TOPICAL ANESTHETIC FOR DIALYSIS PER GRAM | M | 00000.00 |
1 | A4737 | INJECTABLE ANESTHETIC FOR DIALYSIS /10ML | M | 00000.00 |
1 | A4766 | DIAL. CONC. SOL ADD.FOR PERIT./10ML | M | 00000.00 |
1 | A4860 | DISPOSABLE CATH CAPS/PERITONEAL DIALYISI | M | 00000.00 |
1 | A4911 | DRAIN BAG/BOTTLE FOR DIALYSIS EACH | M | 00000.00 |
1 | A4927 | GLOVES, NON STERILE, PER 100 | F | 00007.19 |
1 | A4928 | SURGICAL MASK FOR DIALYSIS PER 20 | F | 00002.96 |
1 | A4929 | TOURNIQUET FOR DIALYSIS,EACH | M | 00000.00 |
1 | A4931 | ORAL THERMOMETER | F | 00002.94 |
1 | A4932 | RECTAL THERMOMETER, REUSABLE, ANY TYPE, | F | 00002.94 |
1 | A5051 | POUCH, CLOSED, WITH BARRIER ATTACHED (1 | F | 00002.29 |
1 | A5052 | POUCH, CLOSED, WITHOUT BARRIER ATTACHED | F | 00001.65 |
1 | A5053 | POUCH, CLOSED FOR USE ON FACEPLATE | F | 00001.65 |
1 | A5054 | POUCH, URINARY, WITH FACEPLATE ATTACHED, | F | 00002.00 |
1 | A5055 | STOMA CAP, EACH | F | 00001.60 |
1 | A5056 | OSTOMY POUCH, DRAINABLE,FILTER,EACH | F | 00004.80 |
1 | A5057 | OSTOMY POUCH, DRAINABLE,CONVEXITY,EACH | F | 00009.89 |
1 | A5061 | POUCH, DRAINABLE, WITH BARRIER ATTACHED | F | 00003.48 |
1 | A5062 | POUCH, DRAINABLE, WITHOUT BARRIER ATTACH | F | 00002.31 |
1 | A5063 | POUCH, DRAINABLE, FOR USE ON BARRIER W/F | F | 00002.97 |
1 | A5071 | POUCH, URINARY, WITH BARRIER ATTACHED (1 | F | 00004.60 |
1 | A5072 | POUCH, URINARY, WITHOUT BARRIER ATTACHED | F | 00003.57 |
1 | A5073 | POUCH, URINARY, FOR USE ON BARRIER WITH | F | 00003.12 |
1 | A5081 | CONTINENT DEVICE,PLUG FOR STOMA | F | 00003.13 |
1 | A5082 | CONTINENT DEVICE, CATHETER FOR STOMA | F | 00009.61 |
1 | A5093 | OSTOMY, ACCESSORY, CONVEX, INSERT | F | 00001.84 |
1 | A5102 | BEDSIDE DRAIN BOTTLE,W/WO TUBING, EACH | F | 00021.33 |
1 | A5105 | URINARY SUSPENSORY,W/LEG BAG,W/WO TUBE | F | 00038.77 |
1 | A5112 | URINARY LEG BAG LATEX, EACH | F | 00033.83 |
1 | A5113 | LEG STRAP,LATEX,REPLACEMENT, PER SET | F | 00004.47 |
1 | A5114 | LEG STRAP,FOAM/FABRIC,REPLACE. PER SET | F | 00007.21 |
1 | A5120 | SKIN BARRIER, WIPE OR SWAB | F | 00000.21 |
1 | A5121 | SKIN BARRIER, SOLID, 6 X 6 OR EQUIVALENT | F | 00007.67 |
1 | A5122 | SKIN BARRIER, SOLID, 8 X 8 OR EQUIVALENT | F | 00013.36 |
1 | A5126 | ADHESIVE, DISK OR FOAM PAD | F | 00001.22 |
1 | A5131 | APPLIANCE CLEANER, INCONTINENCE PER 16OZ | F | 00012.81 |
1 | A5200 | PERCUTANEOUS CATH/TUBE ANCHORING DEVICE | F | 00010.73 |
1 | A5500 | DIAB SHOE FOR DENSITY INSERT | F | 00059.24 |
1 | A5501 | DIAB CUSTOM MOLDED SHOE, PER SHOE | F | 00177.70 |
1 | A5503 | DIAB ROLLAR/RIGID ROCKER BOTTOM MODIFIC | F | 00026.35 |
1 | A5504 | DIABETIC WEDGE INSERT MOD, PER SHOE | F | 00026.35 |
1 | A5505 | DIABETIC METATARSAL BAR MOD, PER SHOE | F | 00026.35 |
1 | A5506 | DIABETIC OFFSET HEEL MOD, PER SHOE | F | 00026.35 |
1 | A5507 | DIABETIC SHOE MODIF, NOS, PER SHOE | F | 00026.35 |
1 | A5512 | MULTI DEN INSERT DIRECT FORM | F | 00024.17 |
1 | A5513 | MULTI DEN INSERT CUSTOM MOLD | F | 00036.06 |
1 | A6010 | COLLAGEN BASED WOUND DRY FILLER PER GM | F | 00031.48 |
1 | A6011 | COLLAGEN BASED WOUND FILLER, GEL/PASTE | F | 00002.34 |
1 | A6021 | COLLAGEN PAD, 16 SQ. INCH OR LESS, EA | F | 00020.98 |
1 | A6022 | COLLAGEN PAD, >16 SQ INCH BUT <48SQ.IN | F | 00019.99 |
1 | A6023 | COLLAGEN PAD MORE THAN 48SQ. INCH EACH | F | 00181.01 |
1 | A6024 | COLLAGEN DRSG WOUND FILLER, PER 6 IN. | F | 00005.87 |
1 | A6025 | SILICONE GEL SHEET, EACH | M | 00000.00 |
1 | A6154 | WOUND POUCH, EACH | F | 00013.65 |
1 | A6196 | ALGINATE DRESS.WOUND COVER,<16 SQ.INCH | F | 00006.98 |
1 | A6197 | ALGINATE DRESS.>16SQ INCH AND <48SQ.IN | F | 00015.64 |
1 | A6198 | ALGINATE DRESS, >48 SQ. INCHES EACH | M | 00000.00 |
1 | A6199 | ALGINATE DRESS.WOUND FILLER,PER 6IN. | F | 00005.02 |
1 | A6203 | COMPOSITE DRESS,<16SQ INCH W/BORDER EA | F | 00003.17 |
1 | A6204 | COMPOSIT DRESS. PAD SIZE>16 SQ<48SQ IN | F | 00005.91 |
1 | A6205 | COMPOSITE DRESS, >48SQ INCH W/BORDR EA | M | 00000.00 |
1 | A6206 | CONTACT LAYER,16SQ INCHES OR LESS,EACH | M | 00000.00 |
1 | A6207 | CONTACT LAYER,>16SQ INCH,<48SQ INCH,EA | F | 00006.97 |
1 | A6208 | CONTACT LAYER, >48SQ INCHES EACH | M | 00000.00 |
1 | A6209 | FOAM DRESS.< | F | 00007.12 |
1 | A6210 | FOAM DRESS>16SQ IN< | F | 00018.94 |
1 | A6211 | FOAM DRESS.>48SQ IN,W/OUT BORDER,EA | F | 00027.93 |
1 | A6212 | FOAM DRESS.<16SQ INCH,W/BORDER EACH | F | 00009.23 |
1 | A6213 | FOAM DRESS.>16SQ IN<48SQ IN W/BORDER | M | 00000.00 |
1 | A6214 | FOAM DRESS,>48SQ INCH,W/BORDER EACH | F | 00009.79 |
1 | A6215 | FOAM DRESS,WOUND FILLER PER GRAM | M | 00000.00 |
1 | A6216 | GAUZE,NON-IMPREG.<16SQ IN. W/OUT BORDER | F | 00000.05 |
1 | A6217 | GAUZE,NON-IMPREG.>16SQ IN,<48SQ IN. | M | 00000.00 |
1 | A6218 | GAUZE, NON-IMPREG,>48SQ IN, W/OUT BORDER | M | 00000.00 |
1 | A6219 | GAUZE,NON-IMPREG,<16 SQ IN, W/BORDER | F | 00000.90 |
1 | A6220 | GAUZE,NON-IMPREG, >16SQ IN,<48SQ INCH | F | 00002.45 |
1 | A6221 | GAUZE,NON-IMPREG,>48SQ IN W/BORDER | M | 00000.00 |
1 | A6222 | GAUZE, IMPREGNATED <16SQ IN W/O BORDER | F | 00002.02 |
1 | A6223 | GAUZE IMPREG>16SQ IN<48 SQ IN WO BORDR | F | 00002.29 |
1 | A6224 | GAUZE, IMPREG. >48SQ IN W/OUT BORDER | F | 00003.43 |
1 | A6228 | GAUZE IMPREG,W/WATER OR NACL<16SQ INCH | M | 00000.00 |
1 | A6229 | GAUZE, IMPREG,W/H2O OR NACL,>16SQ INCH | F | 00003.43 |
1 | A6230 | GAUZE,IMPREG W/H20 OR NACL,>48SQ INCH | M | 00000.00 |
1 | A6231 | GAUZE, IMPREG,HYDROGEL <16SQ IN | F | 00004.45 |
1 | A6232 | GAUZE, IMPREG HYDROGEL 16SQ IN<48SQ | F | 00006.55 |
1 | A6233 | GAUZE, IMPREG,HYDROGEL >48 SQ INCHES | F | 00018.25 |
1 | A6234 | HYDROCOLL. DRESS<16 SQ IN,W/O BORDER | F | 00006.22 |
1 | A6235 | HYDROCOLL. DRESS,>16 BUT<48 SQ INCH | F | 00016.01 |
1 | A6236 | HYDROCOLL,DRESS, >48SQ IN W/OUT BORDER | F | 00025.92 |
1 | A6237 | HYDROCOLL,DRESS,<16 SQ IN W/BORDER | F | 00007.52 |
1 | A6238 | HYDROCOLL,DRESS, >16,<48SQ IN W/BORDER | F | 00021.67 |
1 | A6239 | HYDROCOLL,DRESS,>48SQ INCH W/BORDER | M | 00000.00 |
1 | A6240 | HYDROCOLL,DRESS, WOUND FILLER PASTE | F | 00011.64 |
1 | A6241 | HYDROCOLL, DRESS, WND FILLER, DRY FORM | F | 00002.44 |
1 | A6242 | HYDROGEL DRESS,<16 SQ INCH W/O BORDER | F | 00005.77 |
1 | A6243 | HYDROGEL DRESS,>16SQ INCH,<48 SQ INCH | F | 00011.71 |
1 | A6244 | HYDROGEL DRESS, >48 SQ INCH W/O BORDER | F | 00037.35 |
1 | A6245 | HYDROGEL,DRESS,<16SQ IN W/BORDER | F | 00006.90 |
1 | A6246 | HYDROGEL,DRESS,>16 SQ<48SQ IN W/BORDR | F | 00009.44 |
1 | A6247 | HYDROGEL DRESS, >48SQ IN W/BORDER | F | 00022.61 |
1 | A6248 | HYDROGEL,WOUND FILLER, GEL/FLUID OUNCE | F | 00015.45 |
1 | A6250 | SKIN SEALANTS,PROTECTANTS,MOISTURIZERS | M | 00000.00 |
1 | A6251 | SPECIALTY ABSORB. DRESS.<16SQ IN | F | 00001.89 |
1 | A6252 | SPECIALTY ABSORB. DRESS,>16,<48 SQ IN | F | 00003.09 |
1 | A6253 | SPECIALTY ABSORB. DRESS,>48 SQ INCHES | F | 00006.03 |
1 | A6254 | SPECIALTY ABSORB. DRESS <16 SQ INCHES | F | 00001.15 |
1 | A6255 | SPECIALTY ABSORB. DRESS>16, <48SQ IN | F | 00002.87 |
1 | A6256 | SPECIALTY DRESS, >48SQUARE INCHES | M | 00000.00 |
1 | A6257 | TRANSPARENT FILM,16 SQ IN OR LESS | F | 00001.45 |
1 | A6258 | TRANSPARENT FILM, 16 - 48 INCHES, EACH | F | 00004.09 |
1 | A6259 | TRANSARENT FILM, MORE THAN 48SQ INCH | F | 00010.40 |
1 | A6260 | WOUND CLEANSERS, ANY TYPE, ANY SIZE | M | 00000.00 |
1 | A6261 | WOUND FILLER GEL/PASTE, PER OZ, NOS | M | 00000.00 |
1 | A6262 | WOUND FILLER, DRY FORM, PER GM, NOS | M | 00000.00 |
1 | A6266 | GAUZE, IMPREG OTHER THAN WATER, PER YD | F | 00001.82 |
1 | A6402 | GAUZE,NON-IMPREG,STERILE <16SQ INCHES | F | 00000.11 |
1 | A6403 | GAUZE, NON-IMPREG,STERILE,>16,<48SQ INCH | F | 00000.40 |
1 | A6404 | GAUZE, NON-IMPREG,STERILE,>48 SQ INCHES | M | 00000.00 |
1 | A6407 | PACKING STRIPS,NON-IMPREG, <2IN PER YD | F | 00001.86 |
1 | A6410 | EYE PAD, STERILE EACH | F | 00000.39 |
1 | A6411 | EYE PAD NON-STERILE,EACH | F | 00000.26 |
1 | A6441 | PADDING BANDAGE,NON-ELAST,NON WOVEN;YARD | F | 00000.68 |
1 | A6442 | CONFORMING BANDAGE;NS,-3"WIDE;PER YARD | F | 00000.18 |
1 | A6443 | CORFORMING BANDAGE;NS,+3" WIDE;PER YARD | F | 00000.29 |
1 | A6444 | CONFORMING BANDAGE,WIDTH + 5 IN.,PER YD | F | 00000.58 |
1 | A6445 | CONFORMING BANDAGE; STERILE,-3" WIDE;YD. | F | 00000.32 |
1 | A6446 | CONFORMING BANDAGE,STERILE+3" WIDE;YARD | F | 00000.41 |
1 | A6447 | CONFORMING BANDAGE,STERILE,5" OR +/YARD | F | 00000.68 |
1 | A6448 | LIGHT COMPRESSION BANDAGE, LESS 3"/YARD | F | 00001.19 |
1 | A6449 | LIGHT COMPRESSION BANDAGE, ELASTIC/YARD | F | 00001.79 |
1 | A6450 | LIGHT COMPRESSION BANDAGE +5" WIDTH/YD | M | 00000.00 |
1 | A6451 | MODERATE COMPRESSION, ELASTIC/YARD | M | 00000.00 |
1 | A6452 | HIGH COMPRESSION BANDAGE; PER YARD | F | 00006.07 |
1 | A6453 | SELF-ADHERENT BANDAGE,- 3" WIDE/YARD | F | 00000.63 |
1 | A6454 | SELF-ADHERENT BANDAGE, ELAST,+5"/YARD | F | 00000.78 |
1 | A6455 | SELF-ADHERRENT BANDAGE + 3" WIDTH/YARD | F | 00001.42 |
1 | A6456 | ZINC PASTE BANDAGE; PER YARD | F | 00001.31 |
1 | A6457 | TUBULAR DRESSING | M | 00000.00 |
1 | A6501 | COMPRESSION BURN GARMENT BODY SUIT | M | 00000.00 |
1 | A6502 | COMPRESSION BURN GARMENT CHIN STRAP | M | 00000.00 |
1 | A6503 | COMPRESSION BURN GARMENT,FACIAL HOOD | M | 00000.00 |
1 | A6504 | COMPRESSION BURN GARMENT,GLOVE TO WRIST | M | 00000.00 |
1 | A6505 | COMPRESSION BURN GARMENT GLOVE TO ELBOW | M | 00000.00 |
1 | A6506 | COMPRESSION BURN GARMENT,GLOVE TO AXILLA | M | 00000.00 |
1 | A6507 | COMPRESSION BURN GARMENT FOOT TO KNEE | M | 00000.00 |
1 | A6508 | COMPRESSION BURN GARMENT FOOT/THIGH | M | 00000.00 |
1 | A6509 | COMPRESSION BURN GARMENT VEST | M | 00000.00 |
1 | A6510 | COMPRESSION BURN GARMENT,LEOTARD | M | 00000.00 |
1 | A6511 | COMPRESSION BURN GARMENT, PANTY | M | 00000.00 |
1 | A6512 | COMPRESSION BURN GARMENT,UNCLASSIFIED | M | 00000.00 |
1 | A6513 | COMPRESS BURN MASK FACE/NECK | F | 00030.37 |
1 | A6530 | COMPRESSION STOCKING BK18-30 | F | 00030.37 |
1 | A6531 | COMPRESSION STOCKING BK30-40 | F | 00030.37 |
1 | A6532 | COMPRESSION STOCKING BK40-50 | F | 00042.16 |
1 | A6533 | GC STOCKING THIGHLNGTH 18-30 | F | 00042.16 |
1 | A6534 | GC STOCKING THIGHLNGTH 30-40 | F | 00042.16 |
1 | A6535 | GC STOCKING THIGHLNGTH 40-50 | F | 00042.16 |
1 | A6536 | GC STOCKING FULL LNGTH 18-30 | F | 00042.16 |
1 | A6537 | GC STOCKING FULL LNGTH 30-40 | F | 00042.16 |
1 | A6538 | GC STOCKING FULL LNGTH 40-50 | F | 00042.16 |
1 | A6539 | GC STOCKING WAISTLNGTH 18-30 | F | 00042.16 |
1 | A6540 | GC STOCKING WAISTLNGTH 30-40 | F | 00042.16 |
1 | A6541 | GC STOCKING WAISTLNGTH 40-50 | F | 00042.16 |
1 | A6544 | GC STOCKING GARTER BELT | F | 00042.16 |
1 | A6545 | COMP WRAP NON-ELAS BTK 30-50 MM HG EA | M | 00000.00 |
1 | A6549 | G COMPRESSION STOCKING | M | 00000.00 |
1 | A6550 | DRESSING FOR NEG. PRESSURE; EACH | F | 00026.15 |
1 | A7000 | CANNISTER,DISPOSABLE,USED W/SUCTION PUMP | F | 00009.06 |
R | A7001 | CANNISTER,NON-DISPOSABLE USED W/SUCTION | F | 00032.44 | RR
1 | A7002 | TUBING, USED WITH SUCTION PUMP | F | 00003.64 |
1 | A7003 | ADMINISTRATION SET,W/SMALL VOL NEBULIZER | F | 00002.60 |
1 | A7004 | SMALL VOL. PNEUMATIC NEB. DISPOSABLE | F | 00001.71 |
1 | A7005 | ADM. SET W/SMALL VOL NEB,NON-DISPOSABLE | F | 00029.32 |
1 | A7006 | ADMIN. SET W/SM VOL FILTERED NEB | F | 00009.06 |
1 | A7007 | LARGE VOL,NEB,DISP, UNFILLED USE W/COMPR | F | 00004.39 |
1 | A7008 | LARGE VOL NEB,DISPOSABLE USE W/COMPRESS | F | 00010.46 |
1 | A7009 | RESERVOIR BOTTLE, NON-DISPOSABLE | F | 00039.99 |
1 | A7010 | CORRUGATED TUBING, DISPOS. USE W/NEB | F | 00022.43 |
1 | A7012 | WATER COLLECT. DEVICE USE Q/LRG NEB. | F | 00003.60 |
1 | A7013 | FILTER,DISPOSABLE,W/AEROSOL COMPRESSOR | F | 00000.78 |
1 | A7014 | FILTER,NON-DISPOS,USE W/AEROSOL COMPRESS | F | 00004.26 |
1 | A7015 | AEROSOL MASK, USED WITH DME NEBULIZER | F | 00001.78 |
1 | A7016 | DOME AND MOUTHPIECE, USED W/SM VOL NEB | F | 00006.88 |
1 | A7017 | NEBULIZER, DURABLE, NOT USED WITH OXYGEN | F | 00127.50 |
R | A7017 | NEBULIZER,DURABLE NOT USED WITH OXYGEN | F | 00012.74 | RR
1 | A7018 | WATER, DISTILLED, 1000ML | F | 00000.36 |
1 | A7020 | INTERFACE FOR COUGH STIMULATING DEVICE | M | 00000.00 |
1 | A7025 | HIGH FREQUENCY CHEST OCCILATION VEST | M | 00000.00 |
1 | A7026 | HIGH FREQ.OCILL.DEVICE SYSTEM HOSE | F | 00029.56 |
1 | A7027 | COMBO ORAL/NASAL MASK,USED WITH CPAP,EA | F | 00180.75 |
1 | A7028 | REPLC ORAL CUSHION,ORAL/NASAL MASK,EA | F | 00048.01 |
1 | A7029 | RPLC NASAL PILLOW, ORAL/NASAL MASK,PR | F | 00019.61 |
1 | A7030 | FULL MASK USED WITH POSITIVE AIRWAY DEV. | F | 00180.47 |
1 | A7031 | FACE MASK INTERFACE REPLACEMENT | F | 00066.75 |
1 | A7032 | CUSHION FOR USE ON NASAL MASK INTERFACE | F | 00023.42 |
1 | A7033 | PILLOW FOR USE ON NASAL CANNULA TYPE | F | 00023.42 |
1 | A7034 | NASAL INTERFACE USED WITH AIRWAY DEVICE | F | 00076.45 |
1 | A7035 | HEADGEAR USED WITH AIRWAY DEVICE | F | 00038.01 |
1 | A7036 | CHINSTRAP USED WITH AIRWAY DEVICE | F | 00017.32 |
1 | A7037 | TUBING USED WITH AIRWAY PRESSURE DEVICE | F | 00005.16 |
1 | A7038 | FILTER DISPOSABLE,USED WITH AIRWAY DEVIC | F | 00005.16 |
1 | A7039 | FILTER,NON-DISP.USED WITH AIRWAY DEVICE | F | 00014.66 |
1 | A7044 | ORAL INTERFACE WITH PRESSURE DEVICE | F | 00115.67 |
1 | A7045 | EXHALATION PORT W/W/O SWIVEL USED W ACCE | F | 00018.62 |
1 | A7046 | WATER CHAMBER/HUMIDIFIER/REPLACE;EACH | F | 00018.66 |
1 | A7047 | Oral interface used with respiratory suc | F | 00126.86 |
1 | A7048 | VACUUM DRAINAGE COLLECTION UNIT AND TUBI | F | 00044.83 |
1 | A7501 | TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM | F | 00099.89 |
1 | A7502 | REPLAC. DIAPHRAGM/FACEPLATE,TRACH VALVE | F | 00047.49 |
1 | A7503 | FILTER HOLDER/CAP,REUSABLE FOR TRACHSTOM | F | 00010.77 |
1 | A7504 | FILTER FOR TRACHEOSTOMA | F | 00000.64 |
1 | A7505 | HOUSING, REUSABLE FOR TRACHEOSTOMA VALVE | F | 00004.45 |
1 | A7506 | ADHESIVE DISC FOR TRACHEOSTOMA VALVE | F | 00000.31 |
1 | A7507 | FILTER HOLDER AND FILTER FOR TRACHEOSTOM | F | 00002.36 |
1 | A7508 | HOUSING W/ADHESIVE FOR TRACHEOSTOMA | F | 00002.73 |
1 | A7509 | FILTER HOLDER AND FILTER HOUSING | F | 00001.33 |
1 | A7520 | TRACHEOSTOMY/LARYN TUBE,NON CUFF;EACH | F | 00050.73 |
1 | A7521 | TRACHEOSTOMY/LARYN TUBE, CUFFED,EACH | F | 00048.36 |
1 | A7522 | TRACHEOSTOMY/LARYN TUBE,STAIN. STEEL; EA | F | 00046.42 |
1 | A7524 | TRACHEOSTOMA STENT/STUD BUTTON;EACH | F | 00047.49 |
1 | A7525 | TRACHEOSTOMY MASK; EACH | F | 00002.29 |
1 | A7526 | TRACHEOSTOMY TUBE COLLAR/HOLDER;EACH | F | 00003.46 |
1 | A7527 | TRACH/LARYNGECTOMY TUBE PLUG/STOP,EACH | F | 00003.56 |
1 | A8000 | SOFT PROTECT HELMET PREFAB | F | 00146.63 |
1 | A8001 | HARD PROTECT HELMET PREFAB | F | 00146.63 |
1 | A8002 | SOFT PROTECT HELMET CUSTOM | M | 00000.00 |
1 | A8003 | HARD PROTECT HELMET CUSTOM | M | 00000.00 |
1 | A8004 | REPL SOFT INTERFACE, HELMET | M | 00000.00 |
1 | A9152 | SINGLE VITAMIN/MINERAL/TRACE ELEMENT | M | 00000.00 |
1 | A9153 | MULTIPLE VITAMINS | M | 00000.00 |
1 | A9274 | EXT AMB INSULIN DELIV SYS, DISP, EACH | M | 00000.00 |
1 | A9276 | INVASIVE DISPS SENSOR,1UNIT | M | 00000.00 |
1 | A9277 | EXT TRANSMITTER,FOR INTER CONT GLUC MON | M | 00000.00 |
1 | A9278 | EXT REC FOR INTERST CONT GLUC MON SYS | M | 00000.00 |
1 | A9279 | MONITORING FEATURE/DEVICE NOC | M | 00000.00 |
1 | A9280 | ALERT/ALARM DEVICE,NOS | M | 00000.00 |
R | A9280 | ALERT/ALARM DEVICE,NOS | M | 00000.00 | RR
1 | A9283 | FT PRESS OFF LOAD/SUPPORT DEVIE, ANY,EA | F | 01242.94 |
1 | A9900 | MISC. DME SUPPLY OF ANOTHER HCPCS CODE | M | 00000.00 |
1 | A9999 | MISCELLANEOUS DME SUPPLY OR ACCESSORY NO | M | 00000.00 |
1 | B4034 | ENTERAL FEEDING SUPPLY KIT;SYRINGE FED | F | 00005.45 |
1 | B4035 | ENTERAL FEEDING SUPPLY KIT; PUMP FED | F | 00010.25 |
1 | B4036 | ENTERAL FEEDING SUPPLY KIT;GRAVITY FED | F | 00007.10 |
1 | B4081 | NASOGASTRIC TUBING WITH STYLET | F | 00027.71 |
1 | B4082 | NASOGASTRIC TUBING WITHOUT STYLET (EACH) | F | 00015.29 |
1 | B4083 | STOMACH TUBE- LEVINE TYPE | F | 00002.26 |
1 | B4087 | GAST/JEJUN TUBE, STAND,ANY MAT/TYPE, EA | F | 00037.03 |
1 | B4088 | GAST/J TUBE, LOW PROF,ANY MAT/TYPE, EA | F | 00193.11 |
1 | B4100 | FOOD THICKENER, ADMINISTERED ORALLY | M | 00000.00 |
1 | B4102 | ENTERAL FORMULA | M | 00000.00 |
1 | B4103 | ENTERAL FORMULA | F | 00004.98 |
1 | B4104 | ADDITIVE FOR FORMULA | M | 00000.00 |
1 | B4149 | ENTERAL FORMULA | M | 00000.00 |
1 | B4150 | ENTERAL FORMULAE; CATEGORY I: INTACT PRO | M | 00000.00 |
1 | B4152 | ENTERAL FORMULAE; CATEGORY II: INTACT PR | M | 00000.00 |
1 | B4153 | ENTERAL FORMULAE; CATEGORY III: HYDROLIZ | M | 00000.00 |
1 | B4154 | ENTERAL FORMULAE; CATEGORY IV: DEFINED F | M | 00000.00 |
1 | B4155 | ENTERAL FORMULAE; CATEGORY V: MODULAR CO | M | 00000.00 |
1 | B4157 | ENTERAL FORMULA W PROTEINS,FATS,CARBS,VI | M | 00000.00 |
1 | B4158 | ENTERAL FORM FOR PEDS, PROTEINS,FATS,CAR | M | 00000.00 |
1 | B4159 | ENTERAL FORM, PED,SOY BASED,PROTEINS,FAT | M | 00000.00 |
1 | B4160 | ENTERAL FORM,PED INCLUDES PROT,FATS,CARB | M | 00000.00 |
1 | B4161 | ENT FORM,PED, HYDROLYZED/AMINO ACIDS & P | M | 00000.00 |
1 | B4162 | ENT FORM,SPECIAL METABOLIC NEEDS FOR INH | M | 00000.00 |
1 | B4164 | PNS;50% DEXTROSE SOLUTION 500ML | F | 00013.83 |
1 | B4168 | PNS; AMINO ACID 3.5% 500ML | F | 00038.41 |
1 | B4172 | PNS; AMINO ACID 5.5% THRU 7% 500 ML | F | 00030.47 |
1 | B4176 | PNS; AMINO ACID GREATER THAN 7% 500 ML | F | 00078.37 |
1 | B4178 | PNS; AMINO ACID GREATER THAN 8.5, 500 ML | F | 00078.37 |
1 | B4180 | PARENTL NUTRIN SOLN CARBOHYDRATES,ANY ST | F | 00031.05 |
1 | B4185 | PARENTERAL SOL 10 GM LIPIDS | F | 00011.75 |
1 | B4189 | PNS; COMPOUNDED AMINOACID/CARBOHYD 10-51 | F | 00054.78 |
1 | B4193 | PNS; COMPOUNDED AMINO ACID/CARBOHYD. 52- | F | 00068.28 |
1 | B4197 | PNS; COMPOUNDED AMINO ACID/CARBOHYD. 74 | F | 00080.23 |
1 | B4199 | PNS;COMPOUNDED AMINO ACID/CARBOHYD, OVER | F | 00091.53 |
1 | B4224 | PARENTRAL NUTRITION SUPPLY KIT FOR 1 MON | F | 00640.20 |
1 | B9002 | ENTERAL NUTRITION INFUSION PUMP W/ALARM- | F | 01140.59 |
R | B9002 | ENTERAL NUTRITION INFUSION PUMP W/ALARM- | F | 00114.07 | RR
R | B9004 | PARENTERAL NUTRITION INFUSION PUMP,PORTA | F | 00263.96 | RR
1 | B9998 | NOC FOR ENTERNAL SUPPLIES | M | 00000.00 |
1 | B9999 | PARENTERAL SUPPLIES NOT OTHERWISE CLASSI | M | 00000.00 |
1 | E0100 | CANE OF ANY MATERIAL ADJ OR FIXED W/TIP | F | 00020.02 |
1 | E0105 | CANE QUAD 3/PRONGED, ANY MATERIAL, ADJ O | F | 00043.53 |
1 | E0110 | CRUTCHES FOREARM ANY MATERIA. ADJ OR FIX | F | 00073.74 |
1 | E0111 | CRUTCH FOREARM, INCLUDES CRUTCHES OF VAR | F | 00036.88 |
1 | E0112 | CRUTCHES UNDERARM WOOD ADJ OR FIXED W/PA | F | 00021.95 |
1 | E0113 | CRUTCH UNDERARM, WOOD ADJUSTABLE OR FIXE | F | 00018.55 |
1 | E0114 | CRUTCHES,UNDERARM ALUM ADJ OR FIXED(PR) | F | 00041.06 |
1 | E0116 | CRUTCH, UNDERARM | F | 00022.42 |
1 | E0117 | CRUTCH UNDERARM,ARTICULATING | F | 00192.07 |
1 | E0118 | CRUTCH SUBSTITUTE,LOWER LEG,W/WO WHEELS, | F | 00334.00 |
R | E0118 | CRUTCH SUBSTITUTE,LOWER LEG,W/WO WHEELS, | F | 00033.40 | RR
1 | E0130 | WALKER, RIGID (PICKUP), ADJUSTABLE OR FI | F | 00064.71 |
1 | E0135 | WALKER, FOLDING (PICKUP), ADJUSTABLE OR | F | 00074.12 |
1 | E0140 | WALKER W TRUNK SUPPORT,ADJ/FIXED HEIGHT | F | 00345.10 |
R | E0140 | WALKER, WHEELED, WITH OR WITHOUT SEAT | F | 00034.51 | RR
1 | E0141 | WALKER WHEELED, WITHOUT SEAT | F | 00093.21 |
1 | E0143 | FOLDING WALKER, WHEELED, WITHOUT SEAT | F | 00091.11 |
R | E0143 | FOLDING WALKER WHEELED WITHOUT SEAT | F | 00009.11 | RR
R | E0144 | ENCLOSED FRAME FOLDING WALKER, W SEAT | F | 00030.30 | RR
1 | E0144 | ENCLOSED,FRAME FOLDING WALKER W SEAT | F | 00302.91 |
1 | E0147 | HEAVY DUTY MULTIPLE BREAKING SYSTEM, VAR | F | 00546.76 |
1 | E0148 | WALKER, HEAVY DUTY,W/O WHEELS,RIGID,FOLD | F | 00121.21 |
R | E0148 | WALKER, HEAVY DUTY,W/O WHEELS,RIGID,FOLD | F | 00012.13 | RR
R | E0149 | WALKER, HEAVY DUTY,WHEELS,RIGID OR FOLD | F | 00019.38 | RR
1 | E0149 | WALKER, HEAVY DUTY,WHEELS,RIGID OR FOLD | F | 00193.81 |
1 | E0153 | PLATFORM ATTACHMENT FOR FOREARM CRUTCH | F | 00058.06 |
1 | E0154 | PLATFORM ATTACH, WALKER (EACH), PURCHASE | F | 00067.01 |
1 | E0155 | WHEEL ATTACHMENT,RIGID PICK-UP WALKER AT | F | 00025.84 |
1 | E0156 | SEAT ATTACHMENT, WALKER | F | 00020.71 |
1 | E0157 | CRUTCH ATTACHMENT, WALKER, EACH | F | 00066.62 |
1 | E0158 | LEG EXTENSIONS FOR A WALKER | F | 00021.57 |
1 | E0159 | BRAKE ATTACHMENT FOR WHEELED WALKER | F | 00017.00 |
1 | E0160 | SITZ BATH, PORTABLE, FITS OVER COMMODE S | F | 00027.45 |
1 | E0161 | SITZ BATH, PORTABLE, FITS OVER COMMODE S | F | 00021.21 |
1 | E0162 | SITZ BATH CHAIR | F | 00127.63 |
1 | E0163 | COMMODE CHAIR, STATIONARY, WITH FIXED AR | F | 00101.77 |
1 | E0165 | COMMODE CHAIR, STATIONARY, WITH DETACHAB | F | 00185.45 |
R | E0165 | COMMODE CHAIR,STATIONARY, W DETACH ARMS | F | 00018.54 | RR
1 | E0167 | PAIL OR PAN FOR USE WITH COMMODE CHAIR | F | 00011.07 |
1 | E0168 | EXTRA WIDE COMMODE, W OR WO ARMS | F | 00152.05 |
R | E0168 | EXTRA WIDE COMMODE W OR W/O ARMS | F | 00015.21 | RR
1 | E0170 | COMMODE CHAIR ELECTRIC | F | 00503.72 |
1 | E0171 | COMMODE CHAIR NON-ELECTRIC | F | 00503.72 |
1 | E0172 | SEAT LIFT MECHANISM TOILET | F | 00503.72 |
1 | E0175 | FOOT REST, FOR USE WITH COMMODE CHAIR, E | F | 00062.99 |
1 | E0181 | PRESSURE PAD, ALTERNATING WITH PUMP, HEA | F | 00229.05 |
R | E0181 | PRESSURE PAD,ALTERNATING WITH PUMP,HEAVY | F | 00022.90 | RR
R | E0182 | PUMP FOR ALTERNATING PRESSURE PAD | F | 00026.11 | RR
1 | E0182 | PUMP FOR ALTERNATING PRESSURE PAD | F | 00261.20 |
1 | E0184 | DRY PRESSURE MATTRESS | F | 00160.99 |
1 | E0185 | GEL PRESSURE PAD FOR MATTRESS | F | 00282.61 |
1 | E0186 | AIR PRESSURE MATTRESS | F | 00062.47 |
1 | E0187 | WATER PRESSURE MATTRESS | F | 00390.72 |
1 | E0188 | SYNTHETIC SHEEPSKIN PAD FOR WHEELCHAIR, | F | 00025.61 |
1 | E0189 | LAMBSWOOL SHEEPSKIN PAD, ANY SIZE, PURCH | F | 00049.03 |
1 | E0190 | POSITIONING CUSHION/PILLOW/WEDGE/ANY | M | 00000.00 |
1 | E0191 | HEEL OR ELBOW PROTECTOR, EACH | F | 00008.08 |
R | E0193 | POWERED AIR FLOTATION BED (LOW AIR LOSS) | F | 00859.40 | RR
R | E0196 | GEL PRESSURE MATTRESS | F | 00030.65 | RR
1 | E0196 | GEL PRESSURE MATTRESS | F | 00306.50 |
1 | E0197 | AIR PRESSURE PAD FOR MATTRESS | F | 00223.24 |
R | E0197 | AIR PRESSURE PAD FOR MATTRESS | F | 00022.32 | RR
R | E0198 | WATER PRESSURE PAD FOR MATTRESS | F | 00018.96 | RR
1 | E0198 | WATER PRESSURE PAD FOR MATTRESS | F | 00189.69 |
1 | E0199 | DRY PRESSURE PAD FOR MATTRESS | F | 00030.48 |
1 | E0200 | HEAT LAMP, W/O STAND, W/BULB OR INFRARED | F | 00069.06 |
R | E0202 | PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOT | F | 00069.50 | RR
R | E0205 | HEAT LAMP WITH STAND INCLUDES BULB OR IN | F | 00016.98 | RR
1 | E0205 | HEATLAMP, WITH STAND, INCLUDES BULB, OR | F | 00169.93 |
1 | E0210 | ELECTRIC HEAT PAD, STANDARD | F | 00025.60 |
1 | E0215 | ELECTREC HEAT PAD, MOIST | F | 00067.39 |
1 | E0217 | WATER CIRCULATING HEAT PAD W/PUMP | F | 00472.24 |
1 | E0221 | INFRARED HEATING PAID SYSTEM | F | 02162.11 |
R | E0221 | INFRARED HEATING PAD SYSTEM | F | 00216.20 | RR
R | E0235 | PARAFIN BATH UNIT,PORTABLE | F | 00016.13 | RR
1 | E0235 | PARAFIN BATH UNIT, PORTABLE | F | 00161.35 |
1 | E0240 | BATH/SHOWER CHAIR, W/WO WHEELS,ANY SIZE | M | 00000.00 |
R | E0240 | BATH/SHOWER CHAIR, W/WO WHEELS, ANY SIZE | M | 00000.00 | RR
1 | E0245 | TUB STOOL OR BENCH | M | 00000.00 |
1 | E0247 | TRANSFER BENCH FOR TUB/TOILET, W/WO OPEN | M | 00000.00 |
1 | E0248 | TRANSFER BENCH, HVY DUTY, TUB OR STOOL | M | 00000.00 |
1 | E0250 | HOSPITAL BED, WITH SIDE RAILS, FIXED HEI | F | 00848.87 |
R | E0250 | HOSPITAL BED, WITH SIDE RAILS, FIXED HEI | F | 00084.89 | RR
R | E0255 | HOSP. BED W/SIDE RAILS VARIABLE HGHT. HI | F | 00102.01 | RR
1 | E0255 | HOSP.BED W/SIDE RAILS VARIABLE HGT. HI-L | F | 01020.14 |
1 | E0256 | HOSPITAL BED,VAR.HT,HI-LO W/SIDE RAILS | F | 00792.82 |
R | E0256 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO, W/ | F | 00079.28 | RR
R | E0260 | HOSP. BED W/SIDE RAILS SEMI-ELEC HEAD/FO | F | 00121.97 | RR
1 | E0260 | HOSP. BED W/SIDE RAILS SEMI ELEC HEAD/FO | F | 01219.81 |
1 | E0261 | HOSPITAL BED, SEMI-ELECTRIC, W/SIDE RAIL | F | 01302.62 |
R | E0261 | HOSPITAL BED, SEMI-ELECTRIC, W/SIDE RAIL | F | 00130.25 | RR
R | E0265 | HOSP.BED TOTAL ELEC HEAD,FT. AND HGT. AD | F | 00173.56 | RR
1 | E0265 | HOSP.BED TOTAL ELEC. HEAD,FT. AND HGT. A | F | 01735.64 |
1 | E0266 | HOSP.BED W/SIDE RAILS TOTAL ELEC HD/FT/H | F | 01530.88 |
R | E0266 | HOSP.BED W/SIDE RAILS TOTAL ELEC HD/FT/H | F | 00153.08 | RR
1 | E0270 | HOSPITAL BED, INSTITUTIONAL TYPE INCLUDE | M | 00000.00 |
1 | E0271 | MATTRESS, INNERSPRING | F | 00186.73 |
1 | E0272 | MATTRESS, FOAM RUBBER | F | 00111.97 |
1 | E0276 | BED PAN, STANDARD OR FRACTURE, METAL OR | F | 00010.42 |
R | E0277 | POWERED PRESSURE-REDUCING MATTRESS | F | 00672.98 | RR
1 | E0280 | BED, CRADLE, ANY TYPE (PURCHASE ONLY) | F | 00036.29 |
1 | E0290 | HOSPITAL BED, FIXED HEIGHT, W/O SIDE RAI | F | 00649.00 |
R | E0290 | HOSPITAL BED, FIXED HEIGHT, W/O SIDE RAI | F | 00064.90 | RR
R | E0291 | HOSPITAL BED, FIXED HEIGHT, W/O SIDE RAI | F | 00043.00 | RR
1 | E0291 | HOSPITAL BED, FIXED HEIGHT, W/O SIDE RAI | F | 00430.04 |
1 | E0292 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO, W/ | F | 00729.79 |
R | E0292 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO, W/ | F | 00072.98 | RR
R | E0293 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO, W/ | F | 00062.09 | RR
1 | E0293 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO W/O | F | 00620.98 |
1 | E0294 | HOSPITAL BED, SEMI-ELECTRIC, W/O SIDERAI | F | 01134.51 |
R | E0294 | HOSPITAL BED, SEMI-ELECTRIC, W/O SIDE RA | F | 00113.45 | RR
R | E0295 | HOSPITAL BED, SEMI-ELECTRIC, W/O SIDE RA | F | 00110.58 | RR
1 | E0295 | HOSPITAL BED, SEMI-ELECTRIC, W/O SIDE RA | F | 01105.82 |
1 | E0296 | HOSPITAL BED, TOTAL ELECTRIC, W/O SIDE R | F | 01425.81 |
R | E0296 | HOSPITAL BED, TOTAL ELECTRIC, W/O SIDE R | F | 00142.58 | RR
R | E0297 | HOSPITAL BED, TOTAL ELECTRIC, W/O SIDE R | F | 00122.14 | RR
1 | E0297 | HOSPITAL BED, TOTAL ELECTRIC, W/O SIDE R | F | 01221.54 |
1 | E0300 | PRDIATRIC CRIB, HOSP GRADE,FULLY ENCLOSE | F | 02715.50 |
R | E0300 | PEDIATRIC CRIB FULLY ENCLOSED | F | 00271.55 | RR
R | E0301 | HOSPITAL BED,WEIGHT CAPACITY +350 LBS. | F | 00259.00 | RR
1 | E0301 | HOSPITAL BED,WEIGHT CAPACITY +350 LBS. | F | 02590.00 |
1 | E0302 | HOSPITAL BED, WEIGHT CAPACITY + 600 LBS. | M | 00000.00 |
R | E0302 | HOSPITAL BED,WEIGHT CAPACITY +600 LBS. | F | 00395.36 | RR
R | E0303 | HOSPITAL BED,CAP. +350,WITH MATTRESS | F | 00287.99 | RR
1 | E0303 | HOSPITAL BED,CAP. +350,WITH MATTRESS | F | 03031.50 |
1 | E0304 | HOSPITAL BED,WT CAP. + 600 LBS/MATTRESS | M | 00000.00 |
R | E0304 | HOSPITAL BED,WT CAP. +600 LBS/MATTRESS | F | 00737.28 | RR
1 | E0305 | BED SIDE RAILS, HALF LENGTH | F | 00016.91 |
1 | E0310 | BED SIDE RAILS, FULL LENGTH | F | 00158.98 |
1 | E0325 | URINAL, MALE, ANY MATERIAL | F | 00007.92 |
1 | E0326 | URINAL, FEMALE, ANY MATERIAL | F | 00008.25 |
1 | E0328 | HOSP BED,PED,MANUAL,FULL ENCLOS W/MAT | M | 00000.00 |
R | E0328 | HOSP BED,PED,MANUAL,FULL ENCLOS W/MAT | M | 00000.00 | RR
R | E0329 | HOSP BED,PED,ELECT/SEMI,FULL ENCL W/MAT | M | 00000.00 | RR
1 | E0329 | HOSP BED,PED,ELECT/SEMI,FULL ENCL W/MAT | M | 00000.00 |
1 | E0371 | NON-POWERED PRESS.RED. OVERLAY FOR MATT. | F | 04227.93 |
R | E0371 | NON-POWERED,PRESS,RED.OVERLAY MATTRESS | F | 00422.79 | RR
R | E0372 | POWERED AIR OVERLAY FOR MATT.STANDARD | F | 00513.03 | RR
1 | E0372 | POWERED AIR OVERLAY FOR MATTRESS, | F | 05129.96 |
1 | E0373 | NON-POWERED PRESS,RED. MATTRESS | F | 05844.89 |
R | E0373 | NON-POWERED PRESSURE RED. MATTRESS | F | 00584.49 | RR
R | E0424 | STAT. COMP. GAS OXYGEN, RENTAL | F | 00180.92 | RR
R | E0431 | PORT. GAS OXYGEN, RENTAL;AND SUPPLIES | F | 00030.42 | RR
R | E0433 | PORT. LIQ. O2 SYSTEM, RENTAL; HOME | F | 00049.54 | RR
R | E0434 | PORT LIQUID OXYGEN SYSTEM RENTAL | F | 00030.42 | RR
R | E0439 | STAT. LIQUID OXYGEN SYSTEM, RENTAL | F | 00180.92 | RR
1 | E0441 | OXYGEN CONTENTS, GASEOUS, MONTHLY SUPPLY | F | 00077.45 |
1 | E0442 | OXYGEN CONTENTS, LIQUID, PER MONTH | F | 00077.45 |
1 | E0443 | PORTABLE OXYGEN CONTENTS, GASEOUS,/MONTH | F | 00021.28 |
1 | E0444 | PORTABLE OXYGEN CONTENTS, LIQUID,/MONTH | F | 00021.28 |
R | E0445 | OXIMETER | F | 00297.06 | RR
R | E0465 | HOME VENTILATOR; ANY TYPE; USED WITH INV | M | 00000.00 | RR
R | E0466 | HOME VENTILATOR; ANY TYPE; USED WITH NON | M | 00000.00 | RR
R | E0470 | RESPIRATORY ASSIST DEVICE W/O BACK-UP | F | 00244.08 | RR
R | E0471 | RESPIRATORY ASSIST DEVICE W BACK-UP | F | 00519.22 | RR
1 | E0471 | RESPIRATORY ASSIST DEVICE W BACK-UP | M | 00000.00 |
R | E0472 | RESPIRATORY ASSIST USED W INVASIVE INTER | F | 00519.22 | RR
1 | E0480 | PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME M | F | 00304.79 |
R | E0481 | INTRAPULMONARY PERCUSSIVE DEVICE(IPV) | M | 00000.00 | RR
R | E0482 | COUGH STIMULATING DEVICE, | F | 00306.04 | RR
R | E0483 | CHEST WALL OSCILLATION SYSTEM | F | 01180.02 | RR
1 | E0483 | HIGH FREQUENCY CHEST OSCILLATOR SYSTEM | M | 00000.00 |
1 | E0484 | OSCILLATORY POSITIVE EXPIRATORY DEVICE | F | 00040.99 |
1 | E0500 | IPPB MACHINES ALL TYPES WITH BUILT-IN NE | F | 00681.06 |
R | E0500 | IPPB MACHINES, ALL TYPES, WITH BUILT-IN | F | 00068.10 | RR
R | E0550 | HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLE | F | 00017.78 | RR
1 | E0550 | HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLE | F | 00177.89 |
1 | E0555 | HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVAB | F | 00004.11 |
1 | E0560 | HUMIDIFIER, DURABLE DURING IPPB OR O2 DE | F | 00148.81 |
R | E0560 | HUMIDIFIER, DURABLE USED DURING IPPB OR | F | 00014.87 | RR
1 | E0561 | HUMIDIFIER,NON-HEATED W PAP DEVICE | F | 00101.78 |
1 | E0562 | HUMIDIFIER,HEATED,USE W PAP DEVICE | F | 00286.52 |
1 | E0565 | COMPRESSOR, AIR POWER SOURCE | F | 00614.65 |
R | E0565 | COMPRESSOR,AIR POWER SOURCE | F | 00061.46 | RR
R | E0570 | NEBULIZER WITH COMPRESSOR | F | 00017.87 | RR
1 | E0570 | NEBULIZER WITH COMPRESSOR | F | 00178.70 |
R | E0572 | AEROSOL COMP,ADJ. PRESS, FOR INTERM. USE | F | 00036.36 | RR
R | E0574 | ULTRASONIC GEN, W/SM VOL NEBULIZER | F | 00038.41 | RR
1 | E0574 | ULTRASONIC GEN,W/SM VOL NEBULIZER | F | 00384.14 |
1 | E0575 | NEBULIZER, SELF-CONTAINED ULTRASONIC | F | 00759.90 |
R | E0575 | NEBULIZER, SELF-CONTAINED ULTRASONIC | F | 00075.99 | RR
R | E0580 | NEBULIZER,DURABLE,GLASS OR AUTOCLAVABLE | F | 00012.74 | RR
1 | E0580 | NEBULIZER, DURABLE, GLASS OR AUTOCLAVABL | F | 00127.50 |
1 | E0585 | MEBULIZER WITH COMPRESSOR AND HEATER | F | 00277.94 |
R | E0585 | NEBULIZER, WITH COMPRESSOR AND HEATER | F | 00027.78 | RR
R | E0600 | RESPIRATORY SUCTION PUMP,PORT OR STATION | F | 00033.59 | RR
1 | E0600 | RESPIRATORY SUCTION PUMP,PORT OR STATION | F | 00335.87 |
1 | E0601 | NASAL CONTINOUS AIRWAY PRESSURE (CPAP) D | F | 01068.70 |
R | E0601 | NASAL CONTINOUS AIRWAY PRESSURE (CPAP) D | F | 00106.87 | RR
1 | E0605 | VAPORIZER, ROOM TYPE, HOT OR COLD (PURCH | F | 00022.39 |
1 | E0607 | HOME BLOOD GLUCOSE MONITOR (PURCHASE ONL | F | 00061.65 |
1 | E0617 | EXTERNAL DEFIBRILLATOR WITH ANALYSIS | M | 00000.00 |
R | E0617 | EXTERNAL DEFIBRILLATOR WITH ANALYSIS | F | 00337.47 | RR
R | E0618 | APNEA MONITOR,W/O RECORDING DEVICE | F | 00304.55 | RR
R | E0619 | APNEA MONITOR WITH RECORDING FEATURE | F | 00304.55 | RR
1 | E0621 | SLING OR SEAT PT LIFT CANVAS OR NYLON (E | F | 00075.30 |
1 | E0627 | SEAT LIFT MECHANISM INCORPORATED INTO CO | F | 00366.60 |
R | E0627 | SEAT LIFT MECHANISM INCORPORATED INTO CO | F | 00036.66 | RR
R | E0630 | PATIENT LIFT, HYDRAULIC, WITH SEAT OR SL | F | 00112.67 | RR
1 | E0630 | PATIENT LIFT, HYDRAULIC, WITH SEAT OR SL | F | 01126.75 |
1 | E0635 | PATIENT LIFT, ELECTRIC WITH SEAT OR SLIN | M | 00000.00 |
1 | E0637 | COMB SIT/STAND W SEAT LIFT,W/WO WHEELS | F | 02164.14 |
R | E0637 | COMB SIT/STAND W SEAT LIFT,W/WO WHEELS | F | 00216.42 | RR
R | E0638 | STANDING FRAME,ANY SIZE,W/WO WHEELS | F | 00087.76 | RR
1 | E0638 | STANDING FRAME,ANY SIZE,W/WO WHEELS | F | 00877.57 |
1 | E0639 | PT LIFT,MOVEABLE W DISASSEM & REASSEMBLY | M | 00000.00 |
1 | E0640 | PT LIFT,FIX SYS,ALL COMP/ACCESSORIES | M | 00000.00 |
1 | E0641 | MULTI-POSITION STND FRAM SYS | F | 02164.14 |
R | E0641 | MULTI-POSITION STND FRAM SYS | F | 00216.40 | RR
R | E0642 | DYNAMIC STANDING FRAME | F | 00216.40 | RR
1 | E0642 | DYNAMIC STANDING FRAME | F | 02164.14 |
1 | E0650 | PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME | F | 00703.04 |
R | E0650 | PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME | F | 00070.30 | RR
R | E0651 | PNEUMATIC COMP.,SEGMENTAL FOR HOME | F | 00065.73 | RR
1 | E0651 | PNEUMATIC COMP.,SEGMENTAL FOR HOME | F | 00657.18 |
1 | E0652 | PNEUMATIC COMP. W/CALIBRATED PRESS,HOME | F | 05042.85 |
R | E0652 | PNEUMATIC COMP. W/CALIBRATED PRESS,HOME | F | 00504.28 | RR
1 | E0655 | PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT | F | 00063.81 |
1 | E0656 | SEGMENTAL PNEUMATIC APPLIANCE, TRUNK | F | 00581.44 |
1 | E0657 | SEGMENTAL PNEUMATIC APPLIANCE, CHEST | F | 00546.24 |
1 | E0660 | PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT | F | 00099.07 |
1 | E0665 | PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT | F | 00092.35 |
1 | E0666 | PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT | F | 00089.55 |
1 | E0667 | SEGMENTAL PNEU. APPL.FULL LEG | F | 00261.79 |
1 | E0668 | SEGMENTAL PNEU.APPL. FULL ARM | F | 00357.28 |
1 | E0669 | SEGMENTAL PNEU. APPL. HALF LEG | F | 00174.36 |
1 | E0670 | Segmental pneumatic appliance for use w/ | M | 00000.00 |
1 | E0671 | SEGMENTAL GRAD. PRESS,APPL,FULL LEG | F | 00395.08 |
1 | E0672 | SEGMENTAL GRAD. PRESS.APPL, FULL ARM | F | 00306.99 |
1 | E0673 | SEGMENTAL GRAD. PRESS. APPL, HALF LEG | F | 00255.09 |
R | E0675 | PNEUMATIC COMPRESSION DEVICE,HI-PRESSURE | F | 00321.10 | RR
1 | E0676 | INTER LIMB COMPRESS DEV NOS | M | 00000.00 |
1 | E0705 | TRANSFER BOARD OR DEVICE | F | 00045.77 |
1 | E0720 | TENS, TWO LEAD, LOCALIZED STIMULATION | F | 00333.11 |
R | E0720 | TENS, TWO LEAD, LOCALIZED STIMULATION | F | 00033.30 | RR
R | E0730 | TENS, FOUR LEAD, LARGER AREA/MULTIPLE NE | F | 00039.19 | RR
1 | E0730 | TENS, FOUR LEAD, LARGER AREA/MULTIPLE NE | F | 00391.90 |
1 | E0740 | INCONTINENCE TRMT SYSTEM, PELVIC FLOOR S | F | 00501.69 |
R | E0740 | INCONTINENCE TRMT SYSTEM, PELVIC FLOOR S | F | 00050.17 | RR
R | E0745 | NEUROMUSCULAR STIMULATOR, ELECTRONIC SHO | F | 00072.30 | RR
1 | E0747 | OSTEOGENESIS STIMULATOR (NON-INVASIVE) | F | 03799.91 |
1 | E0748 | OSTEOGENESIS STIMULATOR, NONINVASIVE, SP | F | 03799.91 |
1 | E0749 | OSTEOGENESIS STIMULATOR (SURGICALLY IMPL | F | 02655.07 |
1 | E0760 | OSTEOGENESIS STIM. LOW INTEN. ULTRASOUND | F | 02979.11 |
R | E0760 | OSTEOGENSIS STIM.,ULTRASOUND | F | 00297.90 | RR
1 | E0762 | TRANS ELEC JT STIM DEV SYS | F | 00108.10 |
1 | E0764 | FUNCTIONAL NEUROMUSCULARSTIM | F | 00333.11 |
1 | E0770 | FUNCTIONAL ELECTRICAL STIMULATOR, NOS | M | 00000.00 |
1 | E0776 | IV POLE, PURCHASE | F | 00109.52 |
R | E0776 | IV POLE (RENTAL) | F | 00010.94 | RR
R | E0779 | AMBULATORY INFUSION PUMP >8HR/DAY RENTAL | F | 00006.65 | RR
R | E0780 | AMBULATORY INFUSION PUMP RENTAL <8HR/DAY | F | 00006.65 | RR
R | E0784 | EXTERNAL AMBULATORY INFUSION PUMP RENTAL | F | 00410.63 | RR
1 | E0784 | EXTERNAL AMBULATORY INFUSION PUMP, INSUL | F | 04106.37 |
1 | E0840 | TRACTION FRAME, ATTACHED TO HEADBOARD, S | F | 00035.60 |
1 | E0849 | TRACT.EQUIP,CERV,FREE STANDING | F | 00514.04 |
R | E0849 | TRACT.EQUIP.CERVIC.FREE STANDING | F | 00051.40 | RR
1 | E0850 | TRACTION STAND, FREE STANDING, SIMPLE CE | F | 00083.99 |
1 | E0855 | CERVICAL TRACTION EQUIP. W/OUT ADD.STAND | F | 00470.11 |
1 | E0860 | TRACTION EQUIPMENT, OVERDOOR, CERVICAL | F | 00030.21 |
1 | E0870 | TRACTION FRAME, ATTACHED TO FOOTBOARD, S | F | 00067.17 |
1 | E0880 | TRACTION STAND, FREE STANDING, SIMPLE EX | F | 00107.48 |
1 | E0890 | TRACTION FRAME, ATTACHED TO FOOTBOARD, S | F | 00067.17 |
1 | E0900 | TRACTION STAND, FREE STANDING, SIMPLE PE | F | 00107.02 |
1 | E0910 | TRAPEZE BARS AKA PT. HELPER,ATTACHED TO | F | 00155.43 |
R | E0910 | TRAPEZE BARS AKA PT. HELPER, ATTACHED TO | F | 00015.54 | RR
R | E0911 | HD TRAPEZE BAR ATTACH TO BED W/GRAB BAR | F | 00047.68 | RR
1 | E0911 | HD TRAPEZE BAR ATTACH TO BED | F | 00476.80 |
1 | E0912 | HD TRAPEZE BAR FREE STANDING | F | 01095.20 |
R | E0912 | HD TRAPEZE BAR FREE STANDING | F | 00109.52 | RR
1 | E0920 | FRACTURE FRAME, ATTACHED TO BED, INCLUDE | F | 00258.61 |
R | E0935 | PASSIVE MOTION EXCERCISE DEVICE | F | 00021.45 | RR
R | E0936 | CPM DEVICE, OTHER THAN KNEE | M | 00000.00 | RR
R | E0940 | TRAPEZE BAR, FREE STANDING, COMPLETE WIT | F | 00027.83 | RR
1 | E0940 | TRAPEZE BAR, FREE STANDING, COMPLETE WIT | F | 00278.35 |
1 | E0942 | TRACTION ACCESS: CERVICAL, HEAD HARNESS/ | F | 00018.31 |
1 | E0944 | TRACTION ACCESS: PELVIC BELT/HARNESS/BOO | F | 00035.98 |
1 | E0945 | TRACTION ACCESS: EXTREMITY BELT/HARNESS | F | 00033.59 |
1 | E0950 | WHEELCHAIR TRAY | F | 00084.05 |
1 | E0951 | WHEELCHAIR ATTACH: HEEL LOOP (EACH), PUR | F | 00017.91 |
1 | E0952 | WHEELCHAIR ATTACH: TOE LOOP (EACH) | F | 00017.91 |
1 | E0955 | WHEELCHAIR ACCESSORY,HEADREST,CUSHIONED | F | 00193.40 |
R | E0955 | WHEELCHAIR ACCESSORY,HEADREST,CUSHIONED | F | 00019.34 | RR
1 | E0956 | WHEELCHAIR ACCESSORY,LATERAL TRUNK/HIP | F | 00094.30 |
1 | E0957 | WHEELCHAIR ACCESSORY,MEDIAL THIGH SUPPOR | F | 00131.96 |
1 | E0958 | WHEELCHAIR ATTACHMENT TO CONVERT ANY WHE | F | 00415.04 |
1 | E0959 | AMPUTEE ADAPTER (DEVICE USED TO COMPENSA | F | 00049.07 |
1 | E0960 | WHEELCHAIR ACCESSORY,SHOULDER HARNESS/ST | F | 00087.04 |
1 | E0961 | WHEELCHAIR ATTACH: BRAKE EXTENSION, PURC | F | 00022.01 |
1 | E0966 | WHEELCHAIR ATTACH: HOOK-ON HEADREST EXTE | F | 00067.88 |
1 | E0967 | WHEELCHAIR HAND RIMS WITH 8 VERTICAL RUB | F | 00071.70 |
1 | E0968 | COMMODE SEAT, WHEELCHAIR | F | 00017.05 |
1 | E0969 | NARROWING DEVICE, WHEELCHAIR | F | 00149.00 |
1 | E0971 | MANUAL WHEELCHAIR ACCESSORY | F | 00048.20 |
R | E0971 | MANUAL WHEELCHAIR ACCESSORY | F | 00004.82 | RR
1 | E0973 | ADJUSTABLE HEIGHT DETACHABLE ARMS, DESK | F | 00109.36 |
1 | E0974 | "GRADE-AID" (DEVICE TO PREVENT ROLLING B | F | 00068.47 |
1 | E0978 | BELT, SAFETY W/AIRPLAINE BUCKLE, WHEELCH | F | 00034.70 |
R | E0978 | BELT, SAFETY W/AIRPLANE BUCKLE, WHEELCH | F | 00003.47 | RR
1 | E0980 | SAFETY VEST, WHEELCHAIR | F | 00036.69 |
1 | E0981 | WHEELCHAIR ACCESSORY,SEAT UPHOL REPLACE | F | 00045.11 |
1 | E0982 | WHEELCHAIR ACCESSORY, BACK UPHOL REPLACE | F | 00046.87 |
1 | E0983 | MANUAL WC ACCESS,POWER ADD-ON,CONVERT | F | 02377.39 |
1 | E0984 | MANUAL WC ACCESS,POWER ADD-ON TO CONVERT | F | 01817.29 |
1 | E0986 | MANUAL WC ACCESS, PUSH-RIM POWER ASSIST | M | 00000.00 |
1 | E0988 | MANUAL W/C ACCESSORY, LEVER-ACTIVATED | F | 00308.51 |
1 | E0990 | WHEELCHAIR ASSESS.ELEVATING LEG REST | F | 00094.94 |
R | E0990 | WHEELCHAIR ACCESS. ELEVATING LEG REST | F | 00009.50 | RR
1 | E0992 | SOLID SEAT INSERT | F | 00090.49 |
1 | E0994 | ARM REST,EACH | F | 00014.27 |
1 | E0995 | CALF REST, EACH | F | 00028.91 |
1 | E1002 | WHEELCHAIR ACCESS,POWER SEAT,TILT ONLY | M | 00000.00 |
R | E1002 | WHEELCHAIR ACCESS,POWER SEAT,TILT ONLY | M | 00000.00 | RR
1 | E1003 | WHEELCHAIR ACCESS, RECLINE W/O SHEAR RED | M | 00000.00 |
1 | E1004 | WC ACCESS,POWER SEAT,RECLINE W MECH SHEA | F | 04855.75 |
1 | E1005 | WC ACCESS,POWER SEAT,RECLINE,POWER SHEAR | M | 00000.00 |
1 | E1006 | WC ACCESS,COMB TILT/RECLINE W/O SHEAR RE | M | 00000.00 |
1 | E1007 | WC ACCESS COMB TILT/RECLINE W MECH SHEAR | M | 00000.00 |
1 | E1008 | WC ACCESS COMB TILT/RECLINE W POWER SHEA | M | 00000.00 |
1 | E1009 | WHEELCHAIR,MECH.ELEV.LEG SYSTEM | M | 00000.00 |
1 | E1010 | WHEELCHAIR,POWER LEG ELEVATION SYSTEM | F | 02296.42 |
1 | E1011 | MOD.TO PED.WHEELCHAIR,WIDTH GROWTH | M | 00000.00 |
1 | E1012 | W/C ACCESSORY, ADDITION TO POWER SEATING | M | 00000.00 |
1 | E1014 | RECLINING BACK, ADDITION TO PED.WC | F | 00364.14 |
1 | E1015 | SHOCK ABSORBER FOR MANUAL CHAIR, EACH | F | 00111.16 |
1 | E1016 | SHOCK ABSORBER FOR POWER CHAIR | F | 00127.24 |
1 | E1020 | RESIDUAL LIMB SUPPORT NON-COUNTOURED | F | 00232.86 |
1 | E1028 | WHEELCHAIR,MANUAL SWINGAWAY JOYSTICK | F | 00197.59 |
1 | E1029 | WHEELCHAIR VENTILATOR TRAY FIXED | F | 00379.93 |
1 | E1030 | WHEELCHAIR VENT.TRAY GIMBALED | F | 01198.03 |
1 | E1031 | ROLLABOUT CHAIR, ANY TYPE W/CASTERS 5 IN | F | 00320.41 |
R | E1031 | ROLLABOUT CHAIR, ANY TYPE, W/CASTERS 5 I | F | 00032.01 | RR
1 | E1036 | PT TRANSFER SYS, X-WD, PT WT. 300 OR > | M | 00000.00 |
1 | E1037 | TRANSPORT CHAIR,PEDIATRIC SIZE | F | 01115.40 |
R | E1037 | PEDIATRIC TRANSPORT CHAIR | F | 00105.96 | RR
R | E1038 | ADULT TRANSPORT CHAIR | F | 00020.01 | RR
1 | E1038 | TRANSPORT CHAIR,ADULT SIZE | F | 00200.10 |
1 | E1039 | TRANSPORT CHAIR,ADULT,PT WT. 250 OR + | F | 00225.87 |
1 | E1161 | MANUAL ADULT TILT IN SPACE W/C | F | 02352.75 |
R | E1161 | ADULT MANUAL TILT IN SPACE W/C | F | 00235.27 | RR
1 | E1225 | SEMI-RECLINING BACK FOR CUSTOMIZED WHEEL | F | 00325.58 |
1 | E1226 | FULL RECLINING BACK FOR CUSTOMIZED WHEEL | F | 00519.03 |
R | E1226 | FULL RECLINING BACK FOR CUSTOMIZED WHEEL | F | 00051.91 | RR
1 | E1227 | SPECIAL HEIGHT ARMS FOR WHEELCHAIR | F | 00263.96 |
1 | E1228 | SPECIAL BACK HEIGHT FOR WHEELCHAIR | F | 00064.71 |
1 | E1229 | WC, PED SIZE,NOS | M | 00000.00 |
R | E1229 | WHEELCHAIR,PED.NOT OTHEWISE CLASSIFIED | M | 00000.00 | RR
R | E1231 | WHEELCHAIR,PEDIATRIC,TILT IN SPACE | M | 00000.00 | RR
1 | E1231 | WHEELCHAIR PEDIATRIC TILT IN SPACE | M | 00000.00 |
1 | E1232 | WHEELCHAIR,PED.TILT IN SPACE FOLDING | F | 02132.62 |
R | E1232 | WHEELCHAIR,PED.TILT IN SPACE,FOLDING | F | 00213.26 | RR
R | E1233 | WHEELCHAIR,PED.TILT IN SPACE W/OUT SEAT | F | 00220.96 | RR
1 | E1233 | WHEELCHAIR,PED.TILT IN SPACE,W/OUT SEAT | F | 02209.62 |
1 | E1234 | WHEELCHAIR,PED.TILT IN SPACE,W/OUT SEAT | F | 01923.80 |
R | E1234 | WHEELCHAIR,PED.TILT IN SPACE W/OUT SEAT | F | 00192.38 | RR
R | E1235 | WHEELCHAIR,PED.REGID,ADJ.W/SEATING | F | 00185.25 | RR
1 | E1235 | WHEELCHAIR,PED.RIGID,ADJUST.W/SEATING | F | 01852.46 |
1 | E1236 | WHEELCHAIR,PED.FOLDING,ADJUST,W/SEAT | F | 01634.19 |
R | E1236 | WHEELCHAIR,PED.FOLDING AJUSTABLE,W/SEAT | F | 00163.41 | RR
R | E1237 | WHEELCHAIR,PED.RIGID,ADJUST.W/OUT SEAT | F | 00164.84 | RR
1 | E1237 | WHEELCHAIR,PED.RIGID, W/OUT SEATING | F | 01648.48 |
1 | E1238 | WHEELCHAIR PED.SIZE,FOLD.ADJ.W/OUT SEAT | F | 01718.99 |
R | E1238 | WHEELCHAIR,PED.SIZE,FOLD.,ADJ.W/OUT SEAT | F | 00171.90 | RR
R | E1239 | POWER WC,PEDIATRIC, NOT OTHERWISE SPECIF | M | 00000.00 | RR
1 | E1296 | SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOO | F | 00467.70 |
1 | E1297 | SPECIAL WHEELCHAIR SEAT DEPTH BY UPHOLST | F | 00099.50 |
1 | E1298 | SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WID | F | 00470.24 |
1 | E1310 | WHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE) | M | 00000.00 |
1 | E1352 | TUBING, UNSPECIFIED LENGTH | M | 00000.00 |
R | E1352 | Oxygen accessory, flow regulator capable | M | 00000.00 | RR
1 | E1353 | REGULATOR WITH OR WITHOUT HUMIDIFIER - | F | 00031.44 |
1 | E1355 | OXYGEN ACCESSORY:RACK OR STAND (LG OR SM | F | 00023.68 |
R | E1390 | OXYGEN CONCENTRATOR | F | 00005.95 | RR
R | E1399 | DURABLE MEDICAL EQUIPMENT, NOT OTHERWISE | M | 00000.00 | RR
1 | E1399 | DURABLE MEDICAL EQUIPMENT, NOT OTHERWISE | M | 00000.00 |
1 | E1500 | CENTRIFUGE, FOR DIALYSIS | M | 00000.00 |
1 | E1510 | KIDNEY DIALYSATE DELIVERY SYST. KIDNEY M | M | 00000.00 |
R | E1510 | KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY | M | 00000.00 | RR
R | E1520 | HEPARIN INFUSION PUMP FOR DIALYSIS | F | 00037.94 | RR
R | E1530 | AIR BUBBLE DETECTOR FOR DIALYSIS | M | 00000.00 | RR
R | E1540 | PRESSURE ALARM FOR DIALYSIS | M | 00000.00 | RR
R | E1550 | BATH CONDUCTIVITY METER FOR DIALYSIS | M | 00000.00 | RR
R | E1560 | BLOOD LEAK DETECTOR FOR DIALYSIS | M | 00000.00 | RR
R | E1590 | HEMODIALYSIS MACHINE UNIT OR CYCLER | M | 00000.00 | RR
1 | E1590 | HEMODIALYSIS MACHINE UNIT OR CYCLER | M | 00000.00 |
1 | E1592 | AUTOMATIC INTERMITTENT PERITIONEAL DIALY | F | 09337.11 |
R | E1592 | AUTOMATIC INTERMITTENT PERITIONEAL DIALY | F | 00887.03 | RR
R | E1594 | CYCLER DIALYSIS MACHINE/MO. | F | 00308.43 | RR
R | E1610 | REVERSE OSMOSIS WATER PURIFICATION SYSTE | M | 00000.00 | RR
R | E1615 | DEIONIZER WATER PURIFICATION SYSTEM | M | 00000.00 | RR
R | E1625 | WATER SOFTENING SYSTEM | M | 00000.00 | RR
1 | E1625 | WATER SOFTENING SYSTEM | M | 00000.00 |
1 | E1630 | RECIPROCATING, PERITONEAL DIALYSIS SYSTE | M | 00000.00 |
R | E1630 | RECIPROCATINS PERITONEAL DIALYSIS SYSTEM | M | 00000.00 | RR
1 | E1634 | PERITONEAL DIALYSIS CLAMPS | M | 00000.00 |
1 | E1637 | HEMOSTATS FOR DIALYSIS, EACH | M | 00000.00 |
1 | E1639 | SCALE FOR DIALYSIS EACH | M | 00000.00 |
1 | E1699 | DIALYSIS EQUIPMENT, UNSPECIFIED, BY REPO | M | 00000.00 |
R | E1699 | DIALYSIS EQUIPMENT, UNSPECIFIED, BY REPO | M | 00000.00 | RR
1 | E1700 | JAW MOTION REHABILITATION SYSTEM | F | 00327.81 |
1 | E1701 | REPLAC.CUSIONS FOR JAW MOTION SYSTEM | F | 00010.28 |
1 | E1702 | MEASURING SCALES FOR JAW MOTION SYSTEM | F | 00021.87 |
R | E1800 | DYNAMIC ADJ. ELBOW EXT/FLEX DEVICE | F | 00117.54 | RR
R | E1801 | STATIC PROG STRETCH ELBOW EXT/FLEX DEVIC | F | 00123.77 | RR
R | E1802 | DYNAMIC ADJ.FOREARM PRONATION/SUPINATION | F | 00313.56 | RR
R | E1805 | DYNAMIC ADJUSTABLE WRIST EXTENSION/FLEX | F | 00121.22 | RR
R | E1806 | STATIC PROG STRETCH WRIST EXT/FLEX DEVIC | F | 00101.61 | RR
R | E1810 | DYNAMIC ADJUSTABLE KNEE EXT/FLEX DEVICE | F | 00119.53 | RR
R | E1811 | STATIC PROG STRETCH KNEE EXT/FLEX DEVICE | F | 00128.68 | RR
R | E1812 | KNEE EXT/FLEX W ACT RES CTRL | F | 00086.63 | RR
R | E1815 | DYNAMIC ADJUSTABLE ANKLE EXT/FLEX DEVICE | F | 00127.29 | RR
R | E1816 | BI-DIRECTIONAL STATIC STRETCH ANKLE | F | 00137.25 | RR
R | E1818 | STATIC PROG STRETCH FOREARM DEVICE | F | 00133.46 | RR
1 | E1820 | SOFT INTERFACE MAT. FOR EXT/FLEX DEVICE | F | 00073.98 |
1 | E1821 | REPLACEMENT SOFT INTERFACE MATERIAL/CUFF | F | 00100.98 |
R | E1825 | DYNAMIC ADJ.FINGER EXT/FLEX DEVICE | F | 00121.22 | RR
R | E1830 | DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION | F | 00108.62 | RR
1 | E1831 | STATIC PROGRESSIVE STRETCH TOE DEVICE | M | 00000.00 |
R | E1840 | DYNAMIC ADJ. SHOULDER FLEXION DEVICE | F | 00370.88 | RR
R | E1841 | STRETCH SHOULDER DEVICE W/ROM, W/CUFFS | F | 00470.59 | RR
1 | E1902 | COMMUNICATION BOARD,NON-ELECTRIC | M | 00000.00 |
R | E2000 | GASTRIC SUCTION PUMP HOME MODEL | F | 00053.03 | RR
1 | E2100 | BLOOD GLUCOSE MONITOR W/VOICE SYNTHESIZE | F | 00593.50 |
1 | E2101 | BLOOD GLUCOSE MONITOR W/BLOOD SAMPLE | M | 00000.00 |
1 | E2201 | MANUAL WC NON-STAND SEAT WIDTH 20-24 INC | F | 00383.58 |
1 | E2202 | MANUAL WC NON-STAND WIDTH 24-27INCHES | F | 00487.21 |
1 | E2203 | MANUAL WC NON-STAND SEAT DEPTH 20-22 INC | F | 00492.51 |
1 | E2204 | MANUAL WC,NON-STAND SEAT DEPTH 22-25 INC | F | 00836.25 |
1 | E2205 | HANDRIM W/OUT PROJECTIONS REPLACEMENT | F | 00032.00 |
1 | E2206 | WHEEL LOCK ASSEMBLY,COMPLETE EACH | F | 00044.41 |
1 | E2207 | CRUTCH AND CANE HOLDER | F | 00040.55 |
1 | E2208 | CYLINDER TANK CARRIER | F | 00111.11 |
1 | E2209 | ARM TROUGH EACH | F | 00100.82 |
1 | E2210 | WHEELCHAIR BEARINGS | F | 00006.23 |
1 | E2211 | PNEUMATIC PROPULSION TIRE | F | 00038.60 |
1 | E2212 | PNEUMATIC PROP TIRE TUBE | F | 00006.41 |
1 | E2213 | PNEUMATIC PROP TIRE INSERT | M | 00000.00 |
1 | E2214 | PNEUMATIC CASTER TIRE EACH | F | 00039.96 |
1 | E2215 | PNEUMATIC CASTER TIRE TUBE | F | 00010.48 |
1 | E2216 | FOAM FILLED PROPULSION TIRE | F | 00028.42 |
1 | E2217 | FOAM FILLED CASTER TIRE EACH | F | 00026.19 |
1 | E2218 | FOAM PROPULSION TIRE EACH | F | 00028.42 |
1 | E2219 | FOAM CASTER TIRE ANY SIZE EA | F | 00026.19 |
1 | E2220 | SOLID PROPULSION TIRE EACH | F | 00028.42 |
1 | E2221 | SOLID CASTER TIRE EACH | F | 00026.19 |
1 | E2222 | SOLID CASTER INTEGRATED WHL | F | 00023.38 |
1 | E2224 | PROPULSION WHL EXCLUDES TIRE | F | 00096.27 |
1 | E2225 | CASTER WHEEL EXCLUDES TIRE | F | 00019.32 |
1 | E2226 | CASTER FORK REPLACEMENT ONLY | F | 00042.12 |
1 | E2230 | MANUAL STANDING SYSTEM FOR MANUAL W/C | M | 00000.00 |
1 | E2231 | MANUAL W/C SOLID SEAT SUPPORT BASE | F | 00154.82 |
1 | E2291 | BACK,PLANER,FOR PED WC,INCLUDE HARDWARE | M | 00000.00 |
1 | E2292 | SEAT,PLANAR,FOR PED WC, INCLUDING HARDWA | M | 00000.00 |
1 | E2293 | BACK,CONTOURED,FOR PED WC INCL.HARDWARE | M | 00000.00 |
1 | E2294 | SEAT,CONTOURED PED WC INCLUD HARDWARE | M | 00000.00 |
1 | E2295 | PED MANUAL W/C DYNAMIC SEATINGFRAME | M | 00000.00 |
1 | E2300 | POWER WC,POWER SEAT ELEVATION | M | 00000.00 |
1 | E2310 | POWER WC ELECT.CONN.SEAT MOTOR | F | 01203.14 |
1 | E2311 | POWER WC,ELECT.CONN.TO 2+ SEAT MOTORS | F | 02435.80 |
1 | E2312 | POWER WC HAND OR CHIN CONTROL INTERFACE, | F | 02095.10 |
1 | E2313 | PWC ACCES,HARNESS FOR EXPAND CONTROL,EA | F | 00322.65 |
1 | E2321 | POWER WC HAND CONT. REMOTE JOYSTICK | F | 01575.99 |
1 | E2322 | POWER WC, HAND CONTROL INTERFACE | F | 01450.00 |
1 | E2323 | POWER WC SPECIALTY JOYSTICK,PREFAB | F | 00066.17 |
1 | E2324 | POWER WC,CHIN CUP FOR CHIN INTERFACE | F | 00041.92 |
1 | E2325 | POWER WC,SIP AND PUFF INTERFACE | F | 01384.68 |
1 | E2326 | POWER WC, BREATH TUBE FOR SIP AND PUFF | F | 00328.59 |
1 | E2327 | POWER WC HEAD CONT.INTERFACE MECHANICAL | F | 02370.97 |
1 | E2328 | POWER WC HEAD/EXTREM. CONTROL INTERFACE | F | 03986.31 |
1 | E2329 | POWER WC,HEAD INTERFACE,HEAD ARRAY | F | 01778.96 |
1 | E2330 | POWER WC HEAD CONTROL INTERFACE,HEAD ARR | F | 03426.98 |
1 | E2331 | POWER WC ATTEND CONTROL | M | 00000.00 |
1 | E2340 | POWER WC,NONSTAND SEAT WIDTH 20-23 INCHE | F | 00323.05 |
1 | E2341 | POWER WC.NON-STAND SEAT WIDTH 24-27INCHE | F | 00475.99 |
1 | E2342 | POWER WC NON-STAND.SEAT DEPTH 20-21INCHE | F | 00460.62 |
1 | E2343 | POWER WC,NON-STAND SEAT DEPTH 22-25INCHE | F | 00266.55 |
1 | E2358 | POWER W/C ACCESSORY, GRP 34 NON-SEALED | M | 00000.00 |
1 | E2359 | POWER W/C ACCESSORY, GROUP 34 SEALED | F | 00179.46 |
1 | E2360 | POWER WC, 22NF NON-SEAL LEAD BATTERY | F | 00093.39 |
1 | E2361 | POWER WC.22NF SEALED LEAD BATTERY | F | 00131.22 |
1 | E2362 | POWER WC GROUP 24 NON-SEAL LEAD BATTERY | F | 00100.39 |
1 | E2363 | POWER WC GROUP 24 SEALED LEAD ACID BATTE | F | 00174.97 |
1 | E2364 | POWER WC U-1 NONSEALED BATTERY | F | 00115.57 |
1 | E2365 | POWER WC U-1 BATTERY | F | 00132.32 |
1 | E2366 | POWER WC BATTERY CHARGER SINGLE MODE | F | 00316.22 |
1 | E2367 | POWER WC BATTERY CHARGER DUAL MODE | F | 00418.31 |
1 | E2368 | POWER WC COMPONENT,MOTOR,REPLAC ONLY | F | 00515.16 |
1 | E2369 | POWER WC COMPONENT,GEAR BOX,REPLAC ONLY | F | 00448.71 |
1 | E2370 | POWER WC COMPONENT,MOTOR AND GEAR BOX | F | 00800.63 |
1 | E2371 | GR27 SEALED LEADACID BATTERY | F | 00219.39 |
1 | E2372 | GR27 NON-SEALED LEADACID | F | 00111.75 |
1 | E2373 | HAND/CHIN CTRL SPEC JOYSTICK | M | 00000.00 |
1 | E2374 | HAND/CHIN CTRL STD JOYSTICK | M | 00000.00 |
1 | E2375 | NON-EXPANDABLE CONTROLLER | M | 00000.00 |
1 | E2376 | EXPANDABLE CONTROLLER, REPL | M | 00000.00 |
1 | E2377 | EXPANDABLE CONTROLLER, INITIAL | M | 00000.00 |
1 | E2378 | Power wheelchair component, actuator, re | M | 00000.00 |
1 | E2381 | PNEUM DRIVE WHEEL TIRE | M | 00000.00 |
1 | E2382 | TUBE, PNEUM WHEEL DRIVE TIRE | M | 00000.00 |
1 | E2383 | INSERT, PNEUM WHEEL DRIVE | M | 00000.00 |
1 | E2384 | PNEUMATIC CASTER TIRE | M | 00000.00 |
1 | E2385 | TUBE, PNEUMATIC CASTER TIRE | M | 00000.00 |
1 | E2386 | FOAM FILLED DRIVE WHEEL TIRE | M | 00000.00 |
1 | E2387 | FOAM FILLED CASTER TIRE | M | 00000.00 |
1 | E2388 | FOAM DRIVE WHEEL TIRE | M | 00000.00 |
1 | E2389 | FOAM CASTER TIRE | M | 00000.00 |
1 | E2390 | SOLID DRIVE WHEEL TIRE | M | 00000.00 |
1 | E2391 | SOLID CASTER TIRE | M | 00000.00 |
1 | E2392 | SOLID CASTER TIRE, INTEGRATE | M | 00000.00 |
1 | E2394 | DRIVE WHEEL EXCLUDES TIRE | M | 00000.00 |
1 | E2395 | CASTER WHEEL EXCLUDES TIRE | M | 00000.00 |
1 | E2396 | CASTER FORK | M | 00000.00 |
R | E2402 | NEGATIVE WOUND THERAPY PUMP | F | 00053.30 | RR
R | E2500 | SPEECH DEV.PRE-RECORDED MESS.<8 MINUTES | F | 00037.86 | RR
1 | E2500 | SPEECH DEV.PRE-RECORDED MESS.<8 MINUTES | F | 00378.62 |
1 | E2502 | SPEECH DEV.PRE-RECORDED MESS. >8 BUT <20 | F | 01193.60 |
R | E2502 | SPEECH DEV.PRE-RECORDED MESS. >8 BUT <20 | F | 00119.36 | RR
R | E2504 | SPEECH DEVICE PRE-RECORD.20-40 MINUTES | F | 00157.32 | RR
1 | E2504 | SPEECH DEV.PRE-RECORDED MESSAGES >20<40 | F | 01573.10 |
1 | E2506 | SPEECH DEVICE PRE-RECORDED MESSAGES>40MI | F | 02306.64 |
R | E2506 | SPEECH DEVICE PRE-RECORDED MESS,>40 MIN | F | 00230.76 | RR
R | E2508 | SPEECH DEVICE, MESSAGE FORM. BY SPELLING | F | 00356.69 | RR
1 | E2508 | SPEECH DEVICE MESSAGE FORM BY SPELLING | F | 03566.84 |
1 | E2510 | SPEECH DEVICE MULT. METHODS SPEECH FORM | F | 06749.76 |
R | E2510 | SPEECH DEVICE,MULT.MESSAGE FORMULATION | F | 00674.99 | RR
R | E2511 | SPEECH GENERATING SOFTWARE PROGRAM | M | 00000.00 | RR
1 | E2511 | SPEECH GENERATING SOFTWARE PROGRAM | M | 00000.00 |
1 | E2512 | ASSESS.SPEECH GEN.DEVICE MOUNTING | M | 00000.00 |
R | E2512 | ASSESS.SPEECH GEN.DEVICE MOUNTING | M | 00000.00 | RR
R | E2599 | ASSESS.FOR SPEECH GENER.DEVICE | M | 00000.00 | RR
1 | E2599 | ASSESS.FOR SPEECH GEN.DEVICE | M | 00000.00 |
1 | E2601 | GENERAL USE WC CUSHION,<22INCHES ANY DEP | F | 00058.50 |
1 | E2602 | GENERAL USE CUSHION >22INCHES ANY DEPTH | F | 00114.22 |
1 | E2603 | SKIN PROTECT.CUSHION <22INCHES,ANY DEPTH | F | 00145.01 |
1 | E2604 | SKIN PROTECTION CUSHION >22INCHES ANY DE | F | 00180.25 |
1 | E2605 | POSIT.CUSHION <22 INCHES ANY DEPTH | F | 00257.51 |
1 | E2606 | POSIT.CUSHION >22INCHES ANY DEPTH | F | 00401.74 |
1 | E2607 | SKIN PROT.AND POSIT.SEAT CUSH.<22ANY DEP | F | 00277.29 |
1 | E2608 | SKIN PROTECT AND POSIT CUSHION >22 ANY | F | 00333.00 |
1 | E2609 | CUSTOM FAB.WC SEAT ANY SIZE | F | 00796.78 |
1 | E2611 | GENERAL USE BACK CUSHION,<22INCH ANY HEI | F | 00298.82 |
1 | E2612 | GENERAL WC/BACK CUSHION >22" ANY HEIGHT | F | 00404.23 |
1 | E2613 | POSTIONING WC BACK CUSHION<22"ANY HEIGHT | F | 00376.01 |
1 | E2614 | POSITIONING WC BACK CUSH.POST,>22" | F | 00520.37 |
1 | E2615 | POSIT WC/BACK CUSH,POST-LAT <22" | F | 00432.71 |
1 | E2616 | POSIT WC/BACK CUSH,POST-LAT >22" | F | 00582.21 |
1 | E2617 | CUSTOM FAB,W/C BACK CUSH,ANY SIZE | F | 00789.58 |
1 | E2619 | REPLAC COVER FOR WC SEAT CUSHION | F | 00049.09 |
1 | E2620 | POSIT.SEAT BACK CUSHION,PLANER W/LATER | F | 00523.96 |
1 | E2621 | POSIT.BACK CUSHION,PLANAR W/LAT >22" | F | 00546.21 |
1 | E2622 | SKIN PROTECTION W/C SEAT CUSHION | F | 00287.54 |
1 | E2623 | SKIN PROTECTION W/C SEAT CUSHION | F | 00365.88 |
1 | E2624 | SKIN PROTECT & POSITION W/C SEAT CUSH | F | 00289.90 |
1 | E2625 | SKIN PROTECT & POSITION W/C SEAT CUSH | F | 00367.00 |
1 | E2626 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW | F | 00640.13 |
1 | E2627 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW | F | 01021.46 |
1 | E2628 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW | F | 00769.50 |
1 | E2629 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW | F | 00950.82 |
1 | E2630 | WHEELCHAIR ACCESSORY, SHOULDER ELBOW | F | 00680.97 |
1 | E2631 | W/C ACCESSORY, MOBILE ARM SUPPORT | F | 00272.40 |
1 | E2632 | W/C ACCESSORY, MOBILE ARM SUPPORT | F | 00160.71 |
1 | E2633 | W/C ACCESSORY, MOBILE ARM SUPPORT | F | 00146.91 |
1 | E8000 | GAIT TRAINER, PED,POS SUPPORT,ALL ACCESS | M | 00000.00 |
R | E8000 | GAIT TRAINER, PED SIZE, POST.SUPPORT,INC | M | 00000.00 | RR
R | E8001 | GAIT TRAINER,PED,UPRIGHT SUPPORT | M | 00000.00 | RR
1 | E8001 | GAIT TRAINER,PED,UPRIGHT SUPPORT | M | 00000.00 |
1 | E8002 | GAIT TRAINER,PED,ANTERIOR SUPPORT | M | 00000.00 |
R | E8002 | GAIT TRAINER,PED,ANTERIOR SUPPORT | M | 00000.00 | RR
1 | G0248 | HOME INR MONITOR DEMO | F | 00124.11 |
1 | G0249 | TEST MATERIALS FOR HOME INR MONITOR | F | 00102.54 |
1 | J7131 | HYPERTONIC SALINE SOLUTION, 1 ML | M | 00000.00 |
1 | J7620 | ALBUTEROL NON-COMPOUNDED | F | 00000.80 |
1 | J9098 | CYTARABINE LIPOSOME INJECT 10MG | F | 00361.79 |
1 | K0001 | STANDARD WHEELCHAIR | F | 00519.57 |
R | K0001 | STANDARD WHEELCHAIR | F | 00051.96 | RR
R | K0002 | STANDARD HEMI (LOW SEAT) WHEELCHAIR | F | 00073.95 | RR
1 | K0002 | STANDARD HEMI WHEELCHAIR | F | 00778.36 |
1 | K0003 | LIGHTWEIGHT WHEELCHAIR | F | 00852.12 |
R | K0003 | LIGHTWEIGHT WHEELCHAIR | F | 00080.95 | RR
R | K0004 | HIGH STRENGTH, LIGHT-WEIGHT WHEELCHAIR | F | 00120.77 | RR
1 | K0004 | LIGHTWEIGHT WHEELCHAIR -HIGH STRENGTH | F | 01271.22 |
1 | K0005 | ULTRALIGHTWEIGHT WHEELCHAIR | F | 01831.42 |
R | K0005 | ULTRALIGHTWEIGHT WHEELCHAIR | F | 00183.14 | RR
R | K0006 | HEAVY-DUTY WHEELCHAIR | F | 00112.30 | RR
1 | K0006 | HEAVY-DUTY WHEELCHAIR | F | 01182.03 |
1 | K0007 | EXTRA HEAVY-DUTY WHEELCHAIR | F | 01697.95 |
R | K0007 | EXTRA HEAVY-DUTY WHEELCHAIR | F | 00161.30 | RR
1 | K0008 | CUSTOM MANUAL WHEELCHAIR/BASE | M | 00000.00 |
1 | K0009 | OTHER MANUAL WHEELCHAIR/BASE | M | 00000.00 |
R | K0009 | OTHER MANUAL WHEELCHAIR/BASE | M | 00000.00 | RR
1 | K0013 | CUSTOM MOTORIZED/POWER WHEELCHAIR BASE | M | 00000.00 |
1 | K0015 | DETACHABLE, NONADJUSTABLE HEIGHT ARMREST | F | 00170.94 |
1 | K0017 | DETACHABLE, ADJUSTABLE HEIGHT ARMREST, B | F | 00048.07 |
1 | K0018 | DETACHABLE, ADJUSTABLE HEIGHT ARMREST, U | F | 00026.87 |
1 | K0019 | ARM PAD, EACH | F | 00016.48 |
1 | K0020 | FIXED, ADJUSTABLE HEIGHT ARMREST, PAIR | F | 00043.70 |
1 | K0037 | HIGH MOUNT FLIP-UP FOOTREST, EACH | F | 00045.51 |
1 | K0038 | LEG STRAP, EACH | F | 00022.82 |
1 | K0039 | LEG STRAP, H STYLE, EACH | F | 00050.69 |
1 | K0040 | ADJUSTABLE ANGLE FOOTPLATE, EACH | F | 00070.23 |
1 | K0041 | LARGE SIZE FOOTPLATE, EACH | F | 00049.81 |
1 | K0042 | STANDARD SIZE FOOTPLATE, EACH | F | 00029.63 |
1 | K0043 | FOOTREST, LOWER EXTENSION TUBE, EACH | F | 00018.37 |
1 | K0044 | FOOTREST, UPPER HANGER BRACKET | F | 00015.66 |
1 | K0045 | FOOTREST, COMPLETE ASSEMBLY | F | 00046.04 |
1 | K0046 | ELEVATING LEGREST, LOWER EXTENSION TUBE, | F | 00018.37 |
1 | K0047 | ELEVATING LEGREST, UPPER HANGER BRACKET, | F | 00071.92 |
1 | K0050 | RATCHET ASSEMBLY | F | 00030.57 |
1 | K0051 | CAM RELEASE ASSEMBLY, FOORTREST OR LEGRE | F | 00047.70 |
1 | K0052 | SWINGAWAY, DETACHABLE FOOTRESTS, EACH | F | 00086.96 |
1 | K0053 | ELEVATING FOOTREST, ARTICULATING, EACH | F | 00095.97 |
1 | K0056 | SEAT HEIGHT LESS THAN 17 INCHES OR LESS | F | 00103.78 |
1 | K0065 | SPOKE PROTECTORS | F | 00040.33 |
1 | K0069 | REAR WHEEL ASSEMBLY, COMPLETE, W/SOLID T | F | 00109.02 |
1 | K0070 | REAR WHEEL ASSEMBLY, COMPL W/PNEUMATIC T | F | 00199.91 |
1 | K0071 | FRONT CASTER ASSEMBLY, COMPLETE, WITH PN | F | 00119.21 |
1 | K0072 | FRONT CASTER ASSEMBLY, COMPLETE, W/SEMIP | F | 00043.21 |
1 | K0073 | CASTER PIN LOCK, EACH | F | 00036.53 |
1 | K0077 | FRONT CASTER ASSEMBLY, COMPLETE, WITH SO | F | 00057.34 |
1 | K0105 | IV HANGER, EACH | F | 00092.98 |
1 | K0108 | OTHER ACCESSORIES/WHEELCHAIR | M | 00000.00 |
1 | K0195 | ELEVATING LEG RESTS,PAIR | F | 00020.05 |
R | K0455 | INFUSION PUMP FOR EPOPROSTENOL | F | 00251.94 | RR
1 | K0462 | TEMPORARY REPLACEMENT FOR PT. OWNED | M | 00000.00 |
1 | K0552 | SUPPLIES FOR EXTERNAL INFUSION PUMP, | F | 00002.58 |
R | K0606 | WEARABLE CARDIAC DEFIBRILLATOR | F | 02416.28 | RR
1 | K0607 | REPLA.BATTERY FOR EXT.DIFIBRILLATOR | F | 00241.45 |
1 | K0608 | REPLAC. GARMENT FOR EXT. DIFIBRILLATOR | F | 00129.12 |
1 | K0609 | REPLAC. ELECT.FOR DEFIBRILLATOR | F | 00096.83 |
1 | K0672 | ADD TO LOWER EXTREM ORTHOSIS,REPLC,EA | F | 00073.30 |
1 | K0730 | CTRL DOSE INH DRUG DELIV SYS | M | 00000.00 |
1 | K0733 | POWER WC, 12 TO 24 AMP LEAD ACID BATT | F | 00028.90 |
R | K0738 | PORT. GASEOUS O2 SYSTEM, HOME COMPRESSOR | F | 00047.05 | RR
1 | K0739 | REPAIR OR MAINT. FOR DME PER 15 MIN | F | 00009.79 |
1 | K0800 | POV, GRP1, UP TO 300LBS | F | 01236.80 |
R | K0800 | POV, GRP1, UP TO 300LBS | F | 00123.68 | RR
R | K0801 | POV, GRP1 HEAVY DUTY, 301-450LBS | F | 00199.36 | RR
1 | K0801 | POV, GRP1 HEAVY DUTY, 301-450LBS | F | 01993.60 |
1 | K0802 | POV, GRP1 VERY HEAVY DUTY, 451-600 | F | 02256.40 |
R | K0802 | POV, GRP1 VERY HEAVY DUTY, 451-600 | F | 00225.64 | RR
R | K0806 | POV, GRP2, UP TO 300LBS | F | 00149.61 | RR
1 | K0806 | POV, GRP2, UP TO 300LBS | F | 01496.10 |
1 | K0807 | POV, GRP2 HEAVY DUTY, 301-450LBS | F | 02270.20 |
R | K0807 | POV, GRP2 HEAVY DUTY, 301-450LBS | F | 00227.02 | RR
R | K0808 | POV, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 00351.25 | RR
1 | K0808 | POV, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 03512.50 |
1 | K0812 | POV, NOT OTHERWISE CLASSIFIED | M | 00000.00 |
R | K0812 | POV, NOT OTHERWISE CLASSIFIED | M | 00000.00 | RR
R | K0813 | PWC, GRP1, PORTABLE, UP TO 300LBS | F | 00233.78 | RR
1 | K0813 | PWC, GRP1, PORTABLE, UP TO 300LBS | F | 02337.83 |
1 | K0814 | PWC, GRP1, PORTABLE, UP TO 300LBS | F | 02992.37 |
R | K0814 | PWC, GRP1, PORTABLE, UP TO 300LBS | F | 00299.24 | RR
R | K0815 | PWC, GRP1, UP TO 300LBS | F | 00340.76 | RR
1 | K0815 | PWC, GRP1, UP TO 300LBS | F | 03407.62 |
1 | K0816 | PWC, GRP1, UP TO 300LBS | F | 03263.33 |
R | K0816 | PWC, GRP1, UP TO 300LBS | F | 00326.33 | RR
R | K0820 | PWC, GRP2, PORTABLE, UP TO 300LBS | F | 00249.70 | RR
1 | K0820 | PWC, GRP2, PORTABLE, UP TO 300LBS | F | 02496.97 |
1 | K0821 | PWC, GRP2, PORTABLE, UP TO 300LBS | F | 03205.47 |
R | K0821 | PWC, GRP2, PORTABLE, UP TO 300LBS | F | 00320.55 | RR
R | K0822 | PWC, GRP2, UP TO 300LBS | F | 00388.42 | RR
1 | K0822 | PWC, GRP2, UP TO 300LBS | F | 03884.22 |
1 | K0823 | PWC, GRP2, UP TO 300LBS | F | 03899.34 |
R | K0823 | PWC, GRP2, UP TO 300LBS | F | 00389.93 | RR
R | K0824 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 00469.29 | RR
1 | K0824 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 04693.03 |
1 | K0825 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 04098.89 |
R | K0825 | PWC, GRP2 HEAVY DUTY, 451-600LBS | F | 00409.88 | RR
R | K0826 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 00607.55 | RR
1 | K0826 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 06075.54 |
1 | K0827 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 04660.66 |
R | K0827 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 00466.06 | RR
R | K0828 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 00669.46 | RR
1 | K0828 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 06694.70 |
1 | K0829 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 05826.00 |
R | K0829 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 00582.59 | RR
R | K0830 | PWC, GRP2, SEAT ELEV, UP TO 300LBS | F | 00379.30 | RR
1 | K0830 | PWC, GRP2, SEAT ELEV, UP TO 300LBS | F | 03793.13 |
1 | K0831 | PWC, GRP2, SEAT ELEV, UP TO 300LBS | F | 03793.13 |
R | K0831 | PWC, GRP2, SEAT ELEV, UP TO 300LBS | F | 00379.30 | RR
R | K0835 | PWC, GRP2, UP TO 300LBS | F | 00400.45 | RR
1 | K0835 | PWC, GRP2, UP TO 300LBS | F | 04004.58 |
1 | K0836 | PWC, GRP2, UP TO 300LBS | F | 04077.47 |
R | K0836 | PWC, GRP2, UP TO 300LBS | F | 00407.74 | RR
R | K0837 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 00469.29 | RR
1 | K0837 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 04693.03 |
1 | K0838 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 04237.07 |
R | K0838 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 00423.70 | RR
R | K0839 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 00607.55 | RR
1 | K0839 | PWC, GRP2 VERY HEAVY DUTY, 451-600LBS | F | 06075.54 |
1 | K0840 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 09204.75 |
R | K0840 | PWC, GRP2 X-HEAVY DUTY, 601LBS &UP | F | 00920.47 | RR
R | K0841 | PWC, GRP2, UP TO 300LBS | F | 00418.51 | RR
1 | K0841 | PWC, GRP2, UP TO 300LBS | F | 04185.13 |
1 | K0842 | PWC, GRP2, UP TO 300LBS | F | 04185.13 |
R | K0842 | PWC, GRP2, UP TO 300LBS | F | 00418.51 | RR
R | K0843 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 00503.88 | RR
1 | K0843 | PWC, GRP2 HEAVY DUTY, 301-450LBS | F | 05038.91 |
1 | K0848 | PWC, GRP3, UP TO 300LBS | F | 05265.67 |
R | K0848 | PWC, GRP3, UP TO 300LBS | F | 00526.56 | RR
R | K0849 | PWC, GRP3, UP TO 300LBS | F | 00492.36 | RR
1 | K0849 | PWC, GRP3, UP TO 300LBS | F | 04923.67 |
1 | K0850 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 05950.15 |
R | K0850 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 00595.01 | RR
R | K0851 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 00556.39 | RR
1 | K0851 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 05563.95 |
1 | K0852 | PWC, GRP 3 VERY HEAVY DUTY, 451-600LBS | F | 06863.71 |
R | K0852 | PWC, GRP 3 VERY HEAVY DUTY, 451-600LBS | F | 00686.36 | RR
R | K0853 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 00705.08 | RR
1 | K0853 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 07050.74 |
1 | K0854 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 09340.72 |
R | K0854 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 00934.07 | RR
R | K0855 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 00882.37 | RR
1 | K0855 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 08823.70 |
1 | K0856 | PWC, GRP3, UP TO 300LBS | F | 05496.99 |
R | K0856 | PWC, GRP3, UP TO 300LBS | F | 00549.70 | RR
R | K0857 | PWC, GRP3, UP TO 300LBS | F | 00560.72 | RR
1 | K0857 | PWC, GRP3, UP TO 300LBS | F | 05607.18 |
1 | K0858 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 06820.10 |
R | K0858 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 00682.01 | RR
R | K0859 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 00633.60 | RR
1 | K0859 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 06336.04 |
1 | K0860 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 09743.37 |
R | K0860 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 00974.33 | RR
R | K0861 | PWC, GRP3, UP TO 300LBS | F | 00550.58 | RR
1 | K0861 | PWC, GRP3, UP TO 300LBS | F | 05505.81 |
1 | K0862 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 06820.10 |
R | K0862 | PWC, GRP3 HEAVY DUTY, 301-450LBS | F | 00682.01 | RR
R | K0863 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 00974.33 | RR
1 | K0863 | PWC, GRP3 VERY HEAVY DUTY, 451-600LBS | F | 09743.37 |
1 | K0864 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 12179.10 |
R | K0864 | PWC, GRP3 X-HEAVY DUTY, 601LBS &UP | F | 01217.90 | RR
R | K0868 | PWC, GRP4, UP TO 300LBS | F | 00441.65 | RR
1 | K0868 | PWC, GRP4, UP TO 300LBS | F | 04416.45 |
1 | K0869 | PWC, GRP4, UP TO 300LBS | F | 04416.45 |
R | K0869 | PWC, GRP4, UP TO 300LBS | F | 00441.65 | RR
R | K0870 | PWC, GRP4 HEAVY DUTY, 301-450LBS | M | 00000.00 | RR
1 | K0870 | PWC, GRP4 HEAVY DUTY, 301-450LBS | M | 00000.00 |
1 | K0871 | PWC, GRP4 VERY HEAVY DUTY, 451-600LBS | M | 00000.00 |
R | K0871 | PWC, GRP4 VERY HEAVY DUTY, 451-600LBS | M | 00000.00 | RR
R | K0877 | PWC, GRP4, UP TO 300LBS | M | 00000.00 | RR
1 | K0877 | PWC, GRP4, UP TO 300LBS | M | 00000.00 |
1 | K0878 | PWC, GRP4, UP TO 300LBS | M | 00000.00 |
R | K0878 | PWC, GRP4, UP TO 300LBS | M | 00000.00 | RR
R | K0879 | PWC, GRP4 HEAVY DUTY, 301-450LBS | M | 00000.00 | RR
1 | K0879 | PWC, GRP4 HEAVY DUTY, 301-450LBS | M | 00000.00 |
1 | K0880 | PWC, GRP4 VERY HEAVY DUTY, 451-600LBS | M | 00000.00 |
R | K0880 | PWC, GRP4 VERY HEAVY DUTY, 451-600LBS | M | 00000.00 | RR
R | K0884 | PWC, GRP4, UP TO 300LBS | F | 00592.19 | RR
1 | K0884 | PWC, GRP4, UP TO 300LBS | F | 05921.94 |
1 | K0885 | PWC, GRP4, UP TO 300LBS | F | 05852.36 |
R | K0885 | PWC, GRP4, UP TO 300LBS | F | 00585.23 | RR
R | K0886 | PWC, GRP4 HEAVY DUTY, 301-450LBS | F | 00540.51 | RR
1 | K0886 | PWC, GRP4 HEAVY DUTY, 301-450LBS | F | 05405.13 |
1 | K0890 | PWC, GRP5 PEDIATRIC, UP TO 125LBS | M | 00000.00 |
R | K0890 | PWC, GRP5 PEDIATRIC, UP TO 125LBS | M | 00000.00 | RR
R | K0891 | PWC, GRP5 PEDIATRIC, UP TO 125LBS | M | 00000.00 | RR
1 | K0891 | PWC, GRP5 PEDIATRIC, UP TO 125LBS | M | 00000.00 |
1 | K0898 | POWER WHEELCHAIR, NOC | M | 00000.00 |
R | K0898 | POWER WHEELCHAIR, NOC | M | 00000.00 | RR
1 | K0900 | CUSTOM DME, OTHER THAN WHEELCHAIR | M | 00000.00 |
1 | K0901 | KNEE ORTHOSIS; SINGLE UPRIGHT; THIGH AND | M | 00000.00 |
1 | K0902 | KNEE ORTHOSIS; DOUBLE UPRIGHT; THIGH AND | M | 00000.00 |
1 | L0112 | CRANIAL CERVICAL ORTHOSIS,CUSTOM | F | 01152.36 |
1 | L0113 | CRANIAL CX ORTHOS,W/WO JT/INTRF PREFAB | M | 00000.00 |
1 | L0120 | CERVICAL FLEXIBLE, NON-ADJUSTABLE (FOAM | F | 00024.33 |
1 | L0130 | CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR | F | 00055.31 |
1 | L0140 | CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTI | F | 00023.51 |
1 | L0150 | CERVICAL, SEMI RIGID ADJUSTABLE MOLDED C | F | 00049.78 |
1 | L0160 | CERVICAL, SEMI-RIGID, WIRE FRAME OCCIPIT | F | 00095.16 |
1 | L0170 | CERVICAL, COLLAR, MOLDED TO PATIENT MODE | F | 00398.27 |
1 | L0172 | CERVICAL COLLAR, SEMI-RIGID THERMOPLASTI | F | 00090.72 |
1 | L0174 | CERVICAL COLLAR, SEMI RIGID, TWO PIECE | F | 00207.59 |
1 | L0180 | CERVICAL, MULTIPLE POST COLLAR OCCIPITAL | F | 00162.84 |
1 | L0190 | CERVICAL, MULTIPLE POST COLLAR, OCCIPITA | F | 00360.77 |
1 | L0200 | CERVICAL, MULTIPLE POST COLLAR, OCCIPITA | F | 00309.91 |
1 | L0220 | THORACIC, RIB BELT, CUSTOM FABRICATED | F | 00049.78 |
1 | L0450 | TLSO,FLEX.UPPER TRUNK/THORACIC PREFAB | F | 00151.42 |
1 | L0452 | TLSO,FLEX.TRUNK/UPPER THORACIC,CUSTOM | M | 00000.00 |
1 | L0454 | TLSO,FLEX.TRUNK/SAGGITAL CONTROL,PREFAB | F | 00285.66 |
1 | L0455 | TLSO,flexible,provide trunk support,exte | F | 00312.28 |
1 | L0456 | TLSO FLEX.TRUNK SUPP.THORACIC REGION | F | 00819.15 |
1 | L0457 | TLSO,flexible,provide trunk support,thor | F | 00895.49 |
1 | L0458 | TLSO,TRIPLANER CONTROL,MOD.SEG.SPINAL | F | 00734.53 |
1 | L0460 | TLSO TRIPLANER CONTROL,SCAPULAR TO STERN | F | 00826.76 |
1 | L0462 | TLSO,TRIPLAN,3PLASTIC SHELLS POST/ANT | F | 00322.37 |
1 | L0464 | TLSO,TRIPLAN.CONT.4 RIGID SHELLS | F | 01224.23 |
1 | L0466 | TLSO,SAGITTAL CONT.RIGID FRAME | F | 00302.05 |
1 | L0467 | TLSO,sagital control,rigid posterior fra | F | 00330.17 |
1 | L0468 | TLSO,SAGITAL/CORONAL CONT.RIGID FRAME | F | 00383.61 |
1 | L0469 | TLSO,sagital-coronal control,rigid poste | F | 00419.36 |
1 | L0470 | TLSO,TRIPLAN.CONT.RIGID POST. FRAME | F | 00529.06 |
1 | L0472 | TLSO,TRIPLANER CONT.HYPEREXTENSION FRAME | F | 00333.39 |
1 | L0480 | TLSO,TRIPLANAR CONT.1RIGID SHELL | F | 01427.25 |
1 | L0482 | TLSO,TRIPLAN.CONT.SHELL W/LINER | F | 01335.73 |
1 | L0484 | TLSO,TRIPL.CONT.2 PIECE SHELL,W/OUT LINE | F | 01367.68 |
1 | L0486 | TLSO,TRIPLAN.CONT.2 SHELLS W/LINER | F | 01434.55 |
1 | L0488 | TLSO,TRIPLAN.CONT.1 SHELL W/LINER | F | 00826.76 |
1 | L0490 | TLSO,SAG.CORON.CONT.1 PIECE SHELL | F | 00232.97 |
1 | L0491 | TLSO 2 PIECE RIGID SHELL | F | 00232.97 |
1 | L0492 | TLSO 3 PIECE RIGID SHELL | F | 00232.97 |
1 | L0621 | SIO FLEX PELVISACRAL PREFAB | F | 00090.47 |
1 | L0622 | SIO FLEX PELVISACRAL CUSTOM | F | 00231.95 |
1 | L0623 | SIO PANEL PREFAB | M | 00000.00 |
1 | L0624 | SIO PANEL CUSTOM | M | 00000.00 |
1 | L0625 | LO FLEXIBL L1-BELOW L5 PRE | F | 00044.03 |
1 | L0626 | LO SAG STAYS/PANELS PRE-FAB | F | 00062.71 |
1 | L0627 | LO SAGITT RIGID PANEL PREFAB | F | 00328.68 |
1 | L0628 | LO FLEX W/O RIGID STAYS PRE | F | 00067.08 |
1 | L0629 | LSO FLEX W/RIGID STAYS CUST | F | 01054.65 |
1 | L0630 | LSO POST RIGID PANEL PRE | F | 00129.54 |
1 | L0631 | LSO SAG-CORO RIGID FRAME PRE | F | 00820.87 |
1 | L0632 | LSO SAG RIGID FRAME CUST | M | 00000.00 |
1 | L0633 | LSO FLEXION CONTROL PREFAB | F | 00229.30 |
1 | L0634 | LSO FLEXION CONTROL CUSTOM | M | 00000.00 |
1 | L0635 | LSO SAGIT RIGID PANEL PREFAB | F | 00804.23 |
1 | L0636 | LSO SAGITTAL RIGID PANEL CUS | F | 01322.86 |
1 | L0637 | LSO SAG-CORONAL PANEL PREFAB | F | 00952.38 |
1 | L0638 | LSO SAG-CORONAL PANEL CUSTOM | F | 01053.81 |
1 | L0639 | LSO S/C SHELL/PANEL PREFAB | F | 00952.38 |
1 | L0640 | LSO S/C SHELL/PANEL CUSTOM | F | 00836.72 |
1 | L0641 | Lumbar orthosis, sagittal control, with | F | 00070.18 |
1 | L0642 | Lumbar orthosis, sagittal control, with | F | 00370.09 |
1 | L0643 | Lumbar-sacral orthosis,sagittal control, | F | 00145.79 |
1 | L0648 | Lumbar-sacral orthosis,sagittal control, | F | 00924.31 |
1 | L0649 | Lumbar-sacral orthosis,sagittal-coronal | F | 00258.17 |
1 | L0650 | Lumbar-sacral orthosis,sagittal-coronal | F | 01072.38 |
1 | L0651 | Lumbar-sacral orthosis, sagittal-coronal | F | 01072.38 |
1 | L0700 | CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSIS | F | 01398.33 |
1 | L0710 | CTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTRO | F | 01492.88 |
1 | L0810 | HALO, CERVICAL INTO JACKET VEST | F | 02233.41 |
1 | L0820 | HALO CERVICAL INTO BODY JACKET | F | 01785.84 |
1 | L0830 | HALO INTO MILWAUKEE TYPE ORTHOSIS | F | 02629.46 |
1 | L0859 | MRI COMPATIBLE SYSTEM | F | 00988.63 |
1 | L0861 | HALO, REPLACE LINER/INTERFACE | F | 00186.13 |
1 | L0970 | TLSO, CORSET FRONT | F | 00055.31 |
1 | L0972 | LOS, CORSET FRONT | F | 00055.31 |
1 | L0974 | TLSO, FULL CORSET | F | 00119.47 |
1 | L0976 | LSO, FULL CORSET | F | 00118.90 |
1 | L0978 | AXILLARY CRUTCH EXTENSION | F | 00138.28 |
1 | L0980 | PERITONEAL STRAPS, PAIR | F | 00005.53 |
1 | L0982 | STOCKINGS SUPPORTER GRIPS, SET OF FOUR ( | F | 00008.30 |
1 | L0984 | PROTECTIVE BODY SOCK | F | 00049.76 |
1 | L0999 | ADDITION TO SPINAL ORTHOSIS NOT SPECIFIE | M | 00000.00 |
1 | L1000 | CERVICAL-THORACIC-LUMBAR-SACRAL (CTLSO) | F | 01180.81 |
1 | L1001 | CTLSO INFANT IMMOBILIZER | M | 00000.00 |
1 | L1005 | TENSION BASED SCIOLOSIS ORTH & ACC PADS | F | 02636.11 |
1 | L1010 | ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, | F | 00014.38 |
1 | L1020 | ADD TO CTLSO - KYPHOSIS PAD | F | 00035.41 |
1 | L1025 | ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS | F | 00089.02 |
1 | L1030 | ADD TO CTLSO- LUMBAR BOLSTER PAD | F | 00035.41 |
1 | L1040 | ADD TO CTLSO - LUMBAR OR LUMBAR RIB PAD | F | 00038.58 |
1 | L1050 | ADD TO CTLSO - STERNAL PAD | F | 00037.61 |
1 | L1060 | ADD TO CTLSO - THORACIC PAD | F | 00039.44 |
1 | L1070 | ADDITIONS TO CTLSO OR SCOLIOSIS ORTHOSIS | F | 00014.38 |
1 | L1080 | ADDITIONS TO CTLSO OR SCOLIOSIS ORTHOSES | F | 00011.05 |
1 | L1085 | ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS | F | 00109.88 |
1 | L1090 | ADDITIONS TO CTLSO - LUMBAR SLING | F | 00019.73 |
1 | L1100 | ADDITIONS TO CTLSO OR SCOLIOSIS ORTHOSIS | F | 00100.01 |
1 | L1110 | ADDITIONS TO CTLSO OR SCOLIOSIS ORTHOSES | F | 00199.13 |
1 | L1120 | ADD TO CTLSO OR SIO COVERS FOR UPRIGHT E | F | 00010.04 |
1 | L1200 | THORACIC-LUMBAR-SACAL-ORTHOSES (TLSO), I | F | 01062.03 |
1 | L1210 | ADDITION TO TLSO, LOW PROFILE, LATERAL T | F | 00060.85 |
1 | L1220 | ADDITIONS TO TLSO, (LOW PROFILE) ANTERIO | F | 00060.85 |
1 | L1230 | ADDITION TO TLSO, (LOW PROFILE) MILWAUKE | F | 00300.91 |
1 | L1240 | ADDITION TO TLSO, LOW PROFILE,LUMBAR PAD | F | 00055.43 |
1 | L1250 | ADDITION TO TLSO, ANTERIOR ASIS PAD | F | 00051.58 |
1 | L1260 | ADDITION TO TSLO, ANTERIOR DEROTATION | F | 00054.02 |
1 | L1270 | ADDITION TO TLSO, ABDOMINAL PAD | F | 00055.31 |
1 | L1280 | ADDITION TO TLSO, RIB GUSSET EACH | F | 00061.58 |
1 | L1290 | ADDITION TO TLSO, LATERAL TROCHANTERI | F | 00056.11 |
1 | L1300 | OTHER SCOLIOSIS PROCEDURES BODY JACKET M | F | 01062.03 |
1 | L1310 | OTHER SCOLIOSIS PROC POST - OP BODY JACK | F | 01093.00 |
1 | L1499 | UNLISTED PROCEDURE FOR SPINAL ORTHOSIS | M | 00000.00 |
R | L1500 | THORACIC-HIP-KNEE-ANKLE MOBILITY FRAME | F | 00158.27 | RR
R | L1520 | THKAO, SWIVAL WALKER | F | 00185.73 | RR
1 | L1600 | HIP ORTHOSES (HO) ABDUCTION CONTROL OF H | F | 00099.72 |
1 | L1610 | HO, ABDUCTION CONTROL OF HIP JOINTS, FLE | F | 00040.00 |
1 | L1620 | HO, ABDUCTION CONTROL OF HIP JOINTS, FLE | F | 00106.99 |
1 | L1630 | HO, ABDUCTION CONTROL OF HIP JOINTS, SEM | F | 00127.53 |
1 | L1640 | HO, ABDUCTION CONTROL OF HIP JOINTS, STA | F | 00269.93 |
1 | L1650 | HO, ABDUCTION CONTROL OF HIP JOINTS, STA | F | 00188.72 |
1 | L1652 | HIP ORTHO.BIL.THIGH CUFFS W/SPREADER BAR | F | 00293.60 |
1 | L1660 | HO, ABDUCTION CONTROL OF HIP JOINTS, STA | F | 00132.44 |
1 | L1680 | HO, ABDUCTION CONTROL OF HIP JOINTS DYNA | F | 00955.82 |
1 | L1685 | HO, ABDUCT CONTROL OF HIP JT,POST OP,CUS | F | 00817.78 |
1 | L1686 | HO,ABDUCT CONTROL OF HIP JT,POST OP,CUST | F | 00705.95 |
1 | L1690 | COMBINATION, BILATERAL LUMBO SACRAL | F | 01592.65 |
1 | L1700 | LEGG PERTHES ORTHOSIS, TORONTO TYPE | F | 00979.60 |
1 | L1710 | LEGG PERTHES ORTHOSIS, NEWINGTON TYPE | F | 00796.51 |
1 | L1720 | LEGG PERTHES ORTHOSIS, TRILATERAL, (TACH | F | 00798.24 |
1 | L1730 | LEGG PERTHES ORTHOSIS, SCOTTISH RITE TYP | F | 00830.34 |
1 | L1755 | LEGG PERTHES ORTHOSIS | F | 01156.57 |
1 | L1810 | KNEE ORTHOSIS, ELASTIC WITH JOINTS | F | 00077.46 |
1 | L1812 | Knee orthosis, elastic with joints, pref | F | 00084.68 |
1 | L1820 | KNEE ORTHOSIS,ELASTIC WITH CONDYLAR PADS | F | 00085.18 |
1 | L1830 | KO, IMMOBILIZER; CANVAS LONGITUDINAL | F | 00070.52 |
1 | L1831 | KNEE ORTH.LOCKING JOINT PREFABRICATED | F | 00242.41 |
1 | L1832 | KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS | F | 00470.51 |
1 | L1833 | Knee orthosis, adjustable knee joints,po | F | 00514.37 |
1 | L1834 | KO, WITHOUT KNEE JOINT, RIGID, MOLDED | F | 00598.49 |
1 | L1836 | KNEE ORTH.RIGID,W/OUT JOINT,W/LINER | F | 00109.89 |
1 | L1840 | KO, DEROTAT FAB TO PT MDL LENNOX HILL OR | F | 00683.23 |
1 | L1843 | KNEE ORTHOSIS, SINGLE UPRIGHT | F | 00739.01 |
1 | L1844 | KNEE ORTHOSIS, SINGLE UPRIGHT | F | 01436.54 |
1 | L1845 | KNEE ORTHOSIS, DOUBLE UPRIGHT | F | 00632.57 |
1 | L1846 | KNEE ORTHOSIS, DOUBLE UPRIGHT | F | 00708.68 |
1 | L1847 | KNEE ORTHOSIS, DOUBLE UPRIGHT ADJUSTABLE | F | 00473.71 |
1 | L1848 | Knee orthosis double upright w/ adjustab | F | 00517.85 |
1 | L1850 | KO, SWEDISH TYPE | F | 00230.89 |
1 | L1860 | KO, MODIFICATION OF SRIPIACONDYLAR PROST | F | 00703.59 |
1 | L1900 | AFO, SPRING WIRE, DORSIFLEXICON ASSIST C | F | 00132.75 |
1 | L1902 | AFO, ANKEL GAUNTLET | F | 00065.18 |
1 | L1904 | AFO, MOLDED ANKLE GAUNTLET | F | 00337.47 |
1 | L1906 | AFO, MULTIGAMENTUS ANKLE SUPPORT | F | 00093.08 |
1 | L1907 | AFO SUPRAMALLEOLAR W/STRAPS CUSTOM | F | 00463.41 |
1 | L1910 | AFO, POSTERIOR, SINGLE BAR, CLASP ATTACH | F | 00206.96 |
1 | L1920 | AFO, SINGLE UPRIGHT WITH STATIC OR ADJUS | F | 00233.36 |
1 | L1930 | AFO, PLASTIC OR OTHER,PREFABRICATED | F | 00213.96 |
1 | L1932 | AFO,RIGID ANTERIOR TIBIAL SECTION,TOTAL | F | 00712.91 |
1 | L1940 | AFO, PLASTIC OR OTHER,CUSTOM MADE | F | 00372.35 |
1 | L1945 | AFO,MOLD TO PAT. MODEL,PLASTIC,RIGID ANT | F | 00636.44 |
1 | L1950 | AFO, SPIRAL, MOLDED TO PATIENT MODEL (IR | F | 00535.14 |
1 | L1951 | AFO,SPIRAL,PLASTIC,PREFABRICATED | F | 00691.70 |
1 | L1960 | AFO, POSTERIOR SOLID ANKLE, MOLDED TO PA | F | 00496.07 |
1 | L1970 | AFO, PLASTIC MOLDED TO PATIENT MODEL, WI | F | 00584.73 |
1 | L1971 | AFO,PLASTIC UPRIGHT SOLID STIRRIP CUSTOM | F | 00386.03 |
1 | L1980 | AFO,SINGL UPRIGHT FREE PLANT DORSIFLEX S | F | 00267.02 |
1 | L1990 | AFO DOUBL UPRIGHT FREE PLANTAR DORSIFLEX | F | 00353.77 |
1 | L2000 | KAFO SINGLE UPRIGHT FREE KNE/ANKLE SOL S | F | 00677.04 |
1 | L2005 | KAF ORTH ANY MATERIAL,CUSTOM | F | 02875.82 |
1 | L2010 | KAFO,SINGLE UPRIGHT,FREE KNE/ANKLE SOL S | F | 00639.13 |
1 | L2020 | KAFO SINGLE UPRIGHT FREE ANKLE | F | 00779.39 |
1 | L2030 | KAFO, DOUBLE UPRIGHT, FREE KNEE, FREE AN | F | 00741.74 |
1 | L2034 | KAFO PLA SIN UP W/WO K/A CUS | F | 00067.48 |
1 | L2035 | KAFO, FULL PLASTIC, STATIC/PEDIAT.SIZE | F | 00142.66 |
1 | L2036 | KAFO,FULL PLASTIC,MOLDED TO PATIENT MODE | F | 01324.41 |
1 | L2037 | KAFO,FULL PLASTIC,SINGLE UPRIGHT,FREE KN | F | 01145.14 |
1 | L2038 | KAFO, FULL PLASTIC,SINGLE UPRIGHT | F | 01020.69 |
1 | L2040 | HIP-KNEE-ANKLE-FOOT, ORTHISES TORSION CO | F | 00067.48 |
1 | L2050 | HKAFO, TORSION CONTROL, BILATERAL TORSIO | F | 00317.96 |
1 | L2060 | HKAFO, TORSION CONTROL, BILATERAL TORSIO | F | 00401.25 |
1 | L2070 | HKAFO, TORSION CONTROL, UNILATERAL ROTAT | F | 00056.41 |
1 | L2080 | 3.AFO, TORSION CONTROL, UNILATERAL, TORS | F | 00211.57 |
1 | L2090 | HKAFO, TORSION CONTROL, UNILATERAL TORSI | F | 00252.22 |
1 | L2106 | AFO, FRACTURE ORTHOSIS, TIBIAL FRACTURE | F | 00485.40 |
1 | L2108 | AFO, FRACT ORTH, TIBIAL FRACT CAST ORTHO | F | 00623.81 |
1 | L2112 | AFO, FRACTURE ORTHOSIS, TIBIAL SOFT | F | 00361.07 |
1 | L2114 | AFO, FRACTURE ORTHOSIS,TIBIAL,SEMI RIGID | F | 00474.55 |
1 | L2116 | AFO, FRACTURE ORTHOSIS, TIBIAL RIGID | F | 00583.24 |
1 | L2126 | KAFO, FRACTURE ORTHOSIS, FEMORAL, MOLDED | F | 00854.87 |
1 | L2128 | KAFO,FRACTURE ORTHOSIS,FEMO FRACT CAST O | F | 01144.59 |
1 | L2132 | KAFO,FRACTURE ORTHOSIS,FEMORAL,SOFT | F | 00623.27 |
1 | L2134 | KAFO,FRACTURE ORTHOSIS,FEMORAL,SEMI RIGI | F | 00748.51 |
1 | L2136 | KAFO,FRACTURE ORTHOSIS,FEMORAL,RIGID | F | 00924.07 |
1 | L2180 | PLASTIC SHOE INSERT WITH ANKLE JOINTS | F | 00070.80 |
1 | L2182 | DROP LOCK KNEE JOINT | F | 00073.39 |
1 | L2184 | ADDITION TO LOWER EXTREMITY,LIMITED | F | 00088.43 |
1 | L2186 | ADJUSTABLE MOTION KNEE JOINT (LERMAN TYP | F | 00044.24 |
1 | L2188 | ADDITION TO LOWER EXTREMITY QUADRILATERA | F | 00213.82 |
1 | L2190 | WAIST BELT | F | 00061.62 |
1 | L2192 | HIP JOINT,PELVIC BAND,THIGH FLANGE, AND | F | 00301.50 |
1 | L2200 | ADD-LWR EXTRM ORTHO-LTD ANKLE MOTION EAC | F | 00031.74 |
1 | L2210 | ADD-LWR EXTRM ORTHO-DORSIFLEX ASSIST PLA | F | 00035.41 |
1 | L2220 | ADD-LWR EXTRM ORTHO DORSIFLEX PLANT FLEX | F | 00042.03 |
1 | L2230 | ADD-LWR EXTREM ORTHO SPLIT FLAT CALIP ST | F | 00042.03 |
1 | L2232 | ADD LOWER EXT ORTH,ROCKER BOTTOM CUSTOM | F | 00080.36 |
1 | L2240 | ADD-LWR EXTREM ORTHO ROUND CALIPAR AND P | F | 00040.93 |
1 | L2250 | ADD-LWR EXTREM ORTHO FOOT PLATE MLD TO P | F | 00234.52 |
1 | L2260 | ADD-LWR EXTREM ORTHO REINFORCE SOLID STI | F | 00054.21 |
1 | L2265 | ADD. TO LOWER EXTREMITY, LONG TONGUE | F | 00085.80 |
1 | L2270 | ADDITIONS TO LOWER EXTREMITY, VARUS/VALG | F | 00035.85 |
1 | L2275 | ADD TO LOW EXTREMITY,VARUS/VULGUS CORR,P | F | 00109.61 |
1 | L2280 | ADD-LWR EXTREM ORTHO MOLDED INNER BOOT | F | 00281.69 |
1 | L2300 | ADD-LWR EXTREM ORTHO ABDUCTION BAR JOINT | F | 00106.21 |
1 | L2310 | ADD-LWR EXTREM ORTHO ABDUCTION BAR STRAI | F | 00044.24 |
1 | L2320 | ADD-LWR EXTREM ORTHO NON MOLDED LACER | F | 00039.82 |
1 | L2330 | ADD-LWR EXTREM ORTHO LACER MOLDED TO PT | F | 00114.50 |
1 | L2335 | ADD. TO LOWER EXTREMITY,ANTERIOR BAND | F | 00216.24 |
1 | L2340 | ADD-LWR EXTREM ORTHO PRE TIB SHELL MOLDE | F | 00281.69 |
1 | L2350 | ADD-LWR EXTREM ORTHO BK SOCKET MOLDED TO | F | 00650.70 |
1 | L2360 | ADD-LWR EXTREM ORTHO EXTENDED STEEL SHAN | F | 00019.91 |
1 | L2370 | ADD. TO LOWER EXTREMITY,PATTEN BOTTOM | F | 00244.34 |
1 | L2375 | ADD. TO LOWER EXTREMITY, TORSION CONTROL | F | 00087.00 |
1 | L2380 | TORSION CONTROL,STRAIGHT KNEE JOINT,EACH | F | 00028.20 |
1 | L2385 | STRAIGHT KNEE JOINT,HEAVY DUTY,EACH JOIN | F | 00042.48 |
1 | L2387 | ADD LE POLY KNEE CUSTOM KAFO | F | 00042.48 |
1 | L2390 | ADD:OFFSET KNEE JOINT,EACH JOINT | F | 00073.06 |
1 | L2395 | OFFSET KNEE JOINT,HEAVY DUTY,EACH JOINT | F | 00011.35 |
1 | L2397 | ADD. TO LOWER EXTREMITY SUSPENSION | F | 00096.20 |
1 | L2405 | ADDITION TO KNEE JOINT,DROP LOCK,EACH JO | F | 00033.97 |
1 | L2415 | ADD TO KNEE JOINT,CAM LOCK,EACH JOINT | F | 00042.48 |
1 | L2425 | DISC OR DIAL LOCK FOR ADJ KNEE FLEXION,E | F | 00125.28 |
1 | L2430 | ADD-LWR EXTREM ORTHO STRGHT KNEE JNT POL | F | 00074.17 |
1 | L2492 | ADD TO KNEE JOINT,LIFT LOOP OR DROP LOCK | F | 00037.61 |
1 | L2500 | ADD-LWR EXTREM ORTHO THIGH/WGT BEARING,G | F | 00146.86 |
1 | L2510 | ADD-LWR EXTREM ORTHO THIGH WGT BEARING Q | F | 00371.16 |
1 | L2520 | ADD-LWR EXTREM ORTHO THIGH WGT BEARING Q | F | 00316.72 |
1 | L2525 | ADD TO LOW EXTREM,THIGH/WEIGHT BEARING,I | F | 00918.14 |
1 | L2526 | ADD TO LOW EXTREM,THIGH/WEIGHT BEARING,C | F | 00470.90 |
1 | L2530 | ADD-LWR EXTREM ORTHO THIGH WGT BEARING L | F | 00121.01 |
1 | L2540 | ADD-LWR EXTREM ORTHO THIGH WGT BEARING L | F | 00163.03 |
1 | L2550 | ADD-LWR EXTREM ORTHO THIGH WGT BEARING H | F | 00056.41 |
1 | L2570 | ADD-LWR EXTREM ORTHO GLUTEAL/ISHIAL WGT | F | 00376.76 |
1 | L2580 | ADD-LWR EXTREM ORTHO GLUTEAL/ISHIAL WGT | F | 00064.89 |
1 | L2600 | ADD-LWR EXTREM ORTHO PELVIC CNTRL HIP JN | F | 00095.14 |
1 | L2610 | PELVIC CONTROL, HIP JOINT, CLEIVS OR THR | F | 00162.09 |
1 | L2620 | ADD-LWR EXTREM ORTHO PELVIC CNTR HIP JNT | F | 00225.35 |
1 | L2622 | ADD. TO LOWER EXTREMITY, PELVIC CONTROL | F | 00230.18 |
1 | L2624 | PELVIC C0NTROL,HIP JNT,ADJ FLEX,EXTEN AB | F | 00260.73 |
1 | L2627 | ADD TO LOW EXTREM,PLASTIC,MOLD TO PAT,RE | F | 01178.59 |
1 | L2628 | ADD TO LOW EXTREM,METAL FRAME,RECIPROCAT | F | 01151.88 |
1 | L2630 | ADD-LWR EXTREM PELVIC CNTRL HIP JNT BAND | F | 00131.93 |
1 | L2640 | ADD-LWR EXTREM ORTHO PELVIC CNTRL HIP JN | F | 00189.08 |
1 | L2650 | ADD-LWR EXTREM ORTHO PELVIC/THORACIC CNT | F | 00101.84 |
1 | L2660 | ADD-LWR EXTREM ORTHO THORACIC CONTROL TH | F | 00066.38 |
1 | L2670 | ADD-LWR EXTREM ORTHO THORACIC CONTROL PA | F | 00100.87 |
1 | L2680 | ADD-LWR EXTREM ORTHO THORACIC CNTR LATER | F | 00087.60 |
1 | L2750 | ADDITION TO LOWER EXTREMITY ORTHOSES, PL | F | 00065.44 |
1 | L2755 | ADDITION TO LOWER EXTREM ORTHOSIS | F | 00099.26 |
1 | L2760 | ADD-LWR EXTREM ORTHO EXTENSION PER EXTEN | F | 00016.59 |
1 | L2768 | ORTHOTIC SIDE BAR DISCONNECT DEVICE/BAR | F | 00106.17 |
1 | L2780 | ADDITIONS TO LOWER EXTREMITY NON-CORROSI | F | 00047.98 |
1 | L2785 | ADD. TO LOWER EXTREMITY,DROP LOCK RETAIN | F | 00024.13 |
1 | L2795 | ADD. TO LOWER EXTREMITY, KNEE CONTROL | F | 00060.66 |
1 | L2800 | ADD. TO LOWER EXTREMITY, KNEE CONTROL | F | 00076.15 |
1 | L2810 | KNEE CONTROL,CONDYLAR PAD | F | 00040.65 |
1 | L2820 | SOFT INTERFACE FOR MOLDED PLASTIC,BELOW | F | 00044.80 |
1 | L2830 | SOFT INTERFACE FOR MOLDED PLASTIC,ABOVE | F | 00064.57 |
1 | L2840 | ADD. TO LOWER EXTREMITY, TIBIAL SOCK | F | 00032.26 |
1 | L2850 | ADDITION TO LOWER EXTREMITY ORTHOSIS, FE | F | 00058.52 |
1 | L2999 | UNLISTED PROCEDURES FOR LOWER EXTREMITY | M | 00000.00 |
1 | L3000 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00189.50 |
1 | L3001 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00078.78 |
1 | L3002 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00083.80 |
1 | L3003 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00143.48 |
1 | L3010 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00078.78 |
1 | L3020 | FOOT, INSERT, REMOVABLE, MOLDED TO PATIE | F | 00078.78 |
1 | L3030 | FOOT, INSERT, REMOVABLE FORMED T0 PATIEN | F | 00072.68 |
1 | L3031 | FOOT INSERT,REMOV.ADD.TO LOW.EXTREMITY | M | 00000.00 |
1 | L3040 | FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED | F | 00044.84 |
1 | L3050 | FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED | F | 00044.84 |
1 | L3060 | FOOT, ANKLE SUPPORT, REMOVABLE, PREMOLDE | F | 00042.20 |
1 | L3070 | FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACH | F | 00023.53 |
1 | L3080 | FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACH | F | 00017.65 |
1 | L3090 | FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACH | F | 00035.30 |
1 | L3100 | HALLUS-VALGUS NIGHT DYNAMIC SPLINT | F | 00035.30 |
1 | L3140 | FOOT, ABDUCTION ROTATION BARS (DENNIS BR | F | 00048.26 |
1 | L3150 | FOOT, ABDUCTION ROTATION BARS (DENNIS BR | F | 00048.26 |
1 | L3160 | FOOT, TORQUE HEELS ON ORTHOPEDIC SHOE | M | 00000.00 |
1 | L3170 | FOOT, PLASTIC, SILICONE OR EQUAL, | F | 00014.38 |
1 | L3201 | ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR O | F | 00047.39 |
1 | L3202 | ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR O | F | 00047.39 |
1 | L3203 | ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR O | F | 00047.39 |
1 | L3204 | ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR | F | 00047.39 |
1 | L3206 | ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR | F | 00047.39 |
1 | L3207 | ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR | F | 00047.39 |
1 | L3208 | SURGICAL BOOT, EACH, INFANT | F | 00012.14 |
1 | L3209 | SURGICAL BOOT, EACH, CHILD | F | 00011.76 |
1 | L3211 | SURGICAL BOOT, EACH, JUNIOR | F | 00012.14 |
1 | L3212 | BENESCH BOOT, PAIR, INFANT | F | 00047.39 |
1 | L3213 | BENESCH BOOT, PAIR, CHILD | F | 00047.39 |
1 | L3214 | BENESCH BOOT, PAIR, JUNIOR | F | 00047.39 |
1 | L3215 | ORTHOPEDIC FOOTWEAR, LADIES SHOES, OXFOR | F | 00055.31 |
1 | L3216 | ORTHOPEDIC FOOTWEAR, LADIES SHOES, DEPTH | F | 00055.31 |
1 | L3217 | ORTHOPEDIC FOOTWEAR, LADIES SHOES, HIGHT | F | 00055.31 |
1 | L3219 | ORTHOPEDIC FOOTWEAR, MENS SHOES, OXFORD | F | 00057.46 |
1 | L3221 | ORTHOPEDIC FOOTWEAR, MENS SHOES, DEPTH | F | 00071.69 |
1 | L3222 | ORTHOPEDIC FOOTWEAR, MENS SHOES, HIGHTOP | F | 00071.69 |
1 | L3224 | ORTHOPEDIC FOOTWARE, WOMANS SHOES OXFORD | F | 00051.31 |
1 | L3225 | ORTHOPEDIC FOOTWARE, MANS SHOE,OXFORD | F | 00059.68 |
1 | L3230 | ORTHOPEDIC FOOTWEAR, CUSTOM SHOES, DEPTH | F | 00227.29 |
1 | L3250 | ORTHO FTWR CUSTOM MOLDED REMOVE INNER MO | F | 00227.29 |
1 | L3251 | FOOT, SHOE MOLDED TO PATIENT MODEL, SILI | F | 00227.29 |
1 | L3252 | FT. SHOE MOLDED TO PT. MODEL PLASTAZOTE | F | 00227.29 |
1 | L3253 | FOOT, MOLDED SHOE PLASTAZOTE TYPE CUSTOM | F | 00227.29 |
1 | L3254 | NON-STANDARD SIZE OR WIDTH | M | 00000.00 |
1 | L3255 | NON-STANDARD SIZE OR LENGTH(SHOE) | M | 00000.00 |
1 | L3257 | ORTHOPEDIC FOOTWARE, SPLIT SIZE | F | 00193.60 |
1 | L3260 | AMBULATORY SURGICAL BOOT, EACH, ADULT | F | 00018.05 |
1 | L3265 | PLASTAZOTE SANDAL-ADULT (EACH) | F | 00046.69 |
1 | L3300 | LIFTS, ELEVATION, HEEL TAPERED TO METATA | F | 00033.81 |
1 | L3310 | LIFTS, ELEVATION, HEEL AND SOLE, NEOPREN | F | 00038.92 |
1 | L3320 | LIFTS, ELEVATION, HEEL AND SOLE, CORK, P | F | 00062.47 |
1 | L3330 | LIFTS, ELEVATION, METAL EXTENSION, SKATE | F | 00465.96 |
1 | L3332 | LIFTS, ELEVATION, INSIDE SHOE, TAPERED, | F | 00011.76 |
1 | L3334 | LIFTS, ELEVATION, HEEL, PER INCH | F | 00014.11 |
1 | L3340 | HEEL WEDGE, EACH | F | 00018.93 |
1 | L3350 | HEEL WEDGE | F | 00021.51 |
1 | L3360 | SOLE WEDGE, OUTSIDE SOLE | F | 00021.51 |
1 | L3370 | SOLE WEDGE, BETWEEN SOLE | F | 00021.51 |
1 | L3380 | CLUBFOOT WEDGE | F | 00021.51 |
1 | L3390 | OUTFLARE WEDGE | F | 00021.51 |
1 | L3400 | METATARSAL BAR WEDGE, ROCKER | F | 00021.51 |
1 | L3410 | METATARSAL BAR WEDGE, BETWEEN SOLE | F | 00021.51 |
1 | L3420 | FULL SOLE AND HEEL WEDGE, BETWEEN SOLE | F | 00040.97 |
1 | L3430 | HEEL, COUNTER, PLASTIC REINFORCED | F | 00040.97 |
1 | L3440 | HEEL, COUNTER, LEATHER REINFORCED | F | 00040.97 |
1 | L3450 | HEEL, SACH CUSHION TYPE | F | 00040.97 |
1 | L3455 | HEEL, NEW LEATHER, STANDARD/ORTHPED SHOE | F | 00033.50 |
1 | L3460 | HEEL, NEW RUBBER, STANDARD ON ORTH SHOE | F | 00028.26 |
1 | L3465 | HEEL, THOMAS WITH WEDGE | F | 00040.97 |
1 | L3470 | HEEL, THOMAS EXTENDED TO BALL | F | 00018.93 |
1 | L3480 | HEEL, PAD AND DEPRESSION FOR SPUR | F | 00018.44 |
1 | L3485 | HEEL, PAD, REMOVABLE FOR SPUR | F | 00018.44 |
1 | L3500 | ORTHOPEDIC SHOE ADDITION, INSOL, LEATHER | F | 00024.07 |
1 | L3510 | ORTHOPEDIC SHOE ADDITION,INSOLE, RUBBER | F | 00024.07 |
1 | L3520 | ORTHOPEDIC SHOE ADDITION, INSOLE, FELT | F | 00026.18 |
1 | L3530 | MISCELLANEOUS SHOE ADDITIONS, SOLE, HALF | F | 00011.01 |
1 | L3540 | MISCELLANEOUS SHOE ADDITIONS, SOLE, FULL | F | 00017.65 |
1 | L3550 | MISCELLANEOUS SHOE ADDITIONS, TOE TAP, S | F | 00007.36 |
1 | L3560 | MISCELLANEOUS SHOE ADDITIONS, TOE TAP, H | F | 00018.85 |
1 | L3570 | MISCELLANEOUS SHOE ADDITIONS, SPECIAL EX | F | 00070.16 |
1 | L3580 | MISCELLANEOUS SHOE ADDITIONS, CONVERT IN | F | 00037.86 |
1 | L3590 | MISCELLANEOUS SHOE ADDITIONS, CONVERT FI | F | 00007.14 |
1 | L3595 | MISCELLANEOUS SHOE ADDITIONS MARCH BAR | F | 00034.53 |
1 | L3600 | TRANSFER OF ORTHO FROM 1 SHOE TO OTHER,C | F | 00035.67 |
1 | L3610 | TRANSFER OF ORTHOSIS FROM 1 SHOE TO OTHE | F | 00095.50 |
1 | L3620 | TRANSFER OF ORTHOSIS FROM 1 SHOE TO OTHE | F | 00035.67 |
1 | L3630 | TRANSFER OF ORTHOSIS FROM 1 SHOE TO OTHE | F | 00095.50 |
1 | L3640 | TRANSFERS OF AN ORTHOSIS FROM ONE SHOE T | F | 00023.58 |
1 | L3649 | SHOE INSERTS OR MODIFICATIONS N.O.C. | M | 00000.00 |
1 | L3650 | SHOULDER ORTHOSIS (SO) FIGURE OF "8" DES | F | 00053.30 |
1 | L3660 | SO, FIGURE OF "8" DESIGN ABDUCTION RESTR | F | 00097.47 |
1 | L3670 | SO, ACROMIO/CLAVICULAR (CANVAS AND WEBBI | F | 00114.18 |
1 | L3671 | SHOULDER ORTHOSIS,JNT DESIGN,W/O JNTS | F | 00053.30 |
1 | L3674 | SHOULDER ORTHOSIS, ABD POSITIONING | F | 00929.10 |
1 | L3675 | SO, VEST TYPE, CANVAS | F | 00131.53 |
1 | L3677 | SHOULDER ORTHOSIS,JNT DESIGN,W/O JNTS | M | 00000.00 |
1 | L3678 | Shoulder orthosis, shoulder joint design | M | 00000.00 |
1 | L3702 | EO W/O JOINTS CF | F | 00065.18 |
1 | L3710 | EO, ELASTIC WITH METAL JOINTS DOUBLE UPR | F | 00093.61 |
1 | L3720 | EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFF | F | 00447.29 |
1 | L3730 | EO, DOUBLE UPWRIGHT WITH FOREARM/ARM CUF | F | 00699.16 |
1 | L3740 | EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFF | F | 00741.64 |
1 | L3760 | ELBOW ORTHOSIS, W ADJ LOCKING JOINT | F | 00374.86 |
1 | L3762 | ELBOW ORTH.RIGID,W/OUT JOINTS PREFAB. | F | 00080.67 |
1 | L3763 | EWHO RIGID W/O JNTS CF | F | 00065.18 |
1 | L3764 | EWHO W/JOINT(S) CF | F | 00065.18 |
1 | L3765 | EWHFO RIGID W/O JNTS CF | F | 00065.18 |
1 | L3766 | EWHFO W/JOINT(S) CF | F | 00065.18 |
1 | L3806 | WHFO W/JOINT(S) CUSTOM FAB | F | 00340.38 |
1 | L3807 | WHFO, W/OUT JOINT PREFABRICATED | F | 00187.41 |
1 | L3808 | WHFO, RIGID W/O JOINTS | F | 00257.45 |
1 | L3809 | Wrist hand finger orthosis, without join | F | 00204.87 |
1 | L3900 | WHFO, DYNAMIC FLEXOR HINGE; RECIPROCAL W | F | 00704.87 |
1 | L3901 | WHFO, DYMANIC FLEXOR HINGE, RECIPROCAL W | F | 01126.75 |
1 | L3904 | WHFO, EXTERNAL POWERED, ELECTRIC | F | 02031.58 |
1 | L3905 | WHO W/NONTORSION JNT(S) CF | F | 00084.30 |
1 | L3906 | WHO, WITHOUT JOINTS | F | 00150.59 |
1 | L3908 | WHFO, WRIST EXTENSION CONTROL (COCK-UP), | F | 00046.12 |
1 | L3912 | WHFO, FLEXION GLOVE WITH ELASTIC FINGER | F | 00088.84 |
1 | L3913 | HFO W/O JOINTS CF | F | 00084.30 |
1 | L3915 | WHO W NONTOR JNT(S) PREFAB | F | 00398.33 |
1 | L3916 | WHFO, WRIST EXTENSIONS (COCK-UP), WITH O | F | 00435.59 |
1 | L3917 | HAND ORTH.FRACT.ORTH,PREFABRICATED | F | 00079.16 |
1 | L3918 | WHFO, KNUCKLE BENDER | F | 00086.53 |
1 | L3919 | HO W/O JOINTS CF | F | 00084.30 |
1 | L3921 | HFO W/JOINT(S) CF | F | 00084.30 |
1 | L3923 | HAND FINGER ORTHOSIS, W/O JOINT | F | 00029.17 |
1 | L3924 | WHFO, OPPENHEIMER | F | 00073.53 |
1 | L3925 | FO,PIP/DIP,NON TORSN JOINT/SPRING PREFB | F | 00048.59 |
1 | L3929 | HFO, > | F | 00077.05 |
1 | L3930 | WHFO, FINGER EXTENSION, WITH WRIST SUPPO | F | 00083.41 |
1 | L3931 | WHFO, > | F | 00171.36 |
1 | L3933 | FO W/O JOINTS CF | F | 00084.30 |
1 | L3935 | FO NONTORSION JOINT CF | F | 00084.30 |
1 | L3956 | ADD. OF JOINT TO UPPER EXTREMITY | M | 00000.00 |
1 | L3960 | SEWHO, ABDUCTION POSITIONINGS, AIRPLANE | F | 00610.01 |
1 | L3961 | SEWHO CAP DESIGN W/O JNTS CF | F | 00610.01 |
1 | L3962 | SEWHO, ABDUCTION POSITIONING, ERBS PALSE | F | 00634.21 |
R | L3964 | SEO,MOBILE ARM SUPPORT ATTACH TO WHEELCH | F | 00063.84 | RR
R | L3965 | SEO,MOBILE ARM SUPPORT, RANCHO TYPE | F | 00101.90 | RR
R | L3966 | SEO,MOBILE ARM SUPPORT,BALANCED, RECLINI | F | 00076.77 | RR
1 | L3967 | SEWHO AIRPLANE W/O JNTS CF | F | 00610.01 |
R | L3968 | SEO,MOBILE FRICTION ARM SUPPORT ATTACH | F | 00094.85 | RR
R | L3969 | SEO,MOBILE ARM SUPPORT,MONOSUSPENSION | F | 00067.93 | RR
1 | L3971 | SEWHO CAP DESIGN W/JNT(S) CF | F | 00610.01 |
1 | L3973 | SEWHO AIRPLANE W/JNT(S) CF | F | 00610.01 |
1 | L3975 | SEWHFO CAP DESIGN W/O JNT CF | F | 00610.01 |
1 | L3976 | SEWHFO AIRPLANE W/O JNTS CF | F | 00610.01 |
1 | L3977 | SEWHFO CAP DESGN W/JNT(S) CF | F | 00610.01 |
1 | L3978 | SEWHFO AIRPLANE W/JNT(S) CF | F | 00610.01 |
1 | L3980 | UPPER EXTREMITY FRACTURE ORTHOSIS, HUMER | F | 00278.82 |
1 | L3981 | UPPER EXTREMITY FRACTURE ORTHOSIS; HUMER | M | 00000.00 |
1 | L3982 | UPPER EXTREMITY FRACTURE ORTHOSIS, RADIU | F | 00294.55 |
1 | L3984 | UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST | F | 00313.72 |
1 | L3995 | ADD. TO UPPER EXTREMITY ORTHOSIS, SOCK | F | 00022.85 |
1 | L3999 | UNLISTED PROCEDURES FOR UPPER LIMB ORTHO | M | 00000.00 |
1 | L4000 | REPLACE GIRDLE - FOR SPINAL ORTHOSIS | F | 00846.16 |
1 | L4002 | REPLAC.STRAP,ANY ORTHO.ANY TYPE | M | 00000.00 |
1 | L4010 | REPLACE TRI LATERAL SOCKET BRIM | F | 00526.59 |
1 | L4020 | REPLACE QUAD LATERAL SOCKET BRIM MOLDED | F | 00526.59 |
1 | L4030 | REPLACE QUAD LATERAL SOCKET BRIM CUSTOM | F | 00335.19 |
1 | L4040 | REPLACE MOLDED THIGH LACER | F | 00163.03 |
1 | L4045 | REPLACE NONMOLDED THIGH LACER | F | 00252.15 |
1 | L4050 | REPLACE MOLDED CALF LACER | F | 00114.50 |
1 | L4055 | REPLACE NONMOLDED CALF LACER | F | 00204.05 |
1 | L4060 | REPLACE HI ROLL CUFF | F | 00213.55 |
1 | L4070 | REPLACE PROXIMAL/DISTAL UPRIGHT FOR KAFO | F | 00146.47 |
1 | L4080 | REPLACE METAL BANDS KAFO, PROXIMAL THIGH | F | 00026.49 |
1 | L4090 | REPLACE METAL BANDS KAFO/AFO CALF OR DIS | F | 00030.03 |
1 | L4100 | REPLACE LEATHER CUFF KAFO, PROXIMAL THIG | F | 00049.22 |
1 | L4110 | REPLACE LEATHER CUFF KAFO/AFO CALF OR DI | F | 00049.22 |
1 | L4130 | REPLACE PRETIBIAL SHELL | F | 00256.66 |
1 | L4205 | REPAIR OF ORTHOTIC DEVICE, LABOR PER 15 | F | 00016.65 |
1 | L4210 | REPAIR OF ORTHOTIC DEVICE, REPAIR OR REP | M | 00000.00 |
1 | L4350 | PNEUMATIC ANKLE CONTROL SPLINT | F | 00069.18 |
1 | L4360 | PNEUMATIC/VAC WALKING BOOT, PREFAB | F | 00214.28 |
1 | L4361 | Walking boot,pneumatic and/or vacuum,wit | F | 00234.25 |
1 | L4370 | PNEUMATIC FULL LEG SPLINT | F | 00146.10 |
1 | L4386 | NON-PNUEM.WALKING SPLINT PREFABRICATED | F | 00130.59 |
1 | L4387 | Walking boot non-pneumatic,with or witho | F | 00142.76 |
1 | L4392 | REPLACE INTERFACE MATERIAL, AFO | F | 00017.24 |
1 | L4394 | REPLACE INTERFACE MATERIAL, FOOT DROP | F | 00012.57 |
1 | L4396 | STATIC AFO FOR POSITIONING,PRESSURE | F | 00133.30 |
1 | L4397 | Static or dynamic ankle foot orthosis,in | F | 00145.72 |
1 | L4398 | FOOT DROP SPLINT, RECUMBANT POSITIONING | F | 00061.35 |
1 | L4631 | ANKLE FOOT ORTHOSIS, WALKING BOOT TYPE | F | 01242.94 |
1 | L5000 | PARTIAL FOOT, SHOE INSET WITH LONGITUDIN | F | 00375.33 |
1 | L5010 | PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGH | F | 00940.33 |
1 | L5020 | PARTIAL FOOT MOLDED SOCKET TIBIAL TUBUCL | F | 00969.01 |
1 | L5050 | ANKLE, SYMES, MOLDED SOCKET SACH FOOT | F | 01599.08 |
1 | L5060 | ANKLE, SYMES, METAL FRAME, MOLDED LEATHE | F | 01935.98 |
1 | L5100 | BELOW KNEE, MOLDED SOCKET, SHIN SACH FOO | F | 01929.24 |
1 | L5105 | BELOW KNEE,PLASIC SOCKET,JT AND THIGH LA | F | 02725.78 |
1 | L5150 | KNEE DISARTICULATION (OR THROUGH KNEE), | F | 02560.83 |
1 | L5160 | KNEE DISARTICULATION (OR THROUGH KNEE), | F | 02765.70 |
1 | L5200 | ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS C | F | 02583.53 |
1 | L5210 | ABOVE KNEE, SHORT PROSTHESIS NO KNEE JOI | F | 01536.50 |
1 | L5220 | ABOVE KNEE, SHORT PROSTESIS NO KNEE JOIN | F | 01714.73 |
1 | L5230 | ABOVE KNEE FOR PROXIMAL FEMORAL FOCAL DE | F | 02560.83 |
1 | L5250 | HIP DISARTICULATION CAUAKIAN TYPE MOLDED | F | 03585.17 |
1 | L5270 | HIP DISARTUCULATION TILT TABLE TYPE MOLD | F | 03380.30 |
1 | L5280 | HEMIPELVIC CANADIAN TYPE MOLDED SOCKET H | F | 03790.04 |
1 | L5301 | BK,MOLDED SOCKET,SHIN,SACHFOOT | F | 02121.72 |
1 | L5312 | KNEE DISARTICULATION,ENDOSKELETL SYSTM | F | 03466.73 |
1 | L5321 | AK,MOLDED SOCKET,OPEN END,SACH FOOT | F | 02680.44 |
1 | L5331 | HIP DISART.CANADIAN TYPE, MOLDED SOCKET | F | 04531.09 |
1 | L5341 | HEMIPELVECTOMY,CANADIAN TYPE,MOLDED SOCK | F | 04631.41 |
1 | L5400 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 01116.09 |
1 | L5410 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 00414.86 |
1 | L5420 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 01503.65 |
1 | L5430 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 00492.50 |
1 | L5450 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 00207.97 |
1 | L5460 | IMMEDIATE POST SURGICAL OR EARLY FITTING | F | 00326.59 |
1 | L5500 | PREPARATORY BELOW KNEE, (PTB) (TYPE) SOC | F | 00819.47 |
1 | L5505 | PREPARATORY ABOVE KNEE DISARTICULATION I | F | 01442.63 |
1 | L5510 | PREPARATORY BELOW KNEE (PTB" TYPE) SOCKE | F | 01265.69 |
1 | L5520 | PREPARATORY BELOW KNEE (PTB" TYPE) SOCKE | F | 01285.63 |
1 | L5530 | PREPARATORY BELOW KNEE (PTB" TYPE) SOCKE | F | 01347.47 |
1 | L5535 | PREPARATORY BELOW KNEE TYPE SOCKET | F | 01548.54 |
1 | L5540 | PREPARATORY BELOW KNEE (PTB" TYPE) SOCKE | F | 01653.71 |
1 | L5560 | PREPARATORY ABOVE KNEE DISARTICULATION ( | F | 01590.60 |
1 | L5570 | PREPARATORY ABOVE KNEE DISARTICULATION ( | F | 01759.36 |
1 | L5580 | PREPARATORY ABOVE KNEE DISARTICULATION ( | F | 01909.80 |
1 | L5585 | PREP,AK,KNEE DISARTIC,ISCHIAL LEVEL SOCK | F | 01977.30 |
1 | L5590 | PREPARATORY ABOVE KNEE DISARTICULATION ( | F | 01638.92 |
1 | L5595 | PREPARATORY HIP DISARTICULATION | F | 03062.49 |
1 | L5600 | PREP. HIP DISARTICULATION LAMINATED SOCK | F | 03413.11 |
1 | L5610 | ADDITIONS TO LOWER EXTREMITY, ABOVE KNEE | F | 01963.10 |
1 | L5611 | ADD. TO LOWER EXTREMITY, ABOVE KNEE | F | 01395.71 |
1 | L5613 | ADDITON TO LOWER EXTREMTIY | F | 02269.33 |
1 | L5614 | ADD. TO LO EXTRM PROS - LAWRENCE POLYCEN | F | 01275.65 |
1 | L5616 | ADD. TO LO EXTRM PROS - UNIVERSAL MULTIP | F | 01022.21 |
1 | L5617 | ADDITION TO LOWER EXTREMITY, QUICK-CHANG | F | 00409.77 |
1 | L5618 | ADD. TO LO EXTRM PROS - TEST SOCKET SYME | F | 00217.85 |
1 | L5620 | ADD. TO LO EXTRM PROS - TEST SOCKET BELO | F | 00207.33 |
1 | L5622 | ADD. TO LO EXTRM PROS - TEST SOCKET KNEE | F | 00110.62 |
1 | L5624 | ADD. TO LO EXTRM PROS - TEST SOCKET ABOV | F | 00266.29 |
1 | L5626 | ADD. TO LO EXTRM PROS - TEST OSCKET HIP | F | 00149.35 |
1 | L5628 | ADD. TO LO EXTRM PROS - TEST HEMIPELVECT | F | 00149.35 |
1 | L5629 | ADDITION TO LOWER EXTREMITY,BELOW KNEE,A | F | 00232.78 |
1 | L5630 | ADD. TO LO EXTRM PROS - SYMES TYPE EXPAN | F | 00364.61 |
1 | L5631 | ADD TO LOW EXTREM,ABOVE KNEE/KNEE DISART | F | 00321.81 |
1 | L5632 | ADDITIONS TO LOWER EXTREMITY, SYMES TYPE | F | 00070.80 |
1 | L5634 | ADD. TO LO EXTRM PROS - SYMES TYPE POST. | F | 00070.80 |
1 | L5636 | ADD. TO LO EXTRM PROS - SYMES TYPE MEDIA | F | 00132.75 |
1 | L5637 | ADDITION TO LOWER EXTREMITY,BELOW KNEE,T | F | 00211.58 |
1 | L5638 | ADD. TO LO EXTRM PROS - BELOW KNEE LEATH | F | 00088.50 |
1 | L5639 | ADD. TO LOWER EXTREMTIY,BELOW THE KNEE | F | 00852.74 |
1 | L5640 | ADD. TO LO EXTRM PROS- KNEE DISART LEATH | F | 00222.35 |
1 | L5642 | ADD. TO LO EXTRM PROS - ABOVE KNEE LEATH | F | 00110.62 |
1 | L5643 | HIP DISARTICULATION,FLEXIBLE INNER SOCKE | F | 00414.85 |
1 | L5644 | ADD. TO LO EXTRM PROS - ABOVE KNEE WOOD | F | 00149.35 |
1 | L5645 | BELOW KNEE,FLEXIBLE INNER SOCKET,EXTERNA | F | 00263.29 |
1 | L5646 | ADD. TO LO EXTRM PROS - BELOW KNEE AIR C | F | 00106.21 |
1 | L5647 | ADD TO LO EXTRM-BELOW KNEE SUCTION SOCKE | F | 00776.88 |
1 | L5648 | ADDITIONS TO LOWER EXTREMITY, ABOVE KNEE | F | 00309.76 |
1 | L5649 | ADD TO LOW EXTREM,ISCHIAL CONTAINMENT/NA | F | 01394.57 |
1 | L5650 | ADD TO LO EXTRM PROS-TOTAL CONTACT AK OR | F | 00357.57 |
1 | L5651 | ADD TO LO EXTRM-AK,FLEXIBLE INNER SOCKET | F | 00526.49 |
1 | L5652 | ADD. TO LO EXTRM PROS-SUCTION SUSP AK OR | F | 00319.36 |
1 | L5653 | ADD. TO LO EXTRM PROS - KNEE DISART EXPA | F | 00070.80 |
1 | L5654 | ADD. TO LO EXTRM PROS-SOCKET INSERT SYME | F | 00178.11 |
1 | L5655 | ADD. TO LO EXTRM PROS-SOCKET INSERT KEMB | F | 00194.28 |
1 | L5656 | ADD. TO LO EXTRM PROS-SOCKET INSRT KNEE | F | 00070.80 |
1 | L5658 | ADD. TO LO EXTRM PROS-SOCKET INSERT AK K | F | 00320.63 |
1 | L5661 | ADD. TO LOWER EXTREMTIY, SOCKET INSERT | F | 00519.19 |
1 | L5665 | ADD. TO LOWERE EXTREMTIY, SOCKET, GEL | F | 00513.15 |
1 | L5666 | ADD TO LO EXTRM PROS- BK CUFF SUSPENSION | F | 00054.68 |
1 | L5668 | ADD TO LO EXTRM PROS-BK MOLDED DISTAL CU | F | 00088.86 |
1 | L5670 | ADD TO LO EXTRM PROS-BK MOLDED SUPRA CON | F | 00198.74 |
1 | L5671 | ADD TO LOWER EXT.BK/AK SUSP LOCK | F | 00540.87 |
1 | L5672 | ADD TO LO EXTRM PROS-BK REMOVABLE MEDIAL | F | 00225.82 |
1 | L5673 | ADD.LOWER EXT.BKN,AKN PREFAB.SOCKET INSE | F | 00617.63 |
1 | L5676 | ADD TO LO EXTRM PROS-BK KNEE JNTS (PAIR) | F | 00070.80 |
1 | L5677 | ADD TO LO EXT PROS,BELOW KNEE,KNEE JOINT | F | 00152.66 |
1 | L5678 | ADD TO LO EXTRM PROS-BK JNT COVERS (PAIR | F | 00029.86 |
1 | L5679 | ADD.LOWER EXTBKN/AKN SOCKET PREFABRIC | F | 00514.58 |
1 | L5680 | ADD TO LO EXTRM PROS-BK THIGH LACER NON | F | 00160.40 |
1 | L5681 | ADD.LOWER EXT.BKN/AKN CUSTOM SOCKET INSE | F | 01085.48 |
1 | L5682 | ADD TO LO EXTRM PROS-BK THIGH LACER GLUT | F | 00368.38 |
1 | L5683 | ADD.LOWER EXT.BKN/AKN,CUSTOM INSERT | F | 01085.48 |
1 | L5684 | ADD TO LO EXTRM PROS-BK FORK STRAP | F | 00039.02 |
1 | L5685 | ADD TO LOWER EXT PROTH BELOW KNEE,SUSP | F | 00105.67 |
1 | L5686 | ADD TO LO EXTRM PROS-BK BACK CHECK (EXTE | F | 00014.38 |
1 | L5688 | ADD TO LO EXTRM PROS-BK WAIST BELT WEBBI | F | 00051.95 |
1 | L5690 | ADD TO LO EXTRM PROS-BK WAIST BELT PAD/L | F | 00059.75 |
1 | L5692 | ADD TO LO EXTRM PROS-AK PELVIC CONTROL B | F | 00066.38 |
1 | L5694 | ADD TO LO EXTRM PROS-AK PELVIC CONTROL B | F | 00096.24 |
1 | L5695 | ADD. TO LOWER EXTREM,A/K PELVIC CONTROL | F | 00124.03 |
1 | L5696 | ADD TO LO EXTRM PROS-AK OR KNEE DISART P | F | 00044.24 |
1 | L5697 | ADD TO LO EXTRM PROS-AK OR KNEE DISART P | F | 00030.97 |
1 | L5698 | ADD TO LO EXTRM PROS-AK OR KNEE DISART S | F | 00069.69 |
1 | L5699 | ADD TO LO EXTRM PROS-SHOULDER HARNESS | F | 00089.58 |
1 | L5700 | REPLACEMENT, SOCKET, BELOW KNEE, MOLDED | F | 02396.55 |
1 | L5701 | REPLACE,SOCKET,ABOVE KNEE,WITH ATTACH PL | F | 02904.29 |
1 | L5702 | REPLACEMENT, SOCKET, HIP DISARTICUL. INC | F | 04105.25 |
1 | L5703 | SYMES ANKLE W/O (SACH) FOOT | F | 02005.90 |
1 | L5704 | CUSTOM SHAPED PROTECTIVE CO | F | 00442.12 |
1 | L5705 | CUSTOM COVER, ABOVE KNEE | F | 00770.90 |
1 | L5706 | CUSTOMY SHAPED PROTECTIVE COVER | F | 00719.38 |
1 | L5707 | CUSTOM SHAPED PROTECTIVE COVER HIP | F | 01022.64 |
1 | L5710 | ADDITIONS KNEE-SHIN SYSTEM SINGLE AXIS, | F | 00141.60 |
1 | L5711 | ADD. EXOSKELETAL KNEE-SHIN SINGLE AXIS | F | 00435.45 |
1 | L5712 | ADDITIONS KNEE-SHIN SYSTEM SINGLE AXIS F | F | 00110.62 |
1 | L5714 | ADDITIONS KNEE-SHIN SYSTEM SINGLE AXIS V | F | 00053.10 |
1 | L5716 | ADDITIONS KNEE-SHIN SYSTEM POLYCENTRIC M | F | 00599.27 |
1 | L5718 | ADDITIONS KNEE-SHIN SYSTEM POLYCENTRIC F | F | 00409.73 |
1 | L5722 | ADDITIONS KNEE-SHIN SYSTEM SINGLE AXIS P | F | 00508.88 |
1 | L5724 | ADDITIONS KNEE-SHIN SYSTEM SINGLE SINGLE | F | 00849.63 |
1 | L5726 | ADDITIONS, KNEE-SHIN SYSTEM, SINGLE AXIS | F | 01441.60 |
1 | L5728 | ADDITIONS, KNEE-SHIN SYSTEM, SINGLE AXIS | F | 01690.16 |
1 | L5780 | ADDITIONS, KNEE-SHIN SYSTEM, SINGLE AXIS | F | 01085.58 |
1 | L5781 | ADD.LOWER EXT.VACUME PUMP | F | 03300.81 |
1 | L5782 | ADD.TO LOWER EXT,VAUME PUMP,HEAVY DUTY | F | 03479.82 |
1 | L5785 | ADD,EXOSKELETAL SYS,BELOW KNEE,LIGHT MAT | F | 00380.55 |
1 | L5790 | ADD,EXOSKELETAL SYS,ABOVE KNEE,LIGHT MAT | F | 00541.13 |
1 | L5795 | ADD,EXOSKELETAL SYS,HIP DISARTICULATION, | F | 00786.45 |
1 | L5810 | ADD. ENDOSKELETAL KNEE-SHIN SYSTEM SINGL | F | 00370.29 |
1 | L5811 | ADD. ENDOSKEL KNEE-SHIN, ULTRA LIGHT | F | 00583.14 |
1 | L5812 | ADD,ENDOSKELETAL KNEE-SHIN SYS,SINGLE AX | F | 00444.34 |
1 | L5814 | ADD. ENDOSKEL KNEE SHIN, POLYCENTRIC | F | 02827.17 |
1 | L5816 | ADD. ENDOSKEL KNEE-SHIN MECHANICAL LOCK | F | 00646.82 |
1 | L5818 | ADD. ENDOSKEL KNEE-SHIN FRICTION SWING | F | 00861.99 |
1 | L5822 | ADD., ENDOSKELETAL,KNEE-SHIN PNEUMATIC | F | 01286.20 |
1 | L5824 | ADD. ENDO. KNEE-SHIN,FLUID SWING | F | 01201.36 |
1 | L5826 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM | F | 02040.71 |
1 | L5828 | ADD,ENDOSKELETAL KNEE-SHIN,SINGLE AXIS,S | F | 02297.08 |
1 | L5830 | ADD. ENDO KNEE SHIN, PNEUMATIC SWING | F | 01568.46 |
1 | L5840 | ADD. ENDO KNEE-SHIN 4-BAR LINKAGE | F | 03108.04 |
1 | L5845 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, | F | 01710.48 |
1 | L5848 | ADD.TO ENDOSKEL.KNEE-SHIN SYSTEM | F | 00860.77 |
1 | L5850 | ADD. ENDO KNEE-SHIN AK OR HIP DISART | F | 00096.62 |
1 | L5855 | ADD. ENDO. HIP DISARTICULATION | F | 00311.00 |
1 | L5856 | ADD.LOWER EXT PROST.ENDOSKEL,SYSTEM | F | 19799.35 |
1 | L5857 | ADD.LOWER EXT,PROST.SWING PHASE,ANY TYPE | F | 07022.62 |
1 | L5858 | STANCE PHASE ONLY | F | 15332.09 |
1 | L5859 | Addition to lower extremity prosthesis, | M | 00000.00 |
1 | L5910 | ADD,ENDOSKELETAL SYS, BELOW KNEE,ALIGNAB | F | 00265.28 |
1 | L5920 | ADD,ENDOSKELETAL SYS,ABOVE KNEE OR HIP D | F | 00388.63 |
1 | L5925 | ADDITION,ENDOSKEL,ABOVE KNEE,DISARTIC OR | F | 00335.83 |
1 | L5930 | ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTI | F | 02465.05 |
1 | L5940 | ADD,ENDOSKEL SYS,BELOW KNEE,LIGHT MATERI | F | 00487.30 |
1 | L5950 | ADD,ENDOSKEL SYS,ABOVE KNEE, LIGHT MATER | F | 00612.20 |
1 | L5960 | ADD,ENDOSKEL SYS,HIP DISARTICULATION,LIG | F | 00782.99 |
1 | L5961 | ADDITION, ENDOSKELETAL SYSTEM | M | 00000.00 |
1 | L5962 | ADDITION, ENDOSKELETAL SYS., BELOW KNEE | F | 00591.94 |
1 | L5964 | ADDITION, ENDOSKELETAL SYS., ABOVE KNEE | F | 00868.80 |
1 | L5966 | ADDITION, ENDOSKELETAL SYS., HIP | F | 01126.36 |
1 | L5968 | ADDITION TO LOWER LIMB PROTHESIS, | F | 02747.06 |
1 | L5969 | Addition, endoskeletal ankle-foot or ank | F | 13089.32 |
1 | L5970 | ALL LOWER EXTREMITY PROSTHESES, FOOT, | F | 00158.36 |
1 | L5971 | SACH FOOT, REPLACEMENT | F | 00158.36 |
1 | L5972 | ALL LOWER EXTREMITY PROSTHESES, FLEXIBLE | F | 00294.65 |
1 | L5973 | ANKLE FT SYS,DORSIFLEX&/OR PLANTR FLEX | F | 15227.49 |
1 | L5974 | ALL LOWER EXTREMITY PROSTHESIS, FOOT | F | 00165.72 |
1 | L5975 | ALL LOWER EXTR. PROSTHESIS, COMBINATION | F | 00350.45 |
1 | L5976 | ALL LOWER EXTR. PROSTHESES, ENERGY | F | 00476.45 |
1 | L5978 | ALL LOWER EXTR. PROSTHESES, FOOT, MULTI- | F | 00293.88 |
1 | L5979 | ALL LOWER EXTR. PROSTHESES, DYNAMIC | F | 02297.87 |
1 | L5980 | ALL LOWER EXTREMITY PROSTHESES,FLEX-FOOT | F | 03022.56 |
1 | L5981 | ALL LOWER EXTR. PROSTHESES, FLEX-WALK | F | 02522.36 |
1 | L5982 | ALL EXOSKELETAL LOWER EXTREMITY PROS. | F | 00508.83 |
1 | L5984 | ALL ENDOSKELETAL LOWER EXTREMITY PROS. | F | 00504.19 |
1 | L5985 | ALL ENDOSKELETAL LOWER EXTR. PROS., DYNA | F | 00213.25 |
1 | L5986 | ALL LOWER EXTR. PROS., MULTI-AXIAL ROTAT | F | 00539.56 |
1 | L5987 | ALL LOWER EXTREMITY PROSTHESES, SHANK | F | 05934.58 |
1 | L5988 | ADDITION TO LOWER LIMB PROTHESIS, VERTIC | F | 01510.16 |
1 | L5990 | ADD TO LOWER EXT. USER ADJ.HEEL HEIGHT | F | 01480.84 |
1 | L5999 | UNLISTED PROCEDURES FOR LOWER EXTREMITY | M | 00000.00 |
1 | L6000 | PARTIAL HAND, THUMB REMAINING | F | 00885.02 |
1 | L6010 | PARTIAL HAND,LITTLE&OR RING FINGER | F | 00885.02 |
1 | L6020 | PARTIAL HAND, NO FINGER REMAINING | F | 00885.02 |
1 | L6026 | TRANSCARPAL/METACARPAL OR PARTIAL HAND D | M | 00000.00 |
1 | L6050 | WRIST DISARTICULATION, MOLDED SOCKET, FL | F | 01229.20 |
1 | L6055 | WRIST DISARTICULATION, EXPANDABLE INTERF | F | 02105.20 |
1 | L6100 | BELOW-ELBOW MOLDED SOCKET FLEXIBLE ELBOW | F | 01331.63 |
1 | L6110 | BELOW ELBOW MOLDED SOCKET (MUENSTER OR N | F | 01434.07 |
1 | L6120 | BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SO | F | 01536.50 |
1 | L6130 | BELOW ELBOW MOLDED DOUBLE WALL SPLIT SOC | F | 01741.38 |
1 | L6200 | ELBOW DISARTICULATION, MOLDED SOCKET, OU | F | 02048.66 |
1 | L6205 | ELBOW DISARTICULATION, WITH EXPANDABLE | F | 02825.42 |
1 | L6250 | ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, | F | 01946.22 |
1 | L6300 | SHOULDER DISARTICULATION, MOLDED SOCKET, | F | 02560.83 |
1 | L6310 | SHOULDER DISARTICULATION PASSIVE RESTORA | F | 02151.10 |
1 | L6320 | SHOULDER DISARTICULATION PASSIVE RESTORA | F | 00921.90 |
1 | L6350 | INTERSCAPULAR THORACIC, MOLDED SOCKET, S | F | 02048.66 |
1 | L6360 | INTERSACPULAR THORACIC PASSIVE RESTORATI | F | 01946.22 |
1 | L6370 | INTERSCAPULAR THORACIC PASSIVE RESTORATI | F | 00921.90 |
1 | L6380 | IMMEDIATE POSTSUGICAL OR EARLY FITTING, | F | 01055.52 |
1 | L6382 | IMMED POST SURG/EARLY FIT APLIC INIT RIG | F | 01240.36 |
1 | L6384 | IMMED. POSTSURGICAL OR EARLY FITTING, SH | F | 01572.02 |
1 | L6386 | IMMED. POSTSURGICAL OR EARLY FITTING, EA | F | 00344.85 |
1 | L6388 | IMMED. POSTSURGICAL OR EARLY FITTING, AP | F | 00357.33 |
1 | L6400 | BELOW ELBOW MOLDED SOCKET ENPLOSKELETAL | F | 01024.34 |
1 | L6450 | ELBOW DISARTICULATION MOLDED SOCKET ENDO | F | 01434.07 |
1 | L6500 | ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL | F | 01536.50 |
1 | L6550 | SHOULDER DISARTICULATION MOLDED SOCKET E | F | 01843.80 |
1 | L6570 | INTERSCAPULAR THORACIC MOLDED SOCKET END | F | 01536.50 |
1 | L6580 | PREPARATORY, WRIST DISARTICULATION OR BE | F | 01270.43 |
1 | L6582 | PREP., WRIST DISART. OR BELOW ELBOW, DIR | F | 01080.15 |
1 | L6584 | PREP., ELBOW DISARTICULATION OR ABOVE EL | F | 01567.54 |
1 | L6586 | PREP., ELBOW DISART. OR ABOVE, DIRECT FO | F | 01451.05 |
1 | L6588 | PREPARATORY, SHOULDER DISARTICULATION OR | F | 02297.88 |
1 | L6590 | PREPARATORY, SHOULDER DISART., DIRECT FO | F | 02027.65 |
1 | L6600 | UPPER EXTREMITY ADDITIONS POLYCENTRIC HI | F | 00100.87 |
1 | L6605 | SINGLE PIVOT HINGE (PAIR) | F | 00114.18 |
1 | L6610 | UPPER EXTREMITY ADDITIONS FLEXIBLE METAL | F | 00116.82 |
1 | L6611 | ADDITIONAL SWITCH, EXT POWER | F | 00339.66 |
1 | L6615 | UPPER EXTREMITY ADDITIONS, DISCONNECT LO | F | 00062.92 |
1 | L6616 | UPPER EXTREMITY ADDITION, ADD'L DISCONNE | F | 00048.99 |
1 | L6620 | UPPER EXTREMITY ADDITIONS, FLEXION-FRICT | F | 00142.42 |
1 | L6621 | FLEX/EXT WRIST W/WO FRICTION | F | 00142.42 |
1 | L6623 | SPRING ASSISTED ROTATIONAL WRIST UNIT WI | F | 00531.98 |
1 | L6624 | FLEX/EXT/ROTATION WRIST UNIT | F | 03106.90 |
1 | L6625 | UPPER EXTREMITY ADDITIONS, ROTATION WRIS | F | 00389.57 |
1 | L6628 | UPPER EXTREMITY ADDITION, QUICK DISCONNE | F | 00444.27 |
1 | L6629 | UPPER EXTR. ADD., QUICK DISCONNECT LAMIN | F | 00113.92 |
1 | L6630 | UPPER EXTREMITY ADDITION, STAINLESS STEE | F | 00162.78 |
1 | L6632 | UPPER EXTREMITY ADDITION, LATEX SUSPENSI | F | 00054.12 |
1 | L6635 | UPPER EXTREMITY ADDITIONS, LIFT ASSIST F | F | 00089.01 |
1 | L6637 | UPPER EXTREMITY ADDITION, NUDGE CONTROL | F | 00294.06 |
1 | L6638 | UPP.EXT.ADD.ELECT.LOCK.FOR ELBOW | F | 02063.02 |
1 | L6640 | UPPER EXTREMITY ADDITIONS, SHOULDER ABDU | F | 00189.89 |
1 | L6641 | UPPER EXTREMITY ADDITION, EXCURSION AMPL | F | 00147.36 |
1 | L6642 | UPPER EXTR. ADD., EXCURSION AMP., LEVER | F | 00201.77 |
1 | L6645 | UPPER EXTREMITY ADDITIONS, SHOULDER FLEX | F | 00278.89 |
1 | L6646 | UPPER EXT.ADD.SHOULDER JOINT,LOCKING | F | 02601.89 |
1 | L6647 | UPP.EXT.ADD.SHOULDER LOCK MECHANISM | F | 00428.35 |
1 | L6648 | UPP.EXT.ADD.SHOULDER LOCK,EXTERNAL POWER | F | 02683.49 |
1 | L6650 | SHOULDER UNIVERSAL JOINT (EACH) | F | 00198.02 |
1 | L6655 | UPPER EXTREMITY ADDITIONS STANDARD CONTR | F | 00044.24 |
1 | L6660 | UPPER EXTREMITY ADDITIONS HEAVY DUTY CON | F | 00048.67 |
1 | L6665 | UPPER EXTREMITY ADDITIONS TELFLON OR EQU | F | 00015.37 |
1 | L6670 | UPPER EXTREMITY ADDITIONS HOOK TO HAND C | F | 00019.91 |
1 | L6672 | UPPER EXTRM LIMB ADD:HARNESS, CHEST/SHOU | F | 00070.80 |
1 | L6675 | UPPER EXTRM ADD:HARNESS FIG 8 SINGLE CON | F | 00050.44 |
1 | L6676 | UPPER EXTRM ADD: HARNESS FIG 8 DUAL CONT | F | 00057.51 |
1 | L6677 | UE TRIPLE CONTROL HARNESS | F | 00057.51 |
1 | L6680 | UPPER EXTRM ADD: TEST SOCKET WRIST DISAR | F | 00053.10 |
1 | L6682 | UPPER EXTRM ADD: TEST SOCKET ELBOW DISAR | F | 00053.10 |
1 | L6684 | UPPER EXTRM ADD: TEST SOCKET SHOULDER DI | F | 00053.10 |
1 | L6686 | UPPER EXTREMITY ADDITION, SUCTION SOCKET | F | 00445.89 |
1 | L6687 | UPPER EXTREMITY ADDITION, FRAME TYPE SOC | F | 00435.66 |
1 | L6688 | UPPER EXTR. ADD., FRAME TYPE SOCKET, ABO | F | 00420.82 |
1 | L6689 | UPPER EXTR. ADD., FRAME TYPE SOCKET, SHO | F | 00525.26 |
1 | L6690 | UPPER EXTR. ADD., FRAME TYPE SOCKET, INT | F | 00550.66 |
1 | L6691 | UPPER EXTREMITY ADDITION, REMOVABLE INSE | F | 00310.18 |
1 | L6692 | UPPER EXTREMITY ADDITION, SILICONE GEL | F | 00427.41 |
1 | L6693 | UPPER EXTREMITY ADDITION, LOCKING ELBOW, | F | 02146.14 |
1 | L6694 | ADD.UPPER EXT.PROST.ELBOW CUSTOM | F | 00617.44 |
1 | L6695 | ADD UPPER EXT PROST.ELBOW,CUSTOM | F | 00514.52 |
1 | L6698 | ADD.UPPER EXTE.PROSTH.ELBOW,LOCKING MECH | F | 00546.64 |
1 | L6703 | TERM DEV, PASSIVE HAND MITT | F | 00278.94 |
1 | L6704 | TERM DEV, SPORT/REC/WORK ATT | F | 00553.03 |
1 | L6706 | TERM DEV MECH HOOK VOL OPEN | F | 00336.49 |
1 | L6707 | TERM DEV MECH HOOK VOL CLOSE | F | 01214.72 |
1 | L6708 | TERM DEV MECH HAND VOL OPEN | F | 00816.02 |
1 | L6709 | TERM DEV MECH HAND VOL CLOSE | F | 01133.15 |
1 | L6711 | TERM DEVICE, HOOK, MECH, VOL OPEN, PED | F | 00582.38 |
1 | L6712 | TERM DEVICE, HOOK, MECH, VOL CLOS, PED | F | 01072.27 |
1 | L6713 | TERM DEVICE, HAND, MECH, VOL OPEN, PED | F | 01353.26 |
1 | L6714 | TERM DEVICE, HAND, MECH, VOL CLOS, PED | F | 01146.22 |
1 | L6715 | TERMINL DEVICE,INITIAL ISSUE OR REPLAC | M | 00000.00 |
1 | L6721 | TERM DEVICE, HOOK/HAND, HD,MECH,VOL OP | F | 02037.31 |
1 | L6722 | TERM DEV, HOOK/HAND, HD, MECH,VOL CLOS | F | 01756.31 |
1 | L6805 | TERMINAL DEVICES, MODIFIER WRIST FLEXION | F | 00193.60 |
1 | L6810 | TERMINAL DEVICE,PINCHER TOOL,OTTO BOCK O | F | 00149.09 |
1 | L6881 | AUTOMATIC GRASP FEATURE,ADD.TO LIMB | F | 03337.01 |
1 | L6882 | MICROPROCESSOR CONT FEATURE ADD TO LIMB | F | 02683.52 |
1 | L6883 | REPLC SOCKT BELOW E/W DISA | F | 01331.63 |
1 | L6884 | REPLC SOCKT ABOVE ELBOW DISA | F | 01331.63 |
1 | L6885 | REPLC SOCKT SHLDR DIS/INTERC | F | 01331.63 |
1 | L6890 | GLOVE FOR ABOVE HANDS, PRODUCTION GLOVE | F | 00070.34 |
1 | L6895 | GLOVE FOR ABOVE HANDS, CUSTOM GLOVE | F | 00272.70 |
1 | L6900 | HAND RESTORATION (CASTE SHADING AND MEAS | F | 01492.15 |
1 | L6905 | HAND RESTORATION (CASTE, SHADING AND MEA | F | 01184.97 |
1 | L6910 | HAND RESTORATION (CASTE SHADING AND MEAS | F | 01440.44 |
1 | L6915 | HAND RESTORATION (SHADING AND MEASUREMEN | F | 00625.48 |
1 | L6920 | WRIST DISARTICULATION, EXTERNAL POWER, | F | 06188.72 |
1 | L6925 | WRIST DISARTICULATION, EXT. POWER, MYOEL | F | 06808.52 |
1 | L6930 | BELOW ELBOW, EXTERNAL POWER, SELF- | F | 06139.55 |
1 | L6935 | BELOW ELBOW, EXT. POWER, SELF-SUSPENDED | F | 06942.32 |
1 | L6940 | ELBOW DISARTICULATION, EXTERNAL POWER, | F | 07249.12 |
1 | L6945 | ELBOW DISARTICULATION, EXT. POWER, MYOEL | F | 08413.25 |
1 | L6950 | ABOVE ELBOW, EXTERNAL POWER, MOLDED INNE | F | 08219.86 |
1 | L6955 | ABOVE ELBOW, EXT. POWER, MYOELECTRONIC | F | 09844.39 |
1 | L6960 | SHOULDER DISARTRICULATION, EXTERNAL POWE | F | 10219.98 |
1 | L6965 | SHOULDER DISARTICULATION, MYOELECTRONIC | F | 11839.36 |
1 | L6970 | INTERSCAPULAR-THORACIC EXT. POWER | F | 12443.66 |
1 | L6975 | INTERSCAPULAR-THORACIC, MYOELECTRONIC | F | 14029.61 |
1 | L7007 | ADULT ELECTRIC HAND | F | 02836.28 |
1 | L7008 | PEDIATRIC ELECTRIC HAND | F | 04551.74 |
1 | L7009 | ADULT ELECTRIC HOOK | F | 02893.91 |
1 | L7040 | PREHENSILE ACTUATOR, HOSMER OR EQUAL | F | 02185.28 |
1 | L7045 | ELECTRONIC HOOK, CHILD, MICHIGAN OR EQUA | F | 01332.26 |
1 | L7170 | ELECTRONIC ELBOW, HOSMER OR EQUAL | F | 04832.97 |
1 | L7180 | ELECTRONIC ELBOW, BOSTON, UTAH OR EQUAL | F | 29785.66 |
1 | L7181 | ELECTRONIC ELBOW,MICROPROCESS | F | 33054.60 |
1 | L7185 | ELECTRONIC ELBOW, ADOLESCENT, VARIETY | F | 04894.03 |
1 | L7186 | ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE | F | 08978.81 |
1 | L7190 | ELECTRONIC ELBOW, ADOLESCENT, MYOELECTRO | F | 06282.09 |
1 | L7191 | ELECTRONIC ELBOW, CHILD, MYOELECTRONICAL | F | 08741.37 |
1 | L7360 | SIX VOLT BATTERY, OTTO BOCK OR EQUAL, EA | F | 00172.45 |
1 | L7362 | BATTERY CHARGER, SIX VOLT, OTTO BOCK OR | F | 00189.23 |
1 | L7364 | TWELVE VOLT BATTERY, UTAH OR EQUAL, EACH | F | 00355.78 |
1 | L7366 | BATTERY CHARGER, TWELVE VOLT, UTAH OR EQ | F | 00445.53 |
1 | L7367 | LITHIUM ION BATTERY,REPLACEMENT | F | 00321.16 |
1 | L7368 | LITHIUM ION BATTERY CHARGER,REPLACEMNT | F | 00416.34 |
1 | L7400 | ADD UE PROST BE/WD, ULTLITE | F | 00070.34 |
1 | L7401 | ADD UE PROST A/E ULTLITE MAT | F | 00283.05 |
1 | L7402 | ADD UE PROST S/D ULTLITE MAT | F | 00305.68 |
1 | L7403 | ADD UE PROST B/E ACRYLIC | F | 00303.79 |
1 | L7404 | ADD UE PROST A/E ACRYLIC | F | 00458.52 |
1 | L7405 | ADD UE PROST S/D ACRYLIC | F | 00599.67 |
1 | L7499 | UNLISTED PROCEDURES FOR UPPER EXTREMITY | M | 00000.00 |
1 | L7510 | REPAIR PROSTHETIC DEVICE, REPAIR OR REPL | M | 00000.00 |
1 | L7520 | REPAIR PROSTETIC DEVICE, LABOR COMPONENT | F | 00016.65 |
1 | L7600 | PROSTHETIC DONNING SLEEVE | F | 00007.19 |
1 | L8000 | BREAST PROSTHESES, MASTECTOMY BRA | F | 00028.76 |
1 | L8001 | BREAST PROST.MAST.BRA,WITH FORM UNILATER | F | 00102.38 |
1 | L8002 | BREAST PROST.MAST.BRA WITH FORM BILATER | F | 00134.69 |
1 | L8010 | BREAST PROSTHESIS MASTECTOMY SLEEVE | F | 00057.25 |
1 | L8015 | EXTERNAL BREAST PROSTHESIS GARMENT, WITH | F | 00045.30 |
1 | L8020 | BREAST PROSTHESES, MASTECTOMY FORM | F | 00169.38 |
1 | L8030 | BREAST PROSTHESIS, SILICONE OR EQUAL | F | 00269.34 |
1 | L8032 | NIPPLE PROSTHESIS,REUSABLE,ANY TYPE,EA | M | 00000.00 |
1 | L8035 | CUSTOM BREAST PROSTHESIS, POST MASTECTOM | F | 02769.53 |
1 | L8039 | BREAST PROTHESIS, NOT CLASSIFIED | M | 00000.00 |
1 | L8300 | TRUSSES, SINGLE WITH STANDARD PAD | F | 00033.59 |
1 | L8310 | TRUSSES DOUBLE WITH STANDARD PADS | F | 00128.64 |
1 | L8320 | TRUSSES ADDITION TO STANDARD PADS, WATER | F | 00040.38 |
1 | L8330 | TRUSSES ADDITION TO STANDARD PADS, SCROT | F | 00037.28 |
1 | L8400 | PROSTHETIC SHEATH BELOW KNEE (EACH) | F | 00007.19 |
1 | L8410 | PROSTHETIC SHEATH ABOVE KNEE (EACH) | F | 00007.19 |
1 | L8415 | PROSTHETIC SHEATH, UPPER LIMB, EACH | F | 00018.37 |
1 | L8417 | PROSTHETIC SHEATH/SOCK, INCLUDING A GEL | F | 00056.85 |
1 | L8420 | PROSTHETIC SOCK, WOOL, BELOW KNEE, EACH | F | 00015.77 |
1 | L8430 | PROSTHETIC SOCK,WOOL,ABOVE KNEE, EACH | F | 00017.38 |
1 | L8435 | PROSTHETIC SOCK, MULTIPLE PLY, UPPER LIM | F | 00017.58 |
1 | L8440 | PROSTHETIC SHRINKER, BELOW KNEE, EACH | F | 00027.66 |
1 | L8460 | PROSTHETIC SHRINKER, ABOVE KNEE, EACH | F | 00047.38 |
1 | L8465 | PROSTHETIC SHRINKER, UPPER LIMB, EACH | F | 00036.85 |
1 | L8470 | STUMP SOCK SINGLE PLY BELOW KNEE (EACH) | F | 00001.26 |
1 | L8480 | STUMP SOCK SINGLE ABOVE KNEE (EACH) | F | 00001.50 |
1 | L8485 | PROSTHETIC SOCK, SINGLE PLY, FITTING, UP | F | 00011.05 |
1 | L8499 | UNLISTED PROCEDURE FOR MISCELLANEOUS PRO | M | 00000.00 |
1 | L8500 | ARTIFICIAL LARYNX, ANY TYPE | F | 00618.78 |
1 | L8501 | TRACHEOSTOMY SPEAKING VALVE | F | 00091.24 |
1 | L8505 | ART. LARYNX REPLAC. BATTERY ANY TYPE | M | 00000.00 |
1 | L8507 | TRACHOE-ESOPH VOICE PROSTHESIS PT.INSERT | F | 00034.20 |
1 | L8509 | TRACHEO-ESOPH VOICE PROST,INSERT.BY PROV | F | 00089.14 |
1 | L8510 | VOICE AMPLIFIER | F | 00206.27 |
1 | L8511 | INSERT FOR TRACHEOESOPH.PROSTHESIS REPLA | F | 00060.01 |
1 | L8512 | GELETIN CAPSULES FOR VOICE PROSTHESIS | F | 00001.77 |
1 | L8513 | CLEANING DEVICE FOR TRACHEOSOPH DEVICE | F | 00004.29 |
1 | L8514 | TRACHEOSOPHAGEAL DILATOR REPLACEMENT | F | 00077.81 |
1 | L8515 | GELATIN CAPSULE,APPL DEVICE,FOR VOICE | F | 00050.53 |
1 | L8609 | ARTIFICIAL CORNEA | F | 00618.78 |
1 | L8615 | HEADSET/HEADPIECE W/COCHLEAR DEVICE | F | 00375.79 |
1 | L8616 | MICROPHONE FOR COCH.IMPLANT REPLACE | F | 00087.51 |
1 | L8617 | TRANSMITTING COIL FOR COCH.IMPLANT - REP | F | 00076.44 |
1 | L8618 | TRANSMITTER CABLE FOR COCH.IMPLANT-REPLA | F | 00021.86 |
1 | L8619 | COCHLEAR IMPLANT EXTERNAL SPEECH PROCESS | M | 00000.00 |
1 | L8621 | ZINC AIR BATTERY FOR USE WITH COCH.DEVIC | F | 00000.51 |
1 | L8622 | ALKALINE BATTERY FOR USE WITH COCH DEVIC | F | 00000.27 |
1 | L8623 | LITH ION BATT CID,NON-EARLVL | F | 00056.04 |
1 | L8624 | LITH ION BATT CID, EAR LEVEL | F | 00139.69 |
1 | L8627 | COCHLEAR IMPL,EXT PROCESSOR,REPLACMENT | F | 05967.09 |
1 | L8628 | COCHLEAR IMPL,EXT CONTROLER,REPLACEMNT | F | 01082.04 |
1 | L8629 | COIL&CABLE,W/COCHLR IMPLNT DV,REPLCMNT | M | 00000.00 |
1 | L8690 | AUD OSSEO DEV, INT/EXT COMP | M | 00000.00 |
1 | L8691 | AUD OSSEO DEV EXT SND PROCES | M | 00000.00 |
1 | L8692 | AUDIO OSSEOINTEGRATD DVC,EXT PROCESSOR | M | 00000.00 |
1 | L8693 | AUDITORY OSSEOINTEGRATD DEVICE,REPLACE | F | 01312.17 |
1 | S0395 | IMPRESSION CASTING OF THE FOOT | F | 00023.39 |
1 | S1015 | IV TUBING EXTENSION SET | M | 00000.00 |
1 | S1040 | CRANIAL ORTHOSIS | F | 02691.39 |
1 | S5185 | MED REMINDER SERV, NON-FACE-TO-FACE | M | 00000.00 |
1 | S5560 | INSULIN DELIVERY DEVICE, REUSABLE; 1.5 M | M | 00000.00 |
1 | S5561 | INSULIN DELIVERY DEVICE, REUSABLE; 3 ML | M | 00000.00 |
1 | S8100 | HOLDING CHAMBER FOR SPACER,W/O MASK | F | 00029.66 |
1 | S8101 | HOLDING CHAMBER FOR INHALER W/MASK | F | 00043.93 |
1 | S8270 | ENURESIS ALARM | F | 00047.59 |
R | S8270 | ENURESIS ALARM | F | 00001.12 | RR
1 | S8420 | COMPRESSION SLEEVE&GLOVE COMB, CUSTOM | M | 00000.00 |
1 | S8421 | COMPRESSION SLEEVE&GLOVE COMB,READY MADE | M | 00000.00 |
1 | S8422 | COMPRESSION SLEEVE, CUSTOM MADE, MED WT | M | 00000.00 |
1 | S8423 | COMPRESSION SLEEVE, CUSTOM MADE, HVY WT | M | 00000.00 |
1 | S8424 | COMPRESSION SLEEVE, READY MADE | M | 00000.00 |
1 | S8425 | COMPRESSION GLOVE, CUSTOM MADE, MED WT | M | 00000.00 |
1 | S8426 | COMPRESSION GLOVE, CUSTOM MADE, HVY WT | M | 00000.00 |
1 | S8427 | COMPRESSION GLOVE, READY MADE | M | 00000.00 |
1 | S8428 | COMPRESSION GAUNTLET, READY MADE | M | 00000.00 |
1 | S8429 | GRADIENT PRESSURE EXTERIOR WRAP | M | 00000.00 |
1 | S8430 | PADDING FOR COMPRESSION BANDAGE, ROLL | M | 00000.00 |
1 | S8431 | COMPRESSION BANDAGE, ROLL | M | 00000.00 |
1 | S8450 | SPLINT PREFABRICATED, DIGIT | F | 00002.12 |
1 | S8451 | SPLINT,PREFABRICATED,WRIST OR ANKLE | F | 00353.26 |
1 | S8490 | INSULIN SYRINGE (100 SYRINGES,ANY SIZE) | F | 00030.84 |
1 | S8999 | RESUSCITATION BAG | F | 00178.74 |
1 | S9434 | MODIFIED FOOD SUPP. FOR INBORN ERRORS | M | 00000.00 |
1 | S9435 | MEDICAL FOODS FOR INBORN ERROR OF METAB. | M | 00000.00 |
1 | T1013 | SIGN LANGUAGE OR ORAL INTERP SERVICES | F | 00014.39 |
U | T1013 | TELEPHONIC INTERPRETIVE SERVICES | F | 00001.63 | UC
R | T1505 | ELECTRONIC MED COMPLIANCE MGMT DEVICE | M | 00000.00 | RR
1 | T1505 | ELECTRONIC MED COMPLIANCE MGMT DEVICE | M | 00000.00 |
1 | T1999 | MISCELLANEOUS THERAPEUTIC ITEMS AND SUPP | M | 00000.00 |
1 | T4521 | ADULT BRIEF/DIAPER SMALL | F | 00000.77 |
1 | T4522 | ADULT BRIEF/DIAPER MEDIUM | F | 00000.78 |
1 | T4523 | ADULT BRIEF/DIAPER LARGE | F | 00001.01 |
1 | T4524 | ADULT DIAPER/BRIEF EXTRA LARGE | F | 00001.12 |
1 | T4525 | ADULT PULL-ON SMALL | F | 00000.77 |
1 | T4526 | ADULT PULL ON, MEDIUM | F | 00000.78 |
1 | T4527 | ADULT SIZE PULL ON LARGE | F | 00001.01 |
1 | T4528 | ADULT PULL-ON EXTRA LARGE | F | 00001.12 |
1 | T4529 | PEDIATRIC SIZE BRIEF/DIAPER SMALL/MEDIUM | F | 00000.77 |
1 | T4530 | PEDIATRIC BRIEF/DIAPER LARGE SIZE | F | 00000.87 |
1 | T4531 | PEDIATRIC PULL-ON SMALL/MEDIUM | F | 00000.77 |
1 | T4532 | PEDIATRIC SIZE PULL-ON LARGE | F | 00000.87 |
1 | T4533 | YOUTH SIZE BRIEF/DIAPER | F | 00000.87 |
1 | T4534 | YOUTH SIZE PULL-ON,EACH | F | 00000.87 |
1 | T4535 | DISP.LINER/SHIELD/GUARD/PAD UNDERGARMENT | F | 00000.40 |
1 | T4537 | PROTECTIVE UNDERPAD | F | 00014.14 |
1 | T4540 | PROTECTIVE UNDERPAD REUSABLE | F | 00007.07 |
1 | T4543 | DISP BARIATRIC BRIEF/DIAPER | F | 00000.76 |
1 | T4544 | Adult disposable incontinence product,pr | F | 00000.76 |
1 | T5001 | POSITION SEAT FOR VEHICLE | M | 00000.00 |
1 | V2623 | PROSTHETIC EYE, PLASTIC, CUSTOM | F | 00921.90 |
1 | V2624 | POLISHING/RESURFACING OCULAR PROSTHESIS | F | 00047.81 |
1 | V2625 | ENLARGEMENT OF OCULAR PROSTHESIS | F | 00366.54 |
1 | V2626 | REDUCTION OF OCULAR PROSTHESIS | F | 00199.91 |
1 | V2628 | FABRICATION AND FITTING OF OCULAR CONFOR | F | 00297.14 |
1 | V2629 | NOT OTHERWISE CLASSIFIED, PROSTHETIC EYE | M | 00000.00 |
1 | V2799 | VISION SERVICE, MISCELLANEOUS | M | 00000.00 |
1 | V5266 | BATTERY FOR USE IN HEARING AID | F | 00001.79 |
1 | 94772 | CIRCADIAN RESP PATTERN RECORD,12-24 HR | G | 00024.72 | 26
1 | 94772 | CIRCADIAN RESP PATTERN RECORD,12-24 HR | H | 00098.87 | TC
1 | 94772 | CIRCADIAN RESP PATTERN RECORD,12-24 HR | F | 00123.59 |
1 | 94774 | PED HOME APNEA MONITOR,/30 DAY PERIOD | M | 00000.00 |
1 | 94775 | PED HOME APNEA MONITOR,/30 DAY PERIOD | M | 00000.00 |
1 | 94776 | PED HOME APNEA MONITOR,/30 DAY PERIOD | M | 00000.00 |
1 | 94777 | PED HOME APNEA MONITOR,/30 DAY PERIOD | M | 00000.00 |
1 | 99082 | UNUSUAL TRAVEL; MILEAGE | F | 00000.24 |