Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies
PEIA January 2018 Fee Schedule
The absence or presents of a CPT Code does not determine coverage
HCPCS Mod Mod2 PEIA Fee Description
A4216 0.41 Sterile water/saline, 10 ml
A4217 3.00 Sterile water/saline, 500 ml
A4217 AU 3.00 Sterile water/saline, 500 ml
A4221 16.75 Supp non-insulin inf cath/wk
A4222 31.77 Infusion supplies with pump
A4224 16.75 Supply insulin inf cath/wk
A4225 2.24 Sup/ext insulin inf pump syr
A4233 NU 0.43 Alkalin batt for glucose mon
A4234 NU 2.01 J-cell batt for glucose mon
A4235 NU 0.85 Lithium batt for glucose mon
A4236 NU 0.99 Silvr oxide batt glucose mon
A4253 NU 7.07 Blood glucose/reagent strips
A4255 3.74 Glucose monitor platforms
A4256 2.87 Calibrator solution/chips
A4257 12.21 Replace lensshield cartridge
A4258 1.80 Lancet device each
A4259 1.21 Lancets per box
A4265 3.26 Paraffin
A4280 4.96 Brst prsths adhsv attchmnt
A4310 7.39 Insert tray w/o bag/cath
A4311 14.18 Catheter w/o bag 2-way latex
A4312 17.26 Cath w/o bag 2-way silicone
A4313 17.72 Catheter w/bag 3-way
A4314 24.19 Cath w/drainage 2-way latex
A4315 25.24 Cath w/drainage 2-way silcne
A4316 27.17 Cath w/drainage 3-way
A4320 4.56 Irrigation tray
A4321 0.00 Cath therapeutic irrig agent
A4322 2.78 Irrigation syringe
A4326 9.92 Male external catheter
A4327 40.43 Fem urinary collect dev cup
A4328 9.69 Fem urinary collect pouch
A4330 5.82 Stool collection pouch
A4331 3.04 Extension drainage tubing
A4332 0.11 Lube sterile packet
A4333 2.12 Urinary cath anchor device
A4334 4.71 Urinary cath leg strap
A4336 1.38 Urethral insert
A4338 11.73 Indwelling catheter latex
A4340 25.82 Indwelling catheter special
A4344 15.32 Cath indw foley 2 way silicn
A4346 18.73 Cath indw foley 3 way
A4349 1.93 Disposable male external cat
A4351 1.63 Straight tip urine catheter
A4352 5.23 Coude tip urinary catheter
A4353 6.69 Intermittent urinary cath
A4354 11.29 Cath insertion tray w/bag
A4355 8.41 Bladder irrigation tubing
A4356 43.65 Ext ureth clmp or compr dvc
A4357 9.29 Bedside drainage bag
A4358 6.34 Urinary leg or abdomen bag
A4360 0.47 Disposable ext urethral dev
A4361 17.57 Ostomy face plate
A4362 3.25 Solid skin barrier
A4363 2.27 Ostomy clamp, replacement
A4364 2.39 Adhesive, liquid or equal
A4366 1.24 Ostomy vent
A4367 7.04 Ostomy belt
A4368 0.24 Ostomy filter
A4369 2.32 Skin barrier liquid per oz
A4371 3.49 Skin barrier powder per oz
A4372 4.01 Skin barrier solid 4x4 equiv
A4373 6.00 Skin barrier with flange
A4375 16.43 Drainable plastic pch w fcpl
A4376 45.53 Drainable rubber pch w fcplt
A4377 4.11 Drainable plstic pch w/o fp
A4378 29.41 Drainable rubber pch w/o fp
A4379 14.37 Urinary plastic pouch w fcpl
A4380 35.71 Urinary rubber pouch w fcplt
A4381 4.43 Urinary plastic pouch w/o fp
A4382 23.55 Urinary hvy plstc pch w/o fp
A4383 26.97 Urinary rubber pouch w/o fp
A4384 9.20 Ostomy faceplt/silicone ring
A4385 4.88 Ost skn barrier sld ext wear
A4387 2.15 Ost clsd pouch w att st barr
A4388 4.17 Drainable pch w ex wear barr
A4389 5.95 Drainable pch w st wear barr
A4390 9.19 Drainable pch ex wear convex
A4391 6.77 Urinary pouch w ex wear barr
A4392 7.82 Urinary pouch w st wear barr
A4393 8.65 Urine pch w ex wear bar conv
A4394 2.47 Ostomy pouch liq deodorant
A4395 0.04 Ostomy pouch solid deodorant
A4396 38.73 Peristomal hernia supprt blt
A4397 4.58 Irrigation supply sleeve
A4398 13.23 Ostomy irrigation bag
A4399 9.97 Ostomy irrig cone/cath w brs
A4400 46.75 Ostomy irrigation set
A4402 1.53 Lubricant per ounce
A4404 1.48 Ostomy ring each
A4405 3.26 Nonpectin based ostomy paste
A4406 5.47 Pectin based ostomy paste
A4407 8.38 Ext wear ost skn barr <=4sq"
A4408 9.44 Ext wear ost skn barr >4sq"
A4409 5.95 Ost skn barr convex <=4 sq i
A4410 8.65 Ost skn barr extnd >4 sq
A4411 4.88 Ost skn barr extnd =4sq
A4412 2.58 Ost pouch drain high output
A4413 5.27 2 pc drainable ost pouch
A4414 4.71 Ost sknbar w/o conv<=4 sq in
A4415 5.73 Ost skn barr w/o conv >4 sqi
A4416 2.64 Ost pch clsd w barrier/filtr
A4417 3.56 Ost pch w bar/bltinconv/fltr
A4418 1.73 Ost pch clsd w/o bar w filtr
A4419 1.66 Ost pch for bar w flange/flt
A4420 0.00 Ost pch clsd for bar w lk fl
A4422 0.11 Ost pouch absorbent material
A4423 1.78 Ost pch for bar w lk fl/fltr
A4424 4.56 Ost pch drain w bar & filter
A4425 3.43 Ost pch drain for barrier fl
A4426 2.61 Ost pch drain 2 piece system
A4427 2.66 Ost pch drain/barr lk flng/f
A4428 6.23 Urine ost pouch w faucet/tap
A4429 7.89 Urine ost pouch w bltinconv
A4430 8.14 Ost urine pch w b/bltin conv
A4431 5.95 Ost pch urine w barrier/tapv
A4432 3.43 Os pch urine w bar/fange/tap
A4433 3.20 Urine ost pch bar w lock fln
A4434 3.60 Ost pch urine w lock flng/ft
A4435 5.52 1pc ost pch drain hgh output
A4450 AU 0.08 Non-waterproof tape
A4450 AV 0.08 Non-waterproof tape
A4450 AW 0.10 Non-waterproof tape
A4452 AU 0.34 Waterproof tape
A4452 AV 0.34 Waterproof tape
A4452 AW 0.37 Waterproof tape
A4455 1.37 Adhesive remover per ounce
A4456 0.23 Adhesive remover, wipes
A4461 3.15 Surgicl dress hold non-reuse
A4463 12.73 Surgical dress holder reuse
A4481 0.35 Tracheostoma filter
A4483 0.00 Moisture exchanger
A4556 9.88 Electrodes, pair
A4557 8.95 Lead wires, pair
A4558 5.22 Conductive gel or paste
A4559 0.09 Coupling gel or paste
A4561 19.08 Pessary rubber, any type
A4562 47.52 Pessary, non rubber,any type
A4565 7.36 Slings
A4595 8.79 Tens suppl 2 lead per month
A4602 NU 3.56 Replace lithium battery 1.5v
A4604 NU 32.77 Tubing with heating element
A4605 NU 15.69 Trach suction cath close sys
A4608 47.95 Transtracheal oxygen cath
A4614 22.75 Hand-held pefr meter
A4615 0.70 Cannula nasal
A4616 0.06 Tubing (oxygen) per foot
A4617 2.97 Mouth piece
A4618 NU 7.23 Breathing circuits
A4618 RR 0.84 Breathing circuits
A4618 UE 5.42 Breathing circuits
A4619 NU 1.66 Face tent
A4620 0.60 Variable concentration mask
A4623 5.32 Tracheostomy inner cannula
A4624 NU 2.52 Tracheal suction tube
A4625 6.62 Trach care kit for new trach
A4626 3.05 Tracheostomy cleaning brush
A4628 NU 3.58 Oropharyngeal suction cath
A4629 4.45 Tracheostomy care kit
A4630 NU 5.08 Repl bat t.e.n.s. own by pt
A4633 NU 39.25 Uvl replacement bulb
A4635 NU 4.90 Underarm crutch pad
A4635 RR 0.60 Underarm crutch pad
A4635 UE 3.26 Underarm crutch pad
A4636 NU 2.56 Handgrip for cane etc
A4636 RR 0.26 Handgrip for cane etc
A4636 UE 1.92 Handgrip for cane etc
A4637 NU 1.42 Repl tip cane/crutch/walker
A4637 RR 0.14 Repl tip cane/crutch/walker
A4637 UE 1.07 Repl tip cane/crutch/walker
A4638 NU 0.00 Repl batt pulse gen sys
A4638 RR 0.00 Repl batt pulse gen sys
A4638 UE 0.00 Repl batt pulse gen sys
A4639 RR 27.48 Infrared ht sys replcmnt pad
A4640 NU 42.03 Alternating pressure pad
A4640 RR 4.20 Alternating pressure pad
A4640 UE 31.53 Alternating pressure pad
A5051 1.98 Pouch clsd w barr attached
A5052 1.42 Clsd ostomy pouch w/o barr
A5053 1.66 Clsd ostomy pouch faceplate
A5054 1.72 Clsd ostomy pouch w/flange
A5055 1.27 Stoma cap
A5056 4.47 1 pc ost pouch w filter
A5057 9.19 1 pc ost pou w built-in conv
A5061 3.37 Pouch drainable w barrier at
A5062 2.00 Drnble ostomy pouch w/o barr
A5063 2.58 Drain ostomy pouch w/flange
A5071 5.75 Urinary pouch w/barrier
A5072 3.37 Urinary pouch w/o barrier
A5073 2.99 Urinary pouch on barr w/flng
A5081 3.17 Stoma plug or seal, any type
A5082 11.38 Continent stoma catheter
A5083 0.61 Stoma absorptive cover
A5093 1.59 Ostomy accessory convex inse
A5102 21.44 Bedside drain btl w/wo tube
A5105 39.01 Urinary suspensory
A5112 30.14 Urinary leg bag
A5113 3.83 Latex leg strap
A5114 7.28 Foam/fabric leg strap
A5120 AU 0.20 Skin barrier, wipe or swab
A5120 AV 0.21 Skin barrier, wipe or swab
A5121 6.83 Solid skin barrier 6x6
A5122 12.29 Solid skin barrier 8x8
A5126 1.07 Disk/foam pad +or- adhesive
A5131 12.89 Appliance cleaner
A5200 10.80 Percutaneous catheter anchor
A5500 60.83 Diab shoe for density insert
A5501 182.45 Diabetic custom molded shoe
A5503 29.98 Diabetic shoe w/roller/rockr
A5504 29.98 Diabetic shoe with wedge
A5505 29.98 Diab shoe w/metatarsal bar
A5506 29.98 Diabetic shoe w/off set heel
A5507 29.98 Modification diabetic shoe
A5512 24.81 Multi den insert direct form
A5513 37.03 Multi den insert custom mold
A6010 29.63 Collagen based wound filler
A6011 2.18 Collagen gel/paste wound fil
A6021 20.11 Collagen dressing <=16 sq in
A6022 20.11 Collagen drsg>16<=48 sq in
A6023 182.06 Collagen dressing >48 sq in
A6024 5.92 Collagen dsg wound filler
A6154 13.34 Wound pouch each
A6196 7.04 Alginate dressing <=16 sq in
A6197 15.73 Alginate drsg >16 <=48 sq in
A6199 5.06 Alginate drsg wound filler
A6203 3.22 Composite drsg <= 16 sq in
A6204 5.96 Composite drsg >16<=48 sq in
A6207 7.02 Contact layer >16<= 48 sq in
A6209 7.15 Foam drsg <=16 sq in w/o bdr
A6210 19.06 Foam drg >16<=48 sq in w/o b
A6211 28.10 Foam drg > 48 sq in w/o brdr
A6212 9.29 Foam drg <=16 sq in w/border
A6214 9.84 Foam drg > 48 sq in w/border
A6216 0.04 Non-sterile gauze<=16 sq in
A6217 0.00 Non-sterile gauze>16<=48 sq
A6219 0.92 Gauze <= 16 sq in w/border
A6220 2.47 Gauze >16 <=48 sq in w/bordr
A6222 2.04 Gauze <=16 in no w/sal w/o b
A6223 2.32 Gauze >16<=48 no w/sal w/o b
A6224 3.45 Gauze > 48 in no w/sal w/o b
A6229 3.45 Gauze >16<=48 sq in watr/sal
A6231 4.47 Hydrogel dsg<=16 sq in
A6232 6.56 Hydrogel dsg>16<=48 sq in
A6233 18.34 Hydrogel dressing >48 sq in
A6234 6.26 Hydrocolld drg <=16 w/o bdr
A6235 16.09 Hydrocolld drg >16<=48 w/o b
A6236 26.07 Hydrocolld drg > 48 in w/o b
A6237 7.57 Hydrocolld drg <=16 in w/bdr
A6238 21.81 Hydrocolld drg >16<=48 w/bdr
A6240 11.71 Hydrocolld drg filler paste
A6241 2.46 Hydrocolloid drg filler dry
A6242 5.80 Hydrogel drg <=16 in w/o bdr
A6243 11.79 Hydrogel drg >16<=48 w/o bdr
A6244 37.58 Hydrogel drg >48 in w/o bdr
A6245 6.95 Hydrogel drg <= 16 in w/bdr
A6246 9.50 Hydrogel drg >16<=48 in w/b
A6247 22.75 Hydrogel drg > 48 sq in w/b
A6248 15.55 Hydrogel drsg gel filler
A6251 1.90 Absorpt drg <=16 sq in w/o b
A6252 3.12 Absorpt drg >16 <=48 w/o bdr
A6253 6.06 Absorpt drg > 48 sq in w/o b
A6254 1.15 Absorpt drg <=16 sq in w/bdr
A6255 2.91 Absorpt drg >16<=48 in w/bdr
A6257 1.47 Transparent film <= 16 sq in
A6258 4.12 Transparent film >16<=48 in
A6259 10.46 Transparent film > 48 sq in
A6266 1.84 Impreg gauze no h20/sal/yard
A6402 0.11 Sterile gauze <= 16 sq in
A6403 0.41 Sterile gauze>16 <= 48 sq in
A6407 1.79 Packing strips, non-impreg
A6410 0.37 Sterile eye pad
A6411 0.00 Non-sterile eye pad
A6441 0.65 Pad band w>=3" <5"/yd
A6442 0.15 Conform band n/s w<3"/yd
A6443 0.26 Conform band n/s w>=3"<5"/yd
A6444 0.54 Conform band n/s w>=5"/yd
A6445 0.31 Conform band s w <3"/yd
A6446 0.38 Conform band s w>=3" <5"/yd
A6447 0.65 Conform band s w >=5"/yd
A6448 1.11 Lt compres band <3"/yd
A6449 1.67 Lt compres band >=3" <5"/yd
A6450 1.67 Lt compres band >=5"/yd
A6451 1.67 Mod compres band w>=3"<5"/yd
A6452 5.65 High compres band w>=3"<5"yd
A6453 0.60 Self-adher band w <3"/yd
A6454 0.75 Self-adher band w>=3" <5"/yd
A6455 1.33 Self-adher band >=5"/yd
A6456 1.22 Zinc paste band w >=3"<5"/yd
A6457 1.09 Tubular dressing
A6501 0.00 Compres burngarment bodysuit
A6502 0.00 Compres burngarment chinstrp
A6503 0.00 Compres burngarment facehood
A6504 0.00 Cmprsburngarment glove-wrist
A6505 0.00 Cmprsburngarment glove-elbow
A6506 0.00 Cmprsburngrmnt glove-axilla
A6507 0.00 Cmprs burngarment foot-knee
A6508 0.00 Cmprs burngarment foot-thigh
A6509 0.00 Compres burn garment jacket
A6510 0.00 Compres burn garment leotard
A6511 0.00 Compres burn garment panty
A6513 0.00 Compress burn mask face/neck
A6531 AW 41.39 Compression stocking bk30-40
A6532 AW 58.32 Compression stocking bk40-50
A6545 0.00 Grad comp non-elastic bk
A6545 AW 81.49 Grad comp non-elastic bk
A6550 20.81 Neg pres wound ther drsg set
A7000 NU 6.97 Disposable canister for pump
A7001 NU 31.65 Nondisposable pump canister
A7002 NU 3.66 Tubing used w suction pump
A7003 NU 1.25 Nebulizer administration set
A7004 NU 1.05 Disposable nebulizer sml vol
A7005 NU 9.97 Nondisposable nebulizer set
A7006 NU 6.35 Filtered nebulizer admin set
A7007 NU 2.77 Lg vol nebulizer disposable
A7008 NU 10.52 Disposable nebulizer prefill
A7009 NU 40.22 Nebulizer reservoir bottle
A7010 NU 13.40 Disposable corrugated tubing
A7012 NU 2.46 Nebulizer water collec devic
A7013 NU 0.48 Disposable compressor filter
A7014 NU 2.72 Compressor nondispos filter
A7015 NU 1.09 Aerosol mask used w nebulize
A7016 NU 6.94 Nebulizer dome & mouthpiece
A7017 NU 103.76 Nebulizer not used w oxygen
A7017 RR 10.38 Nebulizer not used w oxygen
A7017 UE 77.82 Nebulizer not used w oxygen
A7018 0.27 Water distilled w/nebulizer
A7020 NU 13.86 Interface, cough stim device
A7025 RR 41.62 Replace chest compress vest
A7026 NU 27.50 Replace chst cmprss sys hose
A7027 NU 102.01 Combination oral/nasal mask
A7028 NU 28.53 Repl oral cushion combo mask
A7029 NU 12.75 Repl nasal pillow comb mask
A7030 NU 73.38 Cpap full face mask
A7031 NU 28.46 Replacement facemask interfa
A7032 NU 15.96 Replacement nasal cushion
A7033 NU 12.85 Replacement nasal pillows
A7034 NU 46.30 Nasal application device
A7035 NU 15.20 Pos airway press headgear
A7036 NU 8.84 Pos airway press chinstrap
A7037 NU 9.81 Pos airway pressure tubing
A7038 NU 1.71 Pos airway pressure filter
A7039 NU 5.02 Filter, non disposable w pap
A7040 37.77 One way chest drain valve
A7041 70.98 Water seal drain container
A7044 NU 70.51 Pap oral interface
A7045 NU 9.71 Repl exhalation port for pap
A7045 RR 0.97 Repl exhalation port for pap
A7045 UE 7.28 Repl exhalation port for pap
A7046 NU 11.30 Repl water chamber, pap dev
A7047 NU 115.67 Resp suction oral interface
A7048 39.51 Vacuum drain bottle/tube kit
A7501 100.47 Tracheostoma valve w diaphra
A7502 47.76 Replacement diaphragm/fplate
A7503 10.85 Hmes filter holder or cap
A7504 0.65 Tracheostoma hmes filter
A7505 4.49 Hmes or trach valve housing
A7506 0.31 Hmes/trachvalve adhesivedisk
A7507 2.38 Integrated filter & holder
A7508 2.75 Housing & integrated adhesiv
A7509 1.35 Heat & moisture exchange sys
A7520 45.42 Trach/laryn tube non-cuffed
A7521 45.00 Trach/laryn tube cuffed
A7522 43.21 Trach/laryn tube stainless
A7524 74.06 Tracheostoma stent/stud/bttn
A7525 1.98 Tracheostomy mask
A7526 3.24 Tracheostomy tube collar
A7527 3.43 Trach/laryn tube plug/stop
A8000 NU 146.72 Soft protect helmet prefab
A8000 RR 14.67 Soft protect helmet prefab
A8000 UE 110.06 Soft protect helmet prefab
A8001 NU 146.72 Hard protect helmet prefab
A8001 RR 14.67 Hard protect helmet prefab
A8001 UE 110.06 Hard protect helmet prefab
A8002 NU 0.00 Soft protect helmet custom
A8002 RR 0.00 Soft protect helmet custom
A8002 UE 0.00 Soft protect helmet custom
A8003 NU 0.00 Hard protect helmet custom
A8003 RR 0.00 Hard protect helmet custom
A8003 UE 0.00 Hard protect helmet custom
A8004 NU 0.00 Repl soft interface, helmet
A8004 RR 0.00 Repl soft interface, helmet
A8004 UE 0.00 Repl soft interface, helmet
E0100 NU 18.68 Cane adjust/fixed with tip
E0100 RR 5.68 Cane adjust/fixed with tip
E0100 UE 15.08 Cane adjust/fixed with tip
E0105 NU 43.44 Cane adjust/fixed quad/3 pro
E0105 RR 8.48 Cane adjust/fixed quad/3 pro
E0105 UE 33.99 Cane adjust/fixed quad/3 pro
E0110 NU 63.10 Crutch forearm pair
E0110 RR 15.29 Crutch forearm pair
E0110 UE 47.30 Crutch forearm pair
E0111 NU 46.32 Crutch forearm each
E0111 RR 8.06 Crutch forearm each
E0111 UE 39.32 Crutch forearm each
E0112 NU 32.10 Crutch underarm pair wood
E0112 RR 9.51 Crutch underarm pair wood
E0112 UE 24.06 Crutch underarm pair wood
E0113 NU 17.19 Crutch underarm each wood
E0113 RR 4.92 Crutch underarm each wood
E0113 UE 12.89 Crutch underarm each wood
E0114 NU 38.38 Crutch underarm pair no wood
E0114 RR 8.19 Crutch underarm pair no wood
E0114 UE 34.14 Crutch underarm pair no wood
E0116 NU 22.57 Crutch underarm each no wood
E0116 RR 5.18 Crutch underarm each no wood
E0116 UE 16.98 Crutch underarm each no wood
E0117 RR 18.43 Underarm springassist crutch
E0130 NU 38.08 Walker rigid adjust/fixed ht
E0130 RR 3.81 Walker rigid adjust/fixed ht
E0130 UE 28.56 Walker rigid adjust/fixed ht
E0135 NU 38.25 Walker folding adjust/fixed
E0135 RR 3.83 Walker folding adjust/fixed
E0135 UE 28.69 Walker folding adjust/fixed
E0140 RR 23.91 Walker w trunk support
E0141 NU 40.42 Rigid wheeled walker adj/fix
E0141 RR 4.05 Rigid wheeled walker adj/fix
E0141 UE 30.31 Rigid wheeled walker adj/fix
E0143 NU 40.42 Walker folding wheeled w/o s
E0143 RR 4.05 Walker folding wheeled w/o s
E0143 UE 30.31 Walker folding wheeled w/o s
E0144 RR 22.17 Enclosed walker w rear seat
E0147 NU 327.20 Walker variable wheel resist
E0147 RR 32.72 Walker variable wheel resist
E0147 UE 245.40 Walker variable wheel resist
E0148 NU 69.90 Heavyduty walker no wheels
E0148 RR 6.99 Heavyduty walker no wheels
E0148 UE 52.42 Heavyduty walker no wheels
E0149 RR 10.41 Heavy duty wheeled walker
E0153 NU 56.43 Forearm crutch platform atta
E0153 RR 6.38 Forearm crutch platform atta
E0153 UE 42.31 Forearm crutch platform atta
E0154 NU 39.51 Walker platform attachment
E0154 RR 3.95 Walker platform attachment
E0154 UE 29.63 Walker platform attachment
E0155 NU 16.86 Walker wheel attachment,pair
E0155 RR 1.68 Walker wheel attachment,pair
E0155 UE 12.64 Walker wheel attachment,pair
E0156 NU 13.33 Walker seat attachment
E0156 RR 1.33 Walker seat attachment
E0156 UE 10.00 Walker seat attachment
E0157 NU 47.67 Walker crutch attachment
E0157 RR 4.77 Walker crutch attachment
E0157 UE 35.75 Walker crutch attachment
E0158 NU 17.88 Walker leg extenders set of4
E0158 RR 1.79 Walker leg extenders set of4
E0158 UE 13.41 Walker leg extenders set of4
E0159 NU 12.42 Brake for wheeled walker
E0159 RR 1.24 Brake for wheeled walker
E0159 UE 9.32 Brake for wheeled walker
E0160 NU 22.17 Sitz type bath or equipment
E0160 RR 2.22 Sitz type bath or equipment
E0160 UE 16.63 Sitz type bath or equipment
E0161 NU 20.77 Sitz bath/equipment w/faucet
E0161 RR 2.07 Sitz bath/equipment w/faucet
E0161 UE 15.57 Sitz bath/equipment w/faucet
E0162 NU 133.83 Sitz bath chair
E0162 RR 14.62 Sitz bath chair
E0162 UE 97.77 Sitz bath chair
E0163 NU 45.30 Commode chair with fixed arm
E0163 RR 4.53 Commode chair with fixed arm
E0163 UE 33.97 Commode chair with fixed arm
E0165 RR 10.43 Commode chair with detacharm
E0167 NU 8.38 Commode chair pail or pan
E0167 RR 0.84 Commode chair pail or pan
E0167 UE 6.29 Commode chair pail or pan
E0168 NU 99.90 Heavyduty/wide commode chair
E0168 RR 9.99 Heavyduty/wide commode chair
E0168 UE 74.93 Heavyduty/wide commode chair
E0170 RR 134.08 Commode chair electric
E0171 RR 24.64 Commode chair non-electric
E0175 NU 58.16 Commode chair foot rest
E0175 RR 5.81 Commode chair foot rest
E0175 UE 43.61 Commode chair foot rest
E0181 RR 13.12 Press pad alternating w/ pum
E0182 RR 16.28 Replace pump, alt press pad
E0184 NU 134.18 Dry pressure mattress
E0184 RR 13.42 Dry pressure mattress
E0184 UE 100.64 Dry pressure mattress
E0185 NU 143.28 Gel pressure mattress pad
E0185 RR 14.33 Gel pressure mattress pad
E0185 UE 107.46 Gel pressure mattress pad
E0186 RR 14.95 Air pressure mattress
E0187 RR 16.30 Water pressure mattress
E0188 NU 19.95 Synthetic sheepskin pad
E0188 RR 2.00 Synthetic sheepskin pad
E0188 UE 14.96 Synthetic sheepskin pad
E0189 NU 41.43 Lambswool sheepskin pad
E0189 RR 4.14 Lambswool sheepskin pad
E0189 UE 31.07 Lambswool sheepskin pad
E0191 NU 9.51 Protector heel or elbow
E0191 RR 0.99 Protector heel or elbow
E0191 UE 7.11 Protector heel or elbow
E0193 RR 574.05 Powered air flotation bed
E0194 RR 2717.94 Air fluidized bed
E0196 RR 25.03 Gel pressure mattress
E0197 RR 14.02 Air pressure pad for mattres
E0198 RR 21.20 Water pressure pad for mattr
E0199 NU 24.52 Dry pressure pad for mattres
E0199 RR 2.46 Dry pressure pad for mattres
E0199 UE 18.39 Dry pressure pad for mattres
E0200 NU 75.85 Heat lamp without stand
E0200 RR 10.29 Heat lamp without stand
E0200 UE 56.92 Heat lamp without stand
E0202 RR 59.90 Phototherapy light w/ photom
E0205 NU 185.66 Heat lamp with stand
E0205 RR 20.43 Heat lamp with stand
E0205 UE 139.24 Heat lamp with stand
E0210 NU 31.23 Electric heat pad standard
E0210 RR 2.94 Electric heat pad standard
E0210 UE 23.42 Electric heat pad standard
E0215 NU 67.78 Electric heat pad moist
E0215 RR 7.09 Electric heat pad moist
E0215 UE 50.84 Electric heat pad moist
E0217 NU 403.72 Water circ heat pad w pump
E0217 RR 44.95 Water circ heat pad w pump
E0217 UE 302.76 Water circ heat pad w pump
E0225 NU 316.04 Hydrocollator unit
E0225 RR 31.15 Hydrocollator unit
E0225 UE 237.02 Hydrocollator unit
E0235 RR 14.03 Paraffin bath unit portable
E0236 RR 35.97 Pump for water circulating p
E0239 NU 365.79 Hydrocollator unit portable
E0239 RR 36.58 Hydrocollator unit portable
E0239 UE 274.35 Hydrocollator unit portable
E0249 NU 81.00 Pad water circulating heat u
E0249 RR 8.90 Pad water circulating heat u
E0249 UE 60.75 Pad water circulating heat u
E0250 RR 51.08 Hosp bed fixed ht w/ mattres
E0251 RR 47.21 Hosp bed fixd ht w/o mattres
E0255 RR 51.73 Hospital bed var ht w/ mattr
E0256 RR 49.23 Hospital bed var ht w/o matt
E0260 RR 51.88 Hosp bed semi-electr w/ matt
E0261 RR 51.68 Hosp bed semi-electr w/o mat
E0265 RR 118.69 Hosp bed total electr w/ mat
E0266 RR 103.28 Hosp bed total elec w/o matt
E0271 NU 105.31 Mattress innerspring
E0271 RR 10.53 Mattress innerspring
E0271 UE 78.98 Mattress innerspring
E0272 NU 118.26 Mattress foam rubber
E0272 RR 11.82 Mattress foam rubber
E0272 UE 88.70 Mattress foam rubber
E0275 NU 11.31 Bed pan standard
E0275 RR 1.13 Bed pan standard
E0275 UE 8.49 Bed pan standard
E0276 NU 9.44 Bed pan fracture
E0276 RR 0.94 Bed pan fracture
E0276 UE 7.07 Bed pan fracture
E0277 RR 166.97 Powered pres-redu air mattrs
E0280 NU 25.34 Bed cradle
E0280 RR 2.53 Bed cradle
E0280 UE 19.01 Bed cradle
E0290 RR 46.86 Hosp bed fx ht w/o rails w/m
E0291 RR 35.67 Hosp bed fx ht w/o rail w/o
E0292 RR 49.65 Hosp bed var ht no sr w/matt
E0293 RR 45.26 Hosp bed var ht no sr no mat
E0294 RR 51.79 Hosp bed semi-elect w/ mattr
E0295 RR 51.68 Hosp bed semi-elect w/o matt
E0296 RR 92.61 Hosp bed total elect w/ matt
E0297 RR 81.73 Hosp bed total elect w/o mat
E0300 RR 206.36 Enclosed ped crib hosp grade
E0301 RR 139.34 Hd hosp bed, 350-600 lbs
E0302 RR 400.72 Ex hd hosp bed > 600 lbs
E0303 RR 141.99 Hosp bed hvy dty xtra wide
E0304 RR 416.25 Hosp bed xtra hvy dty x wide
E0305 RR 9.12 Rails bed side half length
E0310 NU 96.42 Rails bed side full length
E0310 RR 9.64 Rails bed side full length
E0310 UE 72.32 Rails bed side full length
E0316 RR 150.70 Bed safety enclosure
E0325 NU 7.31 Urinal male jug-type
E0325 RR 0.73 Urinal male jug-type
E0325 UE 5.44 Urinal male jug-type
E0326 NU 7.83 Urinal female jug-type
E0326 RR 0.78 Urinal female jug-type
E0326 UE 5.87 Urinal female jug-type
E0371 RR 166.97 Nonpower mattress overlay
E0372 RR 166.97 Powered air mattress overlay
E0373 RR 166.97 Nonpowered pressure mattress
E0424 RR 59.70 Stationary compressed gas 02
E0424 RR QF 59.70 Stationary compressed gas 02
E0431 RR 14.70 Portable gaseous 02
E0431 RR QF 29.85 Stationary compressed gas 02
E0433 RR 31.82 Portable liquid oxygen sys
E0433 RR QF 31.82 Stationary compressed gas 02
E0434 RR 14.70 Portable liquid 02
E0434 RR QF 29.85 Stationary compressed gas 02
E0439 RR 59.70 Stationary liquid 02
E0439 RR QF 59.70 Stationary liquid 02
E0441 45.32 Stationary o2 contents, gas
E0442 45.32 Stationary o2 contents, liq
E0443 41.06 Portable 02 contents, gas
E0444 41.06 Portable 02 contents, liquid
E0462 RR 263.03 Rocking bed w/ or w/o side r
E0465 RR 913.16 Home vent invasive interface
E0466 RR 913.16 Home vent non-invasive inter
E0470 RR 88.91 Rad w/o backup non-inv intfc
E0471 RR 218.96 Rad w/backup non inv intrfc
E0472 RR 331.01 Rad w backup invasive intrfc
E0480 RR 38.56 Percussor elect/pneum home m
E0482 RR 397.49 Cough stimulating device
E0483 RR 1017.07 Chest compression gen system
E0484 NU 35.33 Non-elec oscillatory pep dvc
E0484 RR 3.53 Non-elec oscillatory pep dvc
E0484 UE 26.50 Non-elec oscillatory pep dvc
E0485 NU 0.00 Oral device/appliance prefab
E0485 RR 0.00 Oral device/appliance prefab
E0485 UE 0.00 Oral device/appliance prefab
E0486 NU 0.00 Oral device/appliance cusfab
E0486 RR 0.00 Oral device/appliance cusfab
E0486 UE 0.00 Oral device/appliance cusfab
E0500 RR 105.00 Ippb all types
E0550 RR 40.77 Humidif extens supple w ippb
E0560 NU 141.41 Humidifier supplemental w/ i
E0560 RR 16.57 Humidifier supplemental w/ i
E0560 UE 106.07 Humidifier supplemental w/ i
E0561 NU 61.22 Humidifier nonheated w pap
E0561 RR 6.12 Humidifier nonheated w pap
E0561 UE 45.92 Humidifier nonheated w pap
E0562 NU 115.38 Humidifier heated used w pap
E0562 RR 11.53 Humidifier heated used w pap
E0562 UE 86.54 Humidifier heated used w pap
E0565 RR 34.50 Compressor air power source
E0570 RR 4.89 Nebulizer with compression
E0572 RR 26.18 Aerosol compressor adjust pr
E0574 RR 37.42 Ultrasonic generator w svneb
E0575 RR 98.33 Nebulizer ultrasonic
E0580 NU 107.71 Nebulizer for use w/ regulat
E0580 RR 10.77 Nebulizer for use w/ regulat
E0580 UE 80.78 Nebulizer for use w/ regulat
E0585 RR 24.69 Nebulizer w/ compressor & he
E0600 RR 43.80 Suction pump portab hom modl
E0601 RR 34.48 Cont airway pressure device
E0602 NU 28.24 Manual breast pump
E0602 RR 2.84 Manual breast pump
E0602 UE 21.18 Manual breast pump
E0605 NU 23.94 Vaporizer room type
E0605 RR 2.94 Vaporizer room type
E0605 UE 17.95 Vaporizer room type
E0606 RR 21.96 Drainage board postural
E0607 NU 63.92 Blood glucose monitor home
E0607 RR 6.38 Blood glucose monitor home
E0607 UE 47.93 Blood glucose monitor home
E0610 NU 227.55 Pacemaker monitr audible/vis
E0610 RR 24.00 Pacemaker monitr audible/vis
E0610 UE 170.68 Pacemaker monitr audible/vis
E0615 NU 424.79 Pacemaker monitr digital/vis
E0615 RR 55.96 Pacemaker monitr digital/vis
E0615 UE 318.56 Pacemaker monitr digital/vis
E0617 RR 290.86 Automatic ext defibrillator
E0617 RR KF 322.95 Automatic ext defibrillator
E0618 RR 261.19 Apnea monitor
E0619 RR 0.00 Apnea monitor w recorder
E0620 RR 83.64 Cap bld skin piercing laser
E0621 NU 66.22 Patient lift sling or seat
E0621 RR 6.62 Patient lift sling or seat
E0621 UE 49.67 Patient lift sling or seat
E0627 NU 215.16 Seat lift mech, electric any
E0627 RR 21.51 Seat lift mech, electric any
E0627 UE 161.37 Seat lift mech, electric any
E0629 NU 214.19 Seat lift mech, non-electric
E0629 RR 21.42 Seat lift mech, non-electric
E0629 UE 160.64 Seat lift mech, non-electric
E0630 RR 49.16 Patient lift hydraulic
E0635 RR 96.19 Patient lift electric
E0636 RR 812.80 Pt support & positioning sys
E0639 RR 90.71 Moveable patient lift system
E0640 RR 90.71 Fixed patient lift system
E0650 NU 631.11 Pneuma compresor non-segment
E0650 RR 85.03 Pneuma compresor non-segment
E0650 UE 473.31 Pneuma compresor non-segment
E0651 NU 746.83 Pneum compressor segmental
E0651 RR 76.30 Pneum compressor segmental
E0651 UE 560.13 Pneum compressor segmental
E0652 NU 5012.59 Pneum compres w/cal pressure
E0652 RR 501.23 Pneum compres w/cal pressure
E0652 UE 3759.44 Pneum compres w/cal pressure
E0655 NU 103.26 Pneumatic appliance half arm
E0655 RR 12.14 Pneumatic appliance half arm
E0655 UE 77.54 Pneumatic appliance half arm
E0656 RR 55.28 Segmental pneumatic trunk
E0657 RR 51.93 Segmental pneumatic chest
E0660 NU 152.83 Pneumatic appliance full leg
E0660 RR 15.90 Pneumatic appliance full leg
E0660 UE 114.62 Pneumatic appliance full leg
E0665 NU 111.40 Pneumatic appliance full arm
E0665 RR 11.44 Pneumatic appliance full arm
E0665 UE 83.65 Pneumatic appliance full arm
E0666 NU 132.12 Pneumatic appliance half leg
E0666 RR 13.61 Pneumatic appliance half leg
E0666 UE 99.10 Pneumatic appliance half leg
E0667 NU 309.73 Seg pneumatic appl full leg
E0667 RR 30.99 Seg pneumatic appl full leg
E0667 UE 232.30 Seg pneumatic appl full leg
E0668 NU 359.32 Seg pneumatic appl full arm
E0668 RR 35.46 Seg pneumatic appl full arm
E0668 UE 269.50 Seg pneumatic appl full arm
E0669 NU 166.51 Seg pneumatic appli half leg
E0669 RR 16.65 Seg pneumatic appli half leg
E0669 UE 124.88 Seg pneumatic appli half leg
E0670 NU 1172.12 Seg pneum int legs/trunk
E0670 RR 117.15 Seg pneum int legs/trunk
E0670 UE 879.17 Seg pneum int legs/trunk
E0671 NU 397.36 Pressure pneum appl full leg
E0671 RR 39.75 Pressure pneum appl full leg
E0671 UE 298.00 Pressure pneum appl full leg
E0672 NU 308.74 Pressure pneum appl full arm
E0672 RR 30.89 Pressure pneum appl full arm
E0672 UE 231.57 Pressure pneum appl full arm
E0673 NU 256.55 Pressure pneum appl half leg
E0673 RR 25.66 Pressure pneum appl half leg
E0673 UE 192.44 Pressure pneum appl half leg
E0675 RR 367.89 Pneumatic compression device
E0691 NU 859.65 Uvl pnl 2 sq ft or less
E0691 RR 85.96 Uvl pnl 2 sq ft or less
E0691 UE 644.74 Uvl pnl 2 sq ft or less
E0692 NU 1079.49 Uvl sys panel 4 ft
E0692 RR 104.22 Uvl sys panel 4 ft
E0692 UE 809.61 Uvl sys panel 4 ft
E0693 NU 1330.70 Uvl sys panel 6 ft
E0693 RR 133.08 Uvl sys panel 6 ft
E0693 UE 998.03 Uvl sys panel 6 ft
E0694 NU 4235.50 Uvl md cabinet sys 6 ft
E0694 RR 423.55 Uvl md cabinet sys 6 ft
E0694 UE 3176.65 Uvl md cabinet sys 6 ft
E0705 NU 40.80 Transfer device
E0705 NU KU 44.83 Transfer device
E0705 RR 4.08 Transfer device
E0705 RR KU 4.56 Transfer device
E0705 UE 30.60 Transfer device
E0705 UE KU 32.83 Transfer device
E0720 NU 60.66 Tens two lead
E0730 NU 61.29 Tens four lead
E0731 NU 75.98 Conductive garment for tens/
E0740 RR 50.03 Non-implant pelv flr e-stim
E0744 RR 74.46 Neuromuscular stim for scoli
E0745 RR 85.64 Neuromuscular stim for shock
E0747 NU KF 3746.38 Elec osteogen stim not spine
E0747 RR KF 372.28 Elec osteogen stim not spine
E0747 UE KF 2783.50 Elec osteogen stim not spine
E0748 NU KF 3722.12 Elec osteogen stim spinal
E0748 RR KF 372.19 Elec osteogen stim spinal
E0748 UE KF 2791.59 Elec osteogen stim spinal
E0749 RR KF 231.23 Elec osteogen stim implanted
E0760 NU KF 3093.01 Osteogen ultrasound stimltor
E0760 RR KF 309.31 Osteogen ultrasound stimltor
E0760 UE KF 2319.74 Osteogen ultrasound stimltor
E0762 RR 89.41 Trans elec jt stim dev sys
E0764 RR KF 1058.71 Functional neuromuscularstim
E0765 NU 80.49 Nerve stimulator for tx n&v
E0765 RR 8.06 Nerve stimulator for tx n&v
E0765 UE 60.38 Nerve stimulator for tx n&v
E0776 NU 118.97 Iv pole
E0776 RR 11.90 Iv pole
E0776 UE 89.23 Iv pole
E0779 RR 15.44 Amb infusion pump mechanical
E0780 NU 9.82 Mech amb infusion pump <8hrs
E0781 RR 200.31 External ambulatory infus pu
E0782 NU KF 3875.60 Non-programble infusion pump
E0782 RR KF 387.55 Non-programble infusion pump
E0782 UE KF 2906.72 Non-programble infusion pump
E0783 NU KF 7832.15 Programmable infusion pump
E0783 RR KF 783.24 Programmable infusion pump
E0783 UE KF 5874.13 Programmable infusion pump
E0784 RR 361.18 Ext amb infusn pump insulin
E0785 KF 452.04 Replacement impl pump cathet
E0786 NU KF 7639.78 Implantable pump replacement
E0786 RR KF 763.96 Implantable pump replacement
E0786 UE KF 5729.84 Implantable pump replacement
E0791 RR 237.97 Parenteral infusion pump sta
E0840 NU 70.09 Tract frame attach headboard
E0840 RR 15.62 Tract frame attach headboard
E0840 UE 52.55 Tract frame attach headboard
E0849 RR 49.31 Cervical pneum trac equip
E0850 NU 100.50 Traction stand free standing
E0850 RR 13.80 Traction stand free standing
E0850 UE 75.38 Traction stand free standing
E0855 RR 47.29 Cervical traction equipment
E0856 RR 14.72 Cervic collar w air bladders
E0860 NU 35.59 Tract equip cervical tract
E0860 RR 6.23 Tract equip cervical tract
E0860 UE 26.67 Tract equip cervical tract
E0870 NU 111.27 Tract frame attach footboard
E0870 RR 12.38 Tract frame attach footboard
E0870 UE 83.83 Tract frame attach footboard
E0880 NU 120.11 Trac stand free stand extrem
E0880 RR 18.85 Trac stand free stand extrem
E0880 UE 90.91 Trac stand free stand extrem
E0890 NU 107.78 Traction frame attach pelvic
E0890 RR 31.41 Traction frame attach pelvic
E0890 UE 92.79 Traction frame attach pelvic
E0900 NU 104.19 Trac stand free stand pelvic
E0900 RR 26.43 Trac stand free stand pelvic
E0900 UE 78.17 Trac stand free stand pelvic
E0910 RR 9.27 Trapeze bar attached to bed
E0911 RR 35.19 Hd trapeze bar attach to bed
E0912 RR 70.64 Hd trapeze bar free standing
E0920 RR 37.54 Fracture frame attached to b
E0930 RR 41.90 Fracture frame free standing
E0935 RR 21.76 Cont pas motion exercise dev
E0940 RR 17.48 Trapeze bar free standing
E0941 RR 35.29 Gravity assisted traction de
E0942 NU 16.90 Cervical head harness/halter
E0942 RR 1.91 Cervical head harness/halter
E0942 UE 12.67 Cervical head harness/halter
E0944 NU 43.88 Pelvic belt/harness/boot
E0944 RR 4.42 Pelvic belt/harness/boot
E0944 UE 32.91 Pelvic belt/harness/boot
E0945 NU 42.40 Belt/harness extremity
E0945 RR 4.24 Belt/harness extremity
E0945 UE 32.82 Belt/harness extremity
E0946 RR 48.11 Fracture frame dual w cross
E0947 NU 493.15 Fracture frame attachmnts pe
E0947 RR 51.13 Fracture frame attachmnts pe
E0947 UE 369.85 Fracture frame attachmnts pe
E0948 NU 476.99 Fracture frame attachmnts ce
E0948 RR 47.68 Fracture frame attachmnts ce
E0948 UE 336.42 Fracture frame attachmnts ce
E0950 NU 62.73 Tray
E0950 NU KU 72.85 Tray
E0950 RR 6.27 Tray
E0950 RR KU 7.30 Tray
E0950 UE 47.05 Tray
E0950 UE KU 54.65 Tray
E0951 NU 10.85 Loop heel
E0951 NU KU 13.31 Loop heel
E0951 RR 1.09 Loop heel
E0951 RR KU 1.37 Loop heel
E0951 UE 8.14 Loop heel
E0951 UE KU 9.97 Loop heel
E0952 NU 13.20 Toe loop/holder, each
E0952 NU KU 13.21 Toe loop/holder, each
E0952 RR 1.33 Toe loop/holder, each
E0952 RR KU 1.37 Toe loop/holder, each
E0952 UE 9.90 Toe loop/holder, each
E0952 UE KU 9.90 Toe loop/holder, each
E0953 NU 61.97 W/c lateral thigh/knee sup
E0953 NU KU 81.28 W/C LATERAL THIGH/KNEE SUP
E0953 RR 6.20 W/c lateral thigh/knee sup
E0953 RR KU 8.13 W/C LATERAL THIGH/KNEE SUP
E0953 UE 46.48 W/c lateral thigh/knee sup
E0953 UE KU 60.96 W/C LATERAL THIGH/KNEE SUP
E0954 NU 43.08 Foot box, any type each foot
E0954 NU KU 46.54 FOOT BOX, ANY TYPE EACH FOOT
E0954 RR 4.33 Foot box, any type each foot
E0954 RR KU 4.66 FOOT BOX, ANY TYPE EACH FOOT
E0954 UE 32.31 Foot box, any type each foot
E0954 UE KU 34.90 FOOT BOX, ANY TYPE EACH FOOT
E0955 RR 11.76 Cushioned headrest
E0955 RR KU 16.68 Cushioned headrest
E0956 NU 61.97 W/c lateral trunk/hip suppor
E0956 NU KU 81.28 W/c lateral trunk/hip suppor
E0956 RR 6.20 W/c lateral trunk/hip suppor
E0956 RR KU 8.13 W/c lateral trunk/hip suppor
E0956 UE 46.48 W/c lateral trunk/hip suppor
E0956 UE KU 60.96 W/c lateral trunk/hip suppor
E0957 NU 98.31 W/c medial thigh support
E0957 NU KU 113.74 W/c medial thigh support
E0957 RR 9.83 W/c medial thigh support
E0957 RR KU 11.38 W/c medial thigh support
E0957 UE 73.74 W/c medial thigh support
E0957 UE KU 85.30 W/c medial thigh support
E0958 RR 33.54 Whlchr att- conv 1 arm drive
E0959 NU 35.12 Amputee adapter
E0959 RR 3.51 Amputee adapter
E0959 UE 26.34 Amputee adapter
E0960 NU 59.56 W/c shoulder harness/straps
E0960 NU KU 75.02 W/c shoulder harness/straps
E0960 RR 5.96 W/c shoulder harness/straps
E0960 RR KU 7.52 W/c shoulder harness/straps
E0960 UE 44.68 W/c shoulder harness/straps
E0960 UE KU 56.28 W/c shoulder harness/straps
E0961 NU 16.35 Wheelchair brake extension
E0961 RR 1.63 Wheelchair brake extension
E0961 UE 12.08 Wheelchair brake extension
E0966 NU 56.38 Wheelchair head rest extensi
E0966 RR 5.64 Wheelchair head rest extensi
E0966 UE 42.29 Wheelchair head rest extensi
E0967 NU 58.82 Man wc rim/projection rep ea
E0967 RR 5.88 Man wc rim/projection rep ea
E0967 UE 44.12 Man wc rim/projection rep ea
E0968 RR 17.14 Wheelchair commode seat
E0969 NU 142.22 Wheelchair narrowing device
E0969 RR 14.20 Wheelchair narrowing device
E0969 UE 106.66 Wheelchair narrowing device
E0971 NU 25.45 Wheelchair anti-tipping devi
E0971 RR 2.55 Wheelchair anti-tipping devi
E0971 UE 19.09 Wheelchair anti-tipping devi
E0973 NU 46.85 W/ch access det adj armrest
E0973 NU KU 80.58 W/ch access det adj armrest
E0973 RR 4.68 W/ch access det adj armrest
E0973 RR KU 7.68 W/ch access det adj armrest
E0973 UE 35.14 W/ch access det adj armrest
E0973 UE KU 60.44 W/ch access det adj armrest
E0974 NU 59.47 W/ch access anti-rollback
E0974 RR 5.95 W/ch access anti-rollback
E0974 UE 44.61 W/ch access anti-rollback
E0978 NU 20.54 W/c acc,saf belt pelv strap
E0978 NU KU 34.60 W/c acc,saf belt pelv strap
E0978 RR 2.06 W/c acc,saf belt pelv strap
E0978 RR KU 3.45 W/c acc,saf belt pelv strap
E0978 UE 15.41 W/c acc,saf belt pelv strap
E0978 UE KU 25.96 W/c acc,saf belt pelv strap
E0980 NU 30.57 Wheelchair safety vest
E0980 RR 3.04 Wheelchair safety vest
E0980 UE 22.93 Wheelchair safety vest
E0981 NU 33.05 Seat upholstery, replacement
E0981 NU KU 33.05 Seat upholstery, replacement
E0981 RR 3.36 Seat upholstery, replacement
E0981 RR KU 3.36 Seat upholstery, replacement
E0981 UE 25.02 Seat upholstery, replacement
E0981 UE KU 25.02 Seat upholstery, replacement
E0982 NU 36.12 Back upholstery, replacement
E0982 NU KU 36.10 Back upholstery, replacement
E0982 RR 3.61 Back upholstery, replacement
E0982 RR KU 3.60 Back upholstery, replacement
E0982 UE 27.09 Back upholstery, replacement
E0982 UE KU 27.10 Back upholstery, replacement
E0983 RR 231.51 Add pwr joystick
E0984 RR 161.81 Add pwr tiller
E0985 RR 17.23 W/c seat lift mechanism
E0985 RR KU 19.42 W/c seat lift mechanism
E0986 RR 465.36 Man w/c push-rim powr system
E0988 RR 286.38 Lever-activated wheel drive
E0990 NU 61.81 Wheelchair elevating leg res
E0990 NU KU 82.30 Wheelchair elevating leg res
E0990 RR 6.18 Wheelchair elevating leg res
E0990 RR KU 9.27 Wheelchair elevating leg res
E0990 UE 46.36 Wheelchair elevating leg res
E0990 UE KU 64.31 Wheelchair elevating leg res
E0992 NU 66.78 Wheelchair solid seat insert
E0992 RR 6.68 Wheelchair solid seat insert
E0992 UE 50.09 Wheelchair solid seat insert
E0994 NU 16.79 Wheelchair arm rest
E0994 RR 1.67 Wheelchair arm rest
E0994 UE 12.59 Wheelchair arm rest
E0995 NU 21.31 Wc calf rest, pad replacemnt
E0995 NU KU 21.30 Wc calf rest, pad replacemnt
E0995 RR 2.13 Wc calf rest, pad replacemnt
E0995 RR KU 2.14 Wc calf rest, pad replacemnt
E0995 UE 15.96 Wc calf rest, pad replacemnt
E0995 UE KU 15.96 Wc calf rest, pad replacemnt
E1002 RR 298.95 Pwr seat tilt
E1002 RR KU 334.19 Pwr seat tilt
E1003 RR 349.91 Pwr seat recline
E1003 RR KU 362.09 Pwr seat recline
E1004 RR 384.60 Pwr seat recline mech
E1004 RR KU 401.47 Pwr seat recline mech
E1005 RR 420.72 Pwr seat recline pwr
E1005 RR KU 434.56 Pwr seat recline pwr
E1006 RR 518.74 Pwr seat combo w/o shear
E1006 RR KU 532.30 Pwr seat combo w/o shear
E1007 RR 643.91 Pwr seat combo w/shear
E1007 RR KU 720.77 Pwr seat combo w/shear
E1008 RR 660.47 Pwr seat combo pwr shear
E1008 RR KU 720.83 Pwr seat combo pwr shear
E1009 NU 0.00 Add mech leg elevation
E1009 RR 0.00 Add mech leg elevation
E1009 UE 0.00 Add mech leg elevation
E1010 RR 89.75 Add pwr leg elevation
E1010 RR KU 94.32 Add pwr leg elevation
E1011 NU 0.00 Ped wc modify width adjustm
E1011 RR 0.00 Ped wc modify width adjustm
E1011 UE 0.00 Ped wc modify width adjustm
E1012 RR 89.75 Ctr mount pwr elev leg rest
E1012 RR KU 94.32 Ctr mount pwr elev leg rest
E1014 RR 34.94 Reclining back add ped w/c
E1015 NU 97.15 Shock absorber for man w/c
E1015 RR 9.72 Shock absorber for man w/c
E1015 UE 72.86 Shock absorber for man w/c
E1016 NU 88.63 Shock absorber for power w/c
E1016 NU KU 108.29 Shock absorber for power w/c
E1016 RR 8.87 Shock absorber for power w/c
E1016 RR KU 10.85 Shock absorber for power w/c
E1016 UE 66.47 Shock absorber for power w/c
E1016 UE KU 81.20 Shock absorber for power w/c
E1017 NU 0.00 Hd shck absrbr for hd man wc
E1017 RR 0.00 Hd shck absrbr for hd man wc
E1017 UE 0.00 Hd shck absrbr for hd man wc
E1018 NU 0.00 Hd shck absrber for hd powwc
E1018 RR 0.00 Hd shck absrber for hd powwc
E1018 UE 0.00 Hd shck absrber for hd powwc
E1020 RR 14.88 Residual limb support system
E1020 RR KU 20.06 Residual limb support system
E1028 RR 11.41 W/c manual swingaway
E1028 RR KU 17.03 W/c manual swingaway
E1029 RR 30.24 W/c vent tray fixed
E1029 RR KU 30.46 W/c vent tray fixed
E1030 RR 94.45 W/c vent tray gimbaled
E1030 RR KU 96.08 W/c vent tray gimbaled
E1031 RR 34.94 Rollabout chair with casters
E1035 RR 486.82 Patient transfer system <300
E1036 RR 693.01 Patient transfer system >300
E1037 RR 86.07 Transport chair, ped size
E1038 RR 12.64 Transport chair pt wt<=300lb
E1039 RR 26.86 Transport chair pt wt >300lb
E1050 RR 82.82 Whelchr fxd full length arms
E1060 RR 110.47 Wheelchair detachable arms
E1070 RR 104.79 Wheelchair detachable foot r
E1083 RR 65.06 Hemi-wheelchair fixed arms
E1084 RR 93.85 Hemi-wheelchair detachable a
E1087 RR 112.35 Wheelchair lightwt fixed arm
E1088 RR 135.89 Wheelchair lightweight det a
E1092 RR 104.50 Wheelchair wide w/ leg rests
E1093 RR 105.73 Wheelchair wide w/ foot rest
E1100 RR 84.41 Whchr s-recl fxd arm leg res
E1110 RR 93.31 Wheelchair semi-recl detach
E1150 RR 78.04 Wheelchair standard w/ leg r
E1160 RR 59.80 Wheelchair fixed arms
E1161 RR 226.36 Manual adult wc w tiltinspac
E1170 RR 72.63 Whlchr ampu fxd arm leg rest
E1171 RR 65.18 Wheelchair amputee w/o leg r
E1172 RR 79.66 Wheelchair amputee detach ar
E1180 RR 82.40 Wheelchair amputee w/ foot r
E1190 RR 95.20 Wheelchair amputee w/ leg re
E1195 RR 102.15 Wheelchair amputee heavy dut
E1200 RR 70.75 Wheelchair amputee fixed arm
E1221 RR 45.23 Wheelchair spec size w foot
E1222 RR 61.88 Wheelchair spec size w/ leg
E1223 RR 70.81 Wheelchair spec size w foot
E1224 RR 67.52 Wheelchair spec size w/ leg
E1225 RR 31.08 Manual semi-reclining back
E1226 NU 327.91 Manual fully reclining back
E1226 RR 32.79 Manual fully reclining back
E1226 UE 245.93 Manual fully reclining back
E1227 NU 265.48 Wheelchair spec sz spec ht a
E1227 RR 26.55 Wheelchair spec sz spec ht a
E1227 UE 199.13 Wheelchair spec sz spec ht a
E1228 RR 26.81 Wheelchair spec sz spec ht b
E1230 NU 2144.83 Power operated vehicle
E1230 RR 212.81 Power operated vehicle
E1230 UE 1608.59 Power operated vehicle
E1231 NU 0.00 Rigid ped w/c tilt-in-space
E1231 RR 0.00 Rigid ped w/c tilt-in-space
E1231 UE 0.00 Rigid ped w/c tilt-in-space
E1232 RR 204.59 Folding ped wc tilt-in-space
E1233 RR 211.96 Rig ped wc tltnspc w/o seat
E1234 RR 184.54 Fld ped wc tltnspc w/o seat
E1235 RR 177.71 Rigid ped wc adjustable
E1236 RR 156.77 Folding ped wc adjustable
E1237 RR 158.14 Rgd ped wc adjstabl w/o seat
E1238 RR 156.77 Fld ped wc adjstabl w/o seat
E1240 RR 98.56 Whchr litwt det arm leg rest
E1270 RR 64.19 Wheelchair lightweight leg r
E1280 RR 106.73 Whchr h-duty det arm leg res
E1295 RR 98.77 Wheelchair heavy duty fixed
E1296 NU 399.80 Wheelchair special seat heig
E1296 RR 40.62 Wheelchair special seat heig
E1296 UE 299.85 Wheelchair special seat heig
E1297 NU 85.07 Wheelchair special seat dept
E1297 RR 9.45 Wheelchair special seat dept
E1297 UE 63.79 Wheelchair special seat dept
E1298 NU 405.31 Wheelchair spec seat depth/w
E1298 RR 41.47 Wheelchair spec seat depth/w
E1298 UE 303.97 Wheelchair spec seat depth/w
E1310 NU 1746.21 Whirlpool non-portable
E1310 RR 158.03 Whirlpool non-portable
E1310 UE 1309.65 Whirlpool non-portable
E1353 27.10 Oxygen supplies regulator
E1355 20.42 Oxygen supplies stand/rack
E1372 NU 108.22 Oxy suppl heater for nebuliz
E1372 RR 10.82 Oxy suppl heater for nebuliz
E1372 UE 81.17 Oxy suppl heater for nebuliz
E1390 RR 59.70 Oxygen concentrator
E1390 RR QF 59.70 Oxygen concentrator
E1391 RR 59.70 Oxygen concentrator, dual
E1391 RR QF 59.70 Oxygen concentrator, dual
E1392 RR 31.82 Portable oxygen concentrator
E1392 RR QF 31.82 Stationary compressed gas 02
E1405 RR 84.39 O2/water vapor enrich w/heat
E1406 RR 64.50 O2/water vapor enrich w/o he
E1700 RR 28.05 Jaw motion rehab system
E1701 10.14 Repl cushions for jaw motion
E1702 21.59 Repl measr scales jaw motion
E1800 RR 117.20 Adjust elbow ext/flex device
E1801 RR 119.26 Sps elbow device
E1802 RR 312.65 Adjst forearm pro/sup device
E1805 RR 120.88 Adjust wrist ext/flex device
E1806 RR 97.90 Sps wrist device
E1810 RR 119.19 Adjust knee ext/flex device
E1811 RR 123.98 Sps knee device
E1812 RR 82.26 Knee ext/flex w act res ctrl
E1815 RR 120.88 Adjust ankle ext/flex device
E1816 RR 125.94 Sps ankle device
E1818 RR 128.55 Sps forearm device
E1820 NU 73.76 Soft interface material
E1820 RR 7.39 Soft interface material
E1820 UE 55.34 Soft interface material
E1821 NU 100.68 Replacement interface spsd
E1821 RR 10.05 Replacement interface spsd
E1821 UE 75.54 Replacement interface spsd
E1825 RR 120.88 Adjust finger ext/flex devc
E1830 RR 120.88 Adjust toe ext/flex device
E1831 RR 63.21 Static str toe dev ext/flex
E1840 RR 364.85 Adj shoulder ext/flex device
E1841 RR 433.36 Static str shldr dev rom adj
E2000 RR 47.89 Gastric suction pump hme mdl
E2100 NU 615.32 Bld glucose monitor w voice
E2100 RR 61.54 Bld glucose monitor w voice
E2100 UE 461.49 Bld glucose monitor w voice
E2101 NU 180.39 Bld glucose monitor w lance
E2101 RR 18.04 Bld glucose monitor w lance
E2101 UE 135.29 Bld glucose monitor w lance
E2120 RR 271.24 Pulse gen sys tx endolymp fl
E2201 NU 260.92 Man w/ch acc seat w>=20"<24"
E2201 RR 26.10 Man w/ch acc seat w>=20"<24"
E2201 UE 195.70 Man w/ch acc seat w>=20"<24"
E2202 NU 366.72 Seat width 24-27 in
E2202 RR 36.68 Seat width 24-27 in
E2202 UE 275.04 Seat width 24-27 in
E2203 NU 354.24 Frame depth less than 22 in
E2203 RR 35.43 Frame depth less than 22 in
E2203 UE 265.68 Frame depth less than 22 in
E2204 NU 611.56 Frame depth 22 to 25 in
E2204 RR 61.16 Frame depth 22 to 25 in
E2204 UE 458.67 Frame depth 22 to 25 in
E2205 NU 28.40 Manual wc accessory, handrim
E2205 RR 2.84 Manual wc accessory, handrim
E2205 UE 21.30 Manual wc accessory, handrim
E2206 NU 31.14 Man wc whl lock comp repl ea
E2206 RR 3.11 Man wc whl lock comp repl ea
E2206 UE 23.35 Man wc whl lock comp repl ea
E2207 NU 35.98 Crutch and cane holder
E2207 NU KU 41.47 Crutch and cane holder
E2207 RR 3.60 Crutch and cane holder
E2207 RR KU 4.16 Crutch and cane holder
E2207 UE 26.99 Crutch and cane holder
E2207 UE KU 31.11 Crutch and cane holder
E2208 NU 65.66 Cylinder tank carrier
E2208 NU KU 97.95 Cylinder tank carrier
E2208 RR 6.57 Cylinder tank carrier
E2208 RR KU 9.79 Cylinder tank carrier
E2208 UE 49.25 Cylinder tank carrier
E2208 UE KU 73.46 Cylinder tank carrier
E2209 NU 66.88 Arm trough each
E2209 NU KU 88.36 Arm trough each
E2209 RR 6.69 Arm trough each
E2209 RR KU 8.85 Arm trough each
E2209 UE 50.16 Arm trough each
E2209 UE KU 66.28 Arm trough each
E2210 NU 4.29 Wheelchair bearings
E2210 NU KU 5.39 Wheelchair bearings
E2210 RR 0.43 Wheelchair bearings
E2210 RR KU 0.54 Wheelchair bearings
E2210 UE 3.22 Wheelchair bearings
E2210 UE KU 4.06 Wheelchair bearings
E2211 NU 27.93 Pneumatic propulsion tire
E2211 RR 2.80 Pneumatic propulsion tire
E2211 UE 20.95 Pneumatic propulsion tire
E2212 NU 4.98 Pneumatic prop tire tube
E2212 RR 0.50 Pneumatic prop tire tube
E2212 UE 3.74 Pneumatic prop tire tube
E2213 NU 23.74 Pneumatic prop tire insert
E2213 RR 2.37 Pneumatic prop tire insert
E2213 UE 17.81 Pneumatic prop tire insert
E2214 NU 25.28 Pneumatic caster tire each
E2214 RR 2.53 Pneumatic caster tire each
E2214 UE 18.96 Pneumatic caster tire each
E2215 NU 8.19 Pneumatic caster tire tube
E2215 RR 0.82 Pneumatic caster tire tube
E2215 UE 6.15 Pneumatic caster tire tube
E2216 NU 0.00 Foam filled propulsion tire
E2216 RR 0.00 Foam filled propulsion tire
E2216 UE 0.00 Foam filled propulsion tire
E2217 NU 0.00 Foam filled caster tire each
E2217 RR 0.00 Foam filled caster tire each
E2217 UE 0.00 Foam filled caster tire each
E2218 NU 0.00 Foam propulsion tire each
E2218 RR 0.00 Foam propulsion tire each
E2218 UE 0.00 Foam propulsion tire each
E2219 NU 32.35 Foam caster tire any size ea
E2219 RR 3.24 Foam caster tire any size ea
E2219 UE 24.26 Foam caster tire any size ea
E2220 NU 24.04 Solid propuls tire, repl, ea
E2220 RR 2.41 Solid propuls tire, repl, ea
E2220 UE 18.03 Solid propuls tire, repl, ea
E2221 NU 21.35 Solid caster tire repl, each
E2221 RR 2.13 Solid caster tire repl, each
E2221 UE 16.01 Solid caster tire repl, each
E2222 NU 18.06 Solid caster integ whl, repl
E2222 RR 1.81 Solid caster integ whl, repl
E2222 UE 13.55 Solid caster integ whl, repl
E2224 NU 76.59 Propulsion whl excl tire rep
E2224 RR 7.66 Propulsion whl excl tire rep
E2224 UE 57.45 Propulsion whl excl tire rep
E2225 NU 14.82 Caster wheel excludes tire
E2225 RR 1.48 Caster wheel excludes tire
E2225 UE 11.12 Caster wheel excludes tire
E2226 NU 31.55 Caster fork replacement only
E2226 RR 3.15 Caster fork replacement only
E2226 UE 23.66 Caster fork replacement only
E2227 RR 178.98 Gear reduction drive wheel
E2228 RR 76.44 Mwc acc, wheelchair brake
E2231 NU 115.75 Solid seat support base
E2231 RR 11.58 Solid seat support base
E2231 UE 86.82 Solid seat support base
E2310 RR 87.53 Electro connect btw control
E2310 RR KU 96.48 Electro connect btw control
E2311 RR 176.65 Electro connect btw 2 sys
E2311 RR KU 195.36 Electro connect btw 2 sys
E2312 RR 192.92 Mini-prop remote joystick
E2312 RR KC 246.05 Mini-prop remote joystick
E2313 RR 30.66 Pwc harness, expand control
E2321 RR 118.94 Hand interface joystick
E2321 RR KC 193.73 Hand interface joystick
E2321 RR KU 213.45 Hand interface joystick
E2322 RR 112.37 Mult mech switches
E2322 RR KC 218.42 Mult mech switches
E2322 RR KU 226.02 Mult mech switches
E2323 NU 54.77 Special joystick handle
E2323 NU KU 57.04 Special joystick handle
E2323 RR 5.47 Special joystick handle
E2323 RR KU 5.70 Special joystick handle
E2323 UE 41.08 Special joystick handle
E2323 UE KU 42.76 Special joystick handle
E2324 NU 36.13 Chin cup interface
E2324 NU KU 36.13 Chin cup interface
E2324 RR 3.60 Chin cup interface
E2324 RR KU 3.60 Chin cup interface
E2324 UE 27.10 Chin cup interface
E2324 UE KU 27.10 Chin cup interface
E2325 RR 107.40 Sip and puff interface
E2325 RR KU 111.06 Sip and puff interface
E2326 RR 28.17 Breath tube kit
E2326 RR KU 28.64 Breath tube kit
E2327 RR 210.09 Head control interface mech
E2327 RR KC 319.18 Head control interface mech
E2327 RR KU 327.25 Head control interface mech
E2328 RR 396.53 Head/extremity control inter
E2328 RR KU 408.59 Head/extremity control inter
E2329 RR 143.19 Head control nonproportional
E2329 RR KU 145.62 Head control nonproportional
E2330 RR 274.92 Head control proximity switc
E2330 RR KU 282.16 Head control proximity switc
E2340 NU 342.83 W/c wdth 20-23 in seat frame
E2340 RR 34.30 W/c wdth 20-23 in seat frame
E2340 UE 257.15 W/c wdth 20-23 in seat frame
E2341 NU 514.28 W/c wdth 24-27 in seat frame
E2341 RR 51.43 W/c wdth 24-27 in seat frame
E2341 UE 385.72 W/c wdth 24-27 in seat frame
E2342 NU 428.58 W/c dpth 20-21 in seat frame
E2342 RR 42.86 W/c dpth 20-21 in seat frame
E2342 UE 321.44 W/c dpth 20-21 in seat frame
E2343 NU 685.73 W/c dpth 22-25 in seat frame
E2343 RR 68.56 W/c dpth 22-25 in seat frame
E2343 UE 514.28 W/c dpth 22-25 in seat frame
E2351 NU 569.52 Electronic sgd interface
E2351 NU KU 576.06 Electronic sgd interface
E2351 RR 56.95 Electronic sgd interface
E2351 RR KU 57.63 Electronic sgd interface
E2351 UE 427.14 Electronic sgd interface
E2351 UE KU 432.03 Electronic sgd interface
E2359 NU 135.85 Gr34 sealed leadacid battery
E2359 NU KU 166.60 Gr34 sealed leadacid battery
E2359 RR 13.58 Gr34 sealed leadacid battery
E2359 RR KU 16.66 Gr34 sealed leadacid battery
E2359 UE 101.89 Gr34 sealed leadacid battery
E2359 UE KU 124.93 Gr34 sealed leadacid battery
E2360 NU 84.61 22nf nonsealed leadacid
E2360 NU KU 107.48 22nf nonsealed leadacid
E2360 RR 8.46 22nf nonsealed leadacid
E2360 RR KU 10.80 22nf nonsealed leadacid
E2360 UE 63.46 22nf nonsealed leadacid
E2360 UE KU 80.60 22nf nonsealed leadacid
E2361 NU 92.55 22nf sealed leadacid battery
E2361 NU KU 115.00 22nf sealed leadacid battery
E2361 RR 9.26 22nf sealed leadacid battery
E2361 RR KU 11.50 22nf sealed leadacid battery
E2361 UE 69.41 22nf sealed leadacid battery
E2361 UE KU 86.27 22nf sealed leadacid battery
E2362 NU 77.44 Gr24 nonsealed leadacid
E2362 NU KU 88.00 Gr24 nonsealed leadacid
E2362 RR 7.74 Gr24 nonsealed leadacid
E2362 RR KU 8.80 Gr24 nonsealed leadacid
E2362 UE 58.08 Gr24 nonsealed leadacid
E2362 UE KU 65.99 Gr24 nonsealed leadacid
E2363 NU 119.66 Gr24 sealed leadacid battery
E2363 NU KU 153.37 Gr24 sealed leadacid battery
E2363 RR 11.97 Gr24 sealed leadacid battery
E2363 RR KU 15.33 Gr24 sealed leadacid battery
E2363 UE 89.75 Gr24 sealed leadacid battery
E2363 UE KU 115.02 Gr24 sealed leadacid battery
E2364 NU 81.67 U1nonsealed leadacid battery
E2364 NU KU 107.48 U1nonsealed leadacid battery
E2364 RR 8.17 U1nonsealed leadacid battery
E2364 RR KU 10.80 U1nonsealed leadacid battery
E2364 UE 61.25 U1nonsealed leadacid battery
E2364 UE KU 80.60 U1nonsealed leadacid battery
E2365 NU 63.35 U1 sealed leadacid battery
E2365 NU KU 92.49 U1 sealed leadacid battery
E2365 RR 6.33 U1 sealed leadacid battery
E2365 RR KU 9.24 U1 sealed leadacid battery
E2365 UE 47.52 U1 sealed leadacid battery
E2365 UE KU 69.39 U1 sealed leadacid battery
E2366 NU 135.25 Battery charger, single mode
E2366 NU KU 217.37 Battery charger, single mode
E2366 RR 13.52 Battery charger, single mode
E2366 RR KU 21.80 Battery charger, single mode
E2366 UE 101.44 Battery charger, single mode
E2366 UE KU 163.04 Battery charger, single mode
E2367 NU 261.56 Battery charger, dual mode
E2367 NU KU 345.55 Battery charger, dual mode
E2367 RR 26.15 Battery charger, dual mode
E2367 RR KU 34.55 Battery charger, dual mode
E2367 UE 196.18 Battery charger, dual mode
E2367 UE KU 259.17 Battery charger, dual mode
E2368 RR 33.19 Pwr wc drivewheel motor repl
E2368 RR KU 42.59 Pwr wc drivewheel motor repl
E2369 RR 31.01 Pwr wc drivewheel gear repl
E2369 RR KU 37.12 Pwr wc drivewheel gear repl
E2370 RR 44.00 Pwr wc dr wh motor/gear comb
E2370 RR KU 66.21 Pwr wc dr wh motor/gear comb
E2371 NU 112.38 Gr27 sealed leadacid battery
E2371 NU KU 124.30 Gr27 sealed leadacid battery
E2371 RR 11.24 Gr27 sealed leadacid battery
E2371 RR KU 12.44 Gr27 sealed leadacid battery
E2371 UE 84.29 Gr27 sealed leadacid battery
E2371 UE KU 93.23 Gr27 sealed leadacid battery
E2372 NU 0.00 Gr27 non-sealed leadacid
E2372 RR 0.00 Gr27 non-sealed leadacid
E2372 UE 0.00 Gr27 non-sealed leadacid
E2373 RR 63.77 Hand/chin ctrl spec joystick
E2373 RR KC 98.40 Hand/chin ctrl spec joystick
E2373 RR KU 103.76 Hand/chin ctrl spec joystick
E2374 RR 40.33 Hand/chin ctrl std joystick
E2374 RR KU 44.05 Hand/chin ctrl std joystick
E2375 RR 55.79 Non-expandable controller
E2375 RR KU 70.61 Non-expandable controller
E2376 RR 100.21 Expandable controller, repl
E2376 RR KU 110.69 Expandable controller, repl
E2377 RR 37.12 Expandable controller, initl
E2377 RR KU 40.04 Expandable controller, initl
E2378 RR 46.56 Pw actuator replacement
E2378 RR KU 48.96 Pw actuator replacement
E2381 NU 48.82 Pneum drive wheel tire
E2381 NU KU 62.81 Pneum drive wheel tire
E2381 RR 4.88 Pneum drive wheel tire
E2381 RR KU 6.30 Pneum drive wheel tire
E2381 UE 36.62 Pneum drive wheel tire
E2381 UE KU 47.11 Pneum drive wheel tire
E2382 NU 14.71 Tube, pneum wheel drive tire
E2382 NU KU 17.12 Tube, pneum wheel drive tire
E2382 RR 1.47 Tube, pneum wheel drive tire
E2382 RR KU 1.70 Tube, pneum wheel drive tire
E2382 UE 11.03 Tube, pneum wheel drive tire
E2382 UE KU 12.84 Tube, pneum wheel drive tire
E2383 NU 99.61 Insert, pneum wheel drive
E2383 NU KU 125.23 Insert, pneum wheel drive
E2383 RR 9.96 Insert, pneum wheel drive
E2383 RR KU 12.52 Insert, pneum wheel drive
E2383 UE 74.71 Insert, pneum wheel drive
E2383 UE KU 93.92 Insert, pneum wheel drive
E2384 NU 50.41 Pneumatic caster tire
E2384 NU KU 66.72 Pneumatic caster tire
E2384 RR 5.04 Pneumatic caster tire
E2384 RR KU 6.69 Pneumatic caster tire
E2384 UE 37.81 Pneumatic caster tire
E2384 UE KU 50.05 Pneumatic caster tire
E2385 NU 35.28 Tube, pneumatic caster tire
E2385 NU KU 40.82 Tube, pneumatic caster tire
E2385 RR 3.53 Tube, pneumatic caster tire
E2385 RR KU 4.10 Tube, pneumatic caster tire
E2385 UE 26.46 Tube, pneumatic caster tire
E2385 UE KU 30.60 Tube, pneumatic caster tire
E2386 NU 87.70 Foam filled drive wheel tire
E2386 NU KU 124.09 Foam filled drive wheel tire
E2386 RR 8.77 Foam filled drive wheel tire
E2386 RR KU 12.41 Foam filled drive wheel tire
E2386 UE 65.78 Foam filled drive wheel tire
E2386 UE KU 93.08 Foam filled drive wheel tire
E2387 NU 40.94 Foam filled caster tire
E2387 NU KU 53.54 Foam filled caster tire
E2387 RR 4.10 Foam filled caster tire
E2387 RR KU 5.36 Foam filled caster tire
E2387 UE 30.70 Foam filled caster tire
E2387 UE KU 40.15 Foam filled caster tire
E2388 NU 38.39 Foam drive wheel tire
E2388 NU KU 41.54 Foam drive wheel tire
E2388 RR 3.84 Foam drive wheel tire
E2388 RR KU 4.16 Foam drive wheel tire
E2388 UE 28.80 Foam drive wheel tire
E2388 UE KU 31.17 Foam drive wheel tire
E2389 NU 21.46 Foam caster tire
E2389 NU KU 22.57 Foam caster tire
E2389 RR 2.14 Foam caster tire
E2389 RR KU 2.27 Foam caster tire
E2389 UE 16.10 Foam caster tire
E2389 UE KU 16.91 Foam caster tire
E2390 NU 33.23 Solid drive wheel tire
E2390 NU KU 35.28 Solid drive wheel tire
E2390 RR 3.32 Solid drive wheel tire
E2390 RR KU 3.53 Solid drive wheel tire
E2390 UE 24.92 Solid drive wheel tire
E2390 UE KU 26.44 Solid drive wheel tire
E2391 NU 14.08 Solid caster tire
E2391 NU KU 16.90 Solid caster tire
E2391 RR 1.41 Solid caster tire
E2391 RR KU 1.69 Solid caster tire
E2391 UE 10.57 Solid caster tire
E2391 UE KU 12.67 Solid caster tire
E2392 NU 34.00 Solid caster tire, integrate
E2392 NU KU 44.42 Solid caster tire, integrate
E2392 RR 3.40 Solid caster tire, integrate
E2392 RR KU 4.47 Solid caster tire, integrate
E2392 UE 25.50 Solid caster tire, integrate
E2392 UE KU 33.33 Solid caster tire, integrate
E2394 NU 47.16 Drive wheel excludes tire
E2394 NU KU 63.30 Drive wheel excludes tire
E2394 RR 4.72 Drive wheel excludes tire
E2394 RR KU 6.34 Drive wheel excludes tire
E2394 UE 35.37 Drive wheel excludes tire
E2394 UE KU 47.47 Drive wheel excludes tire
E2395 NU 35.48 Caster wheel excludes tire
E2395 NU KU 44.97 Caster wheel excludes tire
E2395 RR 3.55 Caster wheel excludes tire
E2395 RR KU 4.51 Caster wheel excludes tire
E2395 UE 26.61 Caster wheel excludes tire
E2395 UE KU 33.74 Caster wheel excludes tire
E2396 NU 42.67 Caster fork
E2396 NU KU 50.91 Caster fork
E2396 RR 4.27 Caster fork
E2396 RR KU 5.11 Caster fork
E2396 UE 32.01 Caster fork
E2396 UE KU 38.21 Caster fork
E2397 NU 350.90 Pwc acc, lith-based battery
E2397 NU KU 396.19 Pwc acc, lith-based battery
E2397 RR 35.09 Pwc acc, lith-based battery
E2397 RR KU 39.63 Pwc acc, lith-based battery
E2397 UE 263.18 Pwc acc, lith-based battery
E2397 UE KU 297.11 Pwc acc, lith-based battery
E2402 RR 585.41 Neg press wound therapy pump
E2500 NU 374.10 Sgd digitized pre-rec <=8min
E2500 RR 37.42 Sgd digitized pre-rec <=8min
E2500 UE 280.58 Sgd digitized pre-rec <=8min
E2502 NU 1143.97 Sgd prerec msg >8min <=20min
E2502 RR 114.40 Sgd prerec msg >8min <=20min
E2502 UE 858.00 Sgd prerec msg >8min <=20min
E2504 NU 1509.06 Sgd prerec msg>20min <=40min
E2504 RR 150.93 Sgd prerec msg>20min <=40min
E2504 UE 1131.80 Sgd prerec msg>20min <=40min
E2506 NU 2212.74 Sgd prerec msg > 40 min
E2506 RR 221.26 Sgd prerec msg > 40 min
E2506 UE 1659.51 Sgd prerec msg > 40 min
E2508 NU 3421.62 Sgd spelling phys contact
E2508 RR 342.16 Sgd spelling phys contact
E2508 UE 2566.23 Sgd spelling phys contact
E2510 NU 6474.97 Sgd w multi methods msg/accs
E2510 RR 647.50 Sgd w multi methods msg/accs
E2510 UE 4856.22 Sgd w multi methods msg/accs
E2511 NU 0.00 Sgd sftwre prgrm for pc/pda
E2511 RR 0.00 Sgd sftwre prgrm for pc/pda
E2511 UE 0.00 Sgd sftwre prgrm for pc/pda
E2512 NU 0.00 Sgd accessory, mounting sys
E2512 RR 0.00 Sgd accessory, mounting sys
E2512 UE 0.00 Sgd accessory, mounting sys
E2601 NU 32.68 Gen w/c cushion wdth < 22 in
E2601 NU KU 50.43 Gen w/c cushion wdth < 22 in
E2601 RR 3.27 Gen w/c cushion wdth < 22 in
E2601 RR KU 5.06 Gen w/c cushion wdth < 22 in
E2601 UE 24.51 Gen w/c cushion wdth < 22 in
E2601 UE KU 37.83 Gen w/c cushion wdth < 22 in
E2602 NU 70.21 Gen w/c cushion wdth >=22 in
E2602 NU KU 98.45 Gen w/c cushion wdth >=22 in
E2602 RR 7.02 Gen w/c cushion wdth >=22 in
E2602 RR KU 9.85 Gen w/c cushion wdth >=22 in
E2602 UE 52.66 Gen w/c cushion wdth >=22 in
E2602 UE KU 73.85 Gen w/c cushion wdth >=22 in
E2603 NU 87.46 Skin protect wc cus wd <22in
E2603 NU KU 124.98 Skin protect wc cus wd <22in
E2603 RR 8.75 Skin protect wc cus wd <22in
E2603 RR KU 12.50 Skin protect wc cus wd <22in
E2603 UE 65.59 Skin protect wc cus wd <22in
E2603 UE KU 93.75 Skin protect wc cus wd <22in
E2604 NU 119.71 Skin protect wc cus wd>=22in
E2604 NU KU 155.36 Skin protect wc cus wd>=22in
E2604 RR 11.97 Skin protect wc cus wd>=22in
E2604 RR KU 15.54 Skin protect wc cus wd>=22in
E2604 UE 89.79 Skin protect wc cus wd>=22in
E2604 UE KU 116.54 Skin protect wc cus wd>=22in
E2605 NU 170.48 Position wc cush wdth <22 in
E2605 NU KU 221.95 Position wc cush wdth <22 in
E2605 RR 17.05 Position wc cush wdth <22 in
E2605 RR KU 22.20 Position wc cush wdth <22 in
E2605 UE 127.87 Position wc cush wdth <22 in
E2605 UE KU 166.49 Position wc cush wdth <22 in
E2606 NU 274.01 Position wc cush wdth>=22 in
E2606 NU KU 346.26 Position wc cush wdth>=22 in
E2606 RR 27.40 Position wc cush wdth>=22 in
E2606 RR KU 34.63 Position wc cush wdth>=22 in
E2606 UE 205.50 Position wc cush wdth>=22 in
E2606 UE KU 259.67 Position wc cush wdth>=22 in
E2607 NU 171.61 Skin pro/pos wc cus wd <22in
E2607 NU KU 238.99 Skin pro/pos wc cus wd <22in
E2607 RR 17.16 Skin pro/pos wc cus wd <22in
E2607 RR KU 23.90 Skin pro/pos wc cus wd <22in
E2607 UE 128.71 Skin pro/pos wc cus wd <22in
E2607 UE KU 179.25 Skin pro/pos wc cus wd <22in
E2608 NU 212.37 Skin pro/pos wc cus wd>=22in
E2608 NU KU 287.01 Skin pro/pos wc cus wd>=22in
E2608 RR 21.23 Skin pro/pos wc cus wd>=22in
E2608 RR KU 28.70 Skin pro/pos wc cus wd>=22in
E2608 UE 159.28 Skin pro/pos wc cus wd>=22in
E2608 UE KU 215.26 Skin pro/pos wc cus wd>=22in
E2611 NU 135.16 Gen use back cush wdth <22in
E2611 NU KU 257.55 Gen use back cush wdth <22in
E2611 RR 13.52 Gen use back cush wdth <22in
E2611 RR KU 25.75 Gen use back cush wdth <22in
E2611 UE 101.37 Gen use back cush wdth <22in
E2611 UE KU 193.18 Gen use back cush wdth <22in
E2612 NU 257.89 Gen use back cush wdth>=22in
E2612 NU KU 348.41 Gen use back cush wdth>=22in
E2612 RR 25.79 Gen use back cush wdth>=22in
E2612 RR KU 34.84 Gen use back cush wdth>=22in
E2612 UE 193.42 Gen use back cush wdth>=22in
E2612 UE KU 261.30 Gen use back cush wdth>=22in
E2613 NU 254.07 Position back cush wd <22in
E2613 NU KU 324.09 Position back cush wd <22in
E2613 RR 25.41 Position back cush wd <22in
E2613 RR KU 32.41 Position back cush wd <22in
E2613 UE 190.55 Position back cush wd <22in
E2613 UE KU 243.07 Position back cush wd <22in
E2614 NU 365.25 Position back cush wd>=22in
E2614 NU KU 448.51 Position back cush wd>=22in
E2614 RR 36.52 Position back cush wd>=22in
E2614 RR KU 44.85 Position back cush wd>=22in
E2614 UE 273.95 Position back cush wd>=22in
E2614 UE KU 336.40 Position back cush wd>=22in
E2615 NU 287.33 Pos back post/lat wdth <22in
E2615 NU KU 372.95 Pos back post/lat wdth <22in
E2615 RR 28.74 Pos back post/lat wdth <22in
E2615 RR KU 37.31 Pos back post/lat wdth <22in
E2615 UE 215.50 Pos back post/lat wdth <22in
E2615 UE KU 279.71 Pos back post/lat wdth <22in
E2616 NU 386.14 Pos back post/lat wdth>=22in
E2616 NU KU 501.81 Pos back post/lat wdth>=22in
E2616 RR 38.62 Pos back post/lat wdth>=22in
E2616 RR KU 50.18 Pos back post/lat wdth>=22in
E2616 UE 289.60 Pos back post/lat wdth>=22in
E2616 UE KU 376.36 Pos back post/lat wdth>=22in
E2619 NU 39.53 Replace cover w/c seat cush
E2619 NU KU 42.30 Replace cover w/c seat cush
E2619 RR 3.95 Replace cover w/c seat cush
E2619 RR KU 4.22 Replace cover w/c seat cush
E2619 UE 29.65 Replace cover w/c seat cush
E2619 UE KU 31.76 Replace cover w/c seat cush
E2620 NU 317.29 Wc planar back cush wd <22in
E2620 NU KU 451.60 Wc planar back cush wd <22in
E2620 RR 31.73 Wc planar back cush wd <22in
E2620 RR KU 45.17 Wc planar back cush wd <22in
E2620 UE 237.97 Wc planar back cush wd <22in
E2620 UE KU 338.72 Wc planar back cush wd <22in
E2621 NU 370.63 Wc planar back cush wd>=22in
E2621 NU KU 473.93 Wc planar back cush wd>=22in
E2621 RR 37.07 Wc planar back cush wd>=22in
E2621 RR KU 47.40 Wc planar back cush wd>=22in
E2621 UE 277.98 Wc planar back cush wd>=22in
E2621 UE KU 355.44 Wc planar back cush wd>=22in
E2622 NU 250.77 Adj skin pro w/c cus wd<22in
E2622 NU KU 273.31 Adj skin pro w/c cus wd<22in
E2622 RR 25.08 Adj skin pro w/c cus wd<22in
E2622 RR KU 27.34 Adj skin pro w/c cus wd<22in
E2622 UE 188.08 Adj skin pro w/c cus wd<22in
E2622 UE KU 204.98 Adj skin pro w/c cus wd<22in
E2623 NU 317.11 Adj skin pro wc cus wd>=22in
E2623 NU KU 347.78 Adj skin pro wc cus wd>=22in
E2623 RR 31.71 Adj skin pro wc cus wd>=22in
E2623 RR KU 34.79 Adj skin pro wc cus wd>=22in
E2623 UE 237.84 Adj skin pro wc cus wd>=22in
E2623 UE KU 260.82 Adj skin pro wc cus wd>=22in
E2624 NU 254.82 Adj skin pro/pos cus<22in
E2624 NU KU 275.56 Adj skin pro/pos cus<22in
E2624 RR 25.48 Adj skin pro/pos cus<22in
E2624 RR KU 27.56 Adj skin pro/pos cus<22in
E2624 UE 191.11 Adj skin pro/pos cus<22in
E2624 UE KU 206.69 Adj skin pro/pos cus<22in
E2625 NU 315.37 Adj skin pro/pos wc cus>=22
E2625 NU KU 348.84 Adj skin pro/pos wc cus>=22
E2625 RR 31.54 Adj skin pro/pos wc cus>=22
E2625 RR KU 34.88 Adj skin pro/pos wc cus>=22
E2625 UE 236.53 Adj skin pro/pos wc cus>=22
E2625 UE KU 261.63 Adj skin pro/pos wc cus>=22
E2626 NU 510.22 Seo mobile arm sup att to wc
E2626 NU KU 585.96 Seo mobile arm sup att to wc
E2626 RR 51.03 Seo mobile arm sup att to wc
E2626 RR KU 58.60 Seo mobile arm sup att to wc
E2626 UE 382.66 Seo mobile arm sup att to wc
E2626 UE KU 439.45 Seo mobile arm sup att to wc
E2627 NU 789.45 Arm supp att to wc rancho ty
E2627 NU KU 805.95 Arm supp att to wc rancho ty
E2627 RR 78.95 Arm supp att to wc rancho ty
E2627 RR KU 80.61 Arm supp att to wc rancho ty
E2627 UE 592.09 Arm supp att to wc rancho ty
E2627 UE KU 604.45 Arm supp att to wc rancho ty
E2628 NU 607.16 Mobile arm supports reclinin
E2628 NU KU 607.16 Mobile arm supports reclinin
E2628 RR 60.72 Mobile arm supports reclinin
E2628 RR KU 60.72 Mobile arm supports reclinin
E2628 UE 455.36 Mobile arm supports reclinin
E2628 UE KU 455.35 Mobile arm supports reclinin
E2629 NU 778.61 Friction dampening arm supp
E2629 NU KU 903.92 Friction dampening arm supp
E2629 RR 77.86 Friction dampening arm supp
E2629 RR KU 90.38 Friction dampening arm supp
E2629 UE 583.96 Friction dampening arm supp
E2629 UE KU 677.93 Friction dampening arm supp
E2630 NU 524.90 Monosuspension arm/hand supp
E2630 NU KU 537.29 Monosuspension arm/hand supp
E2630 RR 52.49 Monosuspension arm/hand supp
E2630 RR KU 53.73 Monosuspension arm/hand supp
E2630 UE 393.68 Monosuspension arm/hand supp
E2630 UE KU 402.97 Monosuspension arm/hand supp
E2631 NU 214.92 Elevat proximal arm support
E2631 NU KU 214.94 Elevat proximal arm support
E2631 RR 21.50 Elevat proximal arm support
E2631 RR KU 21.49 Elevat proximal arm support
E2631 UE 161.19 Elevat proximal arm support
E2631 UE KU 161.19 Elevat proximal arm support
E2632 NU 136.66 Offset/lat rocker arm w/ela
E2632 NU KU 136.66 Offset/lat rocker arm w/ela
E2632 RR 13.66 Offset/lat rocker arm w/ela
E2632 RR KU 13.67 Offset/lat rocker arm w/ela
E2632 UE 102.50 Offset/lat rocker arm w/ela
E2632 UE KU 102.49 Offset/lat rocker arm w/ela
E2633 NU 111.55 Mobile arm support supinator
E2633 NU KU 115.91 Mobile arm support supinator
E2633 RR 11.15 Mobile arm support supinator
E2633 RR KU 11.59 Mobile arm support supinator
E2633 UE 83.67 Mobile arm support supinator
E2633 UE KU 86.95 Mobile arm support supinator
K0001 RR 20.62 Standard wheelchair
K0002 RR 35.93 Stnd hemi (low seat) whlchr
K0003 RR 31.20 Lightweight wheelchair
K0004 RR 38.46 High strength ltwt whlchr
K0005 NU 1768.66 Ultralightweight wheelchair
K0005 RR 176.84 Ultralightweight wheelchair
K0005 UE 1326.46 Ultralightweight wheelchair
K0006 RR 56.87 Heavy duty wheelchair
K0007 RR 80.17 Extra heavy duty wheelchair
K0009 RR 71.14 Other manual wheelchair/base
K0010 RR 365.09 Stnd wt frame power whlchr
K0011 RR 489.57 Stnd wt pwr whlchr w control
K0011 RR KF 543.54 Stnd wt pwr whlchr w control
K0012 RR 300.34 Ltwt portbl power whlchr
K0015 RR 11.65 Detach non-adj ht armrst rep
K0015 RR KU 14.92 Detach non-adj ht armrst rep
K0017 NU 38.05 Detach adjust armrest base
K0017 NU KU 42.13 Detach adjust armrest base
K0017 RR 3.81 Detach adjust armrest base
K0017 RR KU 4.21 Detach adjust armrest base
K0017 UE 28.54 Detach adjust armrest base
K0017 UE KU 31.60 Detach adjust armrest base
K0018 NU 21.51 Detach adjust armrst upper
K0018 NU KU 23.53 Detach adjust armrst upper
K0018 RR 2.15 Detach adjust armrst upper
K0018 RR KU 2.35 Detach adjust armrst upper
K0018 UE 16.14 Detach adjust armrst upper
K0018 UE KU 17.66 Detach adjust armrst upper
K0019 NU 10.46 Arm pad repl, each
K0019 NU KU 13.48 Arm pad repl, each
K0019 RR 1.05 Arm pad repl, each
K0019 RR KU 1.35 Arm pad repl, each
K0019 UE 7.85 Arm pad repl, each
K0019 UE KU 10.10 Arm pad repl, each
K0020 NU 37.29 Fixed adjust armrest pair
K0020 NU KU 38.31 Fixed adjust armrest pair
K0020 RR 3.73 Fixed adjust armrest pair
K0020 RR KU 3.83 Fixed adjust armrest pair
K0020 UE 27.97 Fixed adjust armrest pair
K0020 UE KU 28.73 Fixed adjust armrest pair
K0037 NU 33.75 Hi mount flip-up ftrest repl
K0037 NU KU 33.75 Hi mount flip-up ftrest repl
K0037 RR 3.09 Hi mount flip-up ftrest repl
K0037 RR KU 3.10 Hi mount flip-up ftrest repl
K0037 UE 25.32 Hi mount flip-up ftrest repl
K0037 UE KU 25.32 Hi mount flip-up ftrest repl
K0038 NU 19.02 Leg strap each
K0038 NU KU 20.02 Leg strap each
K0038 RR 1.90 Leg strap each
K0038 RR KU 2.01 Leg strap each
K0038 UE 14.26 Leg strap each
K0038 UE KU 14.99 Leg strap each
K0039 NU 40.84 Leg strap h style each
K0039 NU KU 44.42 Leg strap h style each
K0039 RR 4.09 Leg strap h style each
K0039 RR KU 4.47 Leg strap h style each
K0039 UE 30.63 Leg strap h style each
K0039 UE KU 33.33 Leg strap h style each
K0040 NU 43.45 Adjustable angle footplate
K0040 NU KU 61.57 Adjustable angle footplate
K0040 RR 4.34 Adjustable angle footplate
K0040 RR KU 6.15 Adjustable angle footplate
K0040 UE 32.59 Adjustable angle footplate
K0040 UE KU 46.16 Adjustable angle footplate
K0041 NU 39.03 Large size footplate each
K0041 NU KU 43.63 Large size footplate each
K0041 RR 3.90 Large size footplate each
K0041 RR KU 4.40 Large size footplate each
K0041 UE 29.27 Large size footplate each
K0041 UE KU 32.72 Large size footplate each
K0042 NU 25.07 Standard size ftplate rep ea
K0042 NU KU 30.04 Standard size ftplate rep ea
K0042 RR 2.51 Standard size ftplate rep ea
K0042 RR KU 3.00 Standard size ftplate rep ea
K0042 UE 18.80 Standard size ftplate rep ea
K0042 UE KU 22.53 Standard size ftplate rep ea
K0043 NU 15.47 Ftrst lowr exten tube rep ea
K0043 NU KU 16.10 Ftrst lowr exten tube rep ea
K0043 RR 1.55 Ftrst lowr exten tube rep ea
K0043 RR KU 1.60 Ftrst lowr exten tube rep ea
K0043 UE 11.60 Ftrst lowr exten tube rep ea
K0043 UE KU 12.08 Ftrst lowr exten tube rep ea
K0044 NU 13.46 Ftrst upr hanger brac rep ea
K0044 NU KU 13.73 Ftrst upr hanger brac rep ea
K0044 RR 1.35 Ftrst upr hanger brac rep ea
K0044 RR KU 1.38 Ftrst upr hanger brac rep ea
K0044 UE 10.10 Ftrst upr hanger brac rep ea
K0044 UE KU 10.29 Ftrst upr hanger brac rep ea
K0045 NU 44.29 Ftrst compl assembly repl ea
K0045 NU KU 46.69 Ftrst compl assembly repl ea
K0045 RR 4.43 Ftrst compl assembly repl ea
K0045 RR KU 4.67 Ftrst compl assembly repl ea
K0045 UE 33.22 Ftrst compl assembly repl ea
K0045 UE KU 35.02 Ftrst compl assembly repl ea
K0046 NU 15.58 Elev lgrst lwr exten repl ea
K0046 NU KU 16.10 Elev lgrst lwr exten repl ea
K0046 RR 1.56 Elev lgrst lwr exten repl ea
K0046 RR KU 1.60 Elev lgrst lwr exten repl ea
K0046 UE 11.69 Elev lgrst lwr exten repl ea
K0046 UE KU 12.10 Elev lgrst lwr exten repl ea
K0047 NU 55.05 Elev legrst upr hangr rep ea
K0047 NU KU 63.06 Elev legrst upr hangr rep ea
K0047 RR 5.51 Elev legrst upr hangr rep ea
K0047 RR KU 6.32 Elev legrst upr hangr rep ea
K0047 UE 41.28 Elev legrst upr hangr rep ea
K0047 UE KU 47.28 Elev legrst upr hangr rep ea
K0050 NU 25.53 Ratchet assembly replacement
K0050 RR 2.55 Ratchet assembly replacement
K0050 UE 19.16 Ratchet assembly replacement
K0051 NU 40.40 Cam rel asm ft/legrst rep ea
K0051 NU KU 43.38 Cam rel asm ft/legrst rep ea
K0051 RR 4.04 Cam rel asm ft/legrst rep ea
K0051 RR KU 4.37 Cam rel asm ft/legrst rep ea
K0051 UE 30.30 Cam rel asm ft/legrst rep ea
K0051 UE KU 32.52 Cam rel asm ft/legrst rep ea
K0052 NU 58.53 Swingaway detach ftrest repl
K0052 NU KU 76.24 Swingaway detach ftrest repl
K0052 RR 5.86 Swingaway detach ftrest repl
K0052 RR KU 7.62 Swingaway detach ftrest repl
K0052 UE 43.90 Swingaway detach ftrest repl
K0052 UE KU 57.15 Swingaway detach ftrest repl
K0053 NU 67.94 Elevate footrest articulate
K0053 NU KU 84.12 Elevate footrest articulate
K0053 RR 6.79 Elevate footrest articulate
K0053 RR KU 8.41 Elevate footrest articulate
K0053 UE 50.96 Elevate footrest articulate
K0053 UE KU 63.09 Elevate footrest articulate
K0056 NU 77.68 Seat ht <17 or >=21 ltwt wc
K0056 NU KU 90.98 Seat ht <17 or >=21 ltwt wc
K0056 RR 7.77 Seat ht <17 or >=21 ltwt wc
K0056 RR KU 9.10 Seat ht <17 or >=21 ltwt wc
K0056 UE 58.26 Seat ht <17 or >=21 ltwt wc
K0056 UE KU 68.25 Seat ht <17 or >=21 ltwt wc
K0065 NU 36.98 Spoke protectors
K0065 NU KU 42.52 Spoke protectors
K0065 RR 3.70 Spoke protectors
K0065 RR KU 4.25 Spoke protectors
K0065 UE 27.74 Spoke protectors
K0065 UE KU 31.90 Spoke protectors
K0069 NU 76.81 Rr whl compl sol tire rep ea
K0069 NU KU 95.60 Rr whl compl sol tire rep ea
K0069 RR 7.68 Rr whl compl sol tire rep ea
K0069 RR KU 9.95 Rr whl compl sol tire rep ea
K0069 UE 57.61 Rr whl compl sol tire rep ea
K0069 UE KU 71.70 Rr whl compl sol tire rep ea
K0070 RR 13.52 Rr whl compl pne tire rep ea
K0070 RR KU 17.54 Rr whl compl pne tire rep ea
K0071 NU 87.31 Fr cstr comp pne tire rep ea
K0071 NU KU 104.52 Fr cstr comp pne tire rep ea
K0071 RR 8.73 Fr cstr comp pne tire rep ea
K0071 RR KU 10.46 Fr cstr comp pne tire rep ea
K0071 UE 65.49 Fr cstr comp pne tire rep ea
K0071 UE KU 78.36 Fr cstr comp pne tire rep ea
K0072 NU 54.73 Fr cstr semi-pne tire rep ea
K0072 NU KU 62.93 Fr cstr semi-pne tire rep ea
K0072 RR 5.47 Fr cstr semi-pne tire rep ea
K0072 RR KU 6.29 Fr cstr semi-pne tire rep ea
K0072 UE 41.06 Fr cstr semi-pne tire rep ea
K0072 UE KU 47.18 Fr cstr semi-pne tire rep ea
K0073 NU 28.50 Caster pin lock each
K0073 NU KU 32.01 Caster pin lock each
K0073 RR 2.85 Caster pin lock each
K0073 RR KU 3.24 Caster pin lock each
K0073 UE 21.38 Caster pin lock each
K0073 UE KU 24.00 Caster pin lock each
K0077 NU 44.52 Fr cstr asmb sol tire rep ea
K0077 NU KU 56.31 Fr cstr asmb sol tire rep ea
K0077 RR 4.45 Fr cstr asmb sol tire rep ea
K0077 RR KU 5.62 Fr cstr asmb sol tire rep ea
K0077 UE 33.40 Fr cstr asmb sol tire rep ea
K0077 UE KU 42.21 Fr cstr asmb sol tire rep ea
K0098 NU 19.25 Drive belt for pwc, repl
K0098 NU KU 21.79 Drive belt for pwc, repl
K0098 RR 1.93 Drive belt for pwc, repl
K0098 RR KU 2.19 Drive belt for pwc, repl
K0098 UE 14.44 Drive belt for pwc, repl
K0098 UE KU 16.33 Drive belt for pwc, repl
K0105 NU 80.38 Iv hanger
K0105 NU KU 95.12 Iv hanger
K0105 RR 8.04 Iv hanger
K0105 RR KU 9.51 Iv hanger
K0105 UE 60.29 Iv hanger
K0105 UE KU 71.34 Iv hanger
K0195 RR 9.03 Elevating whlchair leg rests
K0455 RR 238.27 Pump uninterrupted infusion
K0552 2.24 Sup/ext non-ins inf pump syr
K0553 213.44 Ther cgm supply allowance
K0554 NU 224.54 Ther cgm receiver/monitor
K0554 RR 22.46 Ther cgm receiver/monitor
K0554 UE 168.41 Ther cgm receiver/monitor
K0601 NU 1.02 Repl batt silver oxide 1.5 v
K0602 NU 5.75 Repl batt silver oxide 3 v
K0603 NU 0.52 Repl batt alkaline 1.5 v
K0604 NU 5.54 Repl batt lithium 3.6 v
K0605 NU 13.24 Repl batt lithium 4.5 v
K0606 RR KF 2409.16 Aed garment w elec analysis
K0607 RR 18.59 Repl batt for aed
K0607 RR KF 20.63 Repl batt for aed
K0608 NU 115.95 Repl garment for aed
K0608 NU KF 128.76 Repl garment for aed
K0608 RR 11.62 Repl garment for aed
K0608 RR KF 12.89 Repl garment for aed
K0608 UE 86.96 Repl garment for aed
K0608 UE KF 96.56 Repl garment for aed
K0609 771.15 Repl electrode for aed
K0609 KF 856.19 Repl electrode for aed
K0672 68.26 Removable soft interface le
K0730 RR 164.93 Ctrl dose inh drug deliv sys
K0733 NU 22.75 12-24hr sealed lead acid
K0733 NU KU 24.91 12-24hr sealed lead acid
K0733 RR 2.28 12-24hr sealed lead acid
K0733 RR KU 2.51 12-24hr sealed lead acid
K0733 UE 17.07 12-24hr sealed lead acid
K0733 UE KU 18.69 12-24hr sealed lead acid
K0738 RR 31.82 Portable gas oxygen system
K0738 RR QF 31.82 Stationary compressed gas 02
K0800 NU 702.43 Pov group 1 std up to 300lbs
K0800 RR 70.24 Pov group 1 std up to 300lbs
K0800 UE 526.83 Pov group 1 std up to 300lbs
K0801 NU 1262.49 Pov group 1 hd 301-450 lbs
K0801 RR 126.25 Pov group 1 hd 301-450 lbs
K0801 UE 946.87 Pov group 1 hd 301-450 lbs
K0802 NU 1670.34 Pov group 1 vhd 451-600 lbs
K0802 RR 167.03 Pov group 1 vhd 451-600 lbs
K0802 UE 1252.76 Pov group 1 vhd 451-600 lbs
K0806 NU 1128.11 Pov group 2 std up to 300lbs
K0806 RR 112.81 Pov group 2 std up to 300lbs
K0806 UE 846.08 Pov group 2 std up to 300lbs
K0807 NU 1748.29 Pov group 2 hd 301-450 lbs
K0807 RR 174.83 Pov group 2 hd 301-450 lbs
K0807 UE 1311.22 Pov group 2 hd 301-450 lbs
K0808 NU 2702.56 Pov group 2 vhd 451-600 lbs
K0808 RR 270.26 Pov group 2 vhd 451-600 lbs
K0808 UE 2026.93 Pov group 2 vhd 451-600 lbs
K0813 RR 213.51 Pwc gp 1 std port seat/back
K0814 RR 223.76 Pwc gp 1 std port cap chair
K0815 RR 248.63 Pwc gp 1 std seat/back
K0816 RR 232.19 Pwc gp 1 std cap chair
K0820 RR 218.37 Pwc gp 2 std port seat/back
K0821 RR 232.42 Pwc gp 2 std port cap chair
K0822 RR 248.88 Pwc gp 2 std seat/back
K0823 RR 232.53 Pwc gp 2 std cap chair
K0824 RR 362.58 Pwc gp 2 hd seat/back
K0825 RR 328.31 Pwc gp 2 hd cap chair
K0826 RR 605.97 Pwc gp 2 vhd seat/back
K0827 RR 533.47 Pwc gp vhd cap chair
K0828 RR 706.40 Pwc gp 2 xtra hd seat/back
K0829 RR 708.55 Pwc gp 2 xtra hd cap chair
K0835 RR 289.86 Pwc gp2 std sing pow opt s/b
K0836 RR 300.65 Pwc gp2 std sing pow opt cap
K0837 RR 371.77 Pwc gp 2 hd sing pow opt s/b
K0838 RR 329.52 Pwc gp 2 hd sing pow opt cap
K0839 RR 493.84 Pwc gp2 vhd sing pow opt s/b
K0840 RR 758.22 Pwc gp2 xhd sing pow opt s/b
K0841 RR 326.65 Pwc gp2 std mult pow opt s/b
K0842 RR 326.17 Pwc gp2 std mult pow opt cap
K0843 RR 387.21 Pwc gp2 hd mult pow opt s/b
K0848 RR 653.60 Pwc gp 3 std seat/back
K0849 RR 628.39 Pwc gp 3 std cap chair
K0850 RR 758.14 Pwc gp 3 hd seat/back
K0851 RR 728.96 Pwc gp 3 hd cap chair
K0852 RR 875.98 Pwc gp 3 vhd seat/back
K0853 RR 899.86 Pwc gp 3 vhd cap chair
K0854 RR 1192.12 Pwc gp 3 xhd seat/back
K0855 RR 1126.13 Pwc gp 3 xhd cap chair
K0856 RR 701.56 Pwc gp3 std sing pow opt s/b
K0857 RR 715.62 Pwc gp3 std sing pow opt cap
K0858 RR 870.43 Pwc gp3 hd sing pow opt s/b
K0859 RR 830.13 Pwc gp3 hd sing pow opt cap
K0860 RR 1243.52 Pwc gp3 vhd sing pow opt s/b
K0861 RR 702.68 Pwc gp3 std mult pow opt s/b
K0862 RR 870.43 Pwc gp3 hd mult pow opt s/b
K0863 RR 1243.52 Pwc gp3 vhd mult pow opt s/b
K0864 RR 1479.80 Pwc gp3 xhd mult pow opt s/b
L0112 1126.98 Cranial cervical orthosis
L0113 229.62 Cranial cervical torticollis
L0120 21.57 Cerv flex n/adj foam pre ots
L0130 152.46 Flex thermoplastic collar mo
L0140 50.42 Cervical semi-rigid adjustab
L0150 92.50 Cerv semi-rig adj molded chn
L0160 120.81 Cerv sr wire occ/man pre ots
L0170 497.48 Cervical collar molded to pt
L0172 107.87 Cerv col sr foam 2pc pre ots
L0174 211.91 Cerv sr 2pc thor ext pre ots
L0180 293.85 Cer post col occ/man sup adj
L0190 382.11 Cerv collar supp adj cerv ba
L0200 398.34 Cerv col supp adj bar & thor
L0220 108.79 Thor rib belt custom fabrica
L0450 136.59 Tlso flex trunk/thor pre ots
L0452 0.00 Tlso flex custom fab thoraci
L0454 279.26 Tlso trnk sj-t9 pre cst
L0455 279.26 Tlso flex trnk sj-t9 pre ots
L0456 800.84 Tlso flex trnk sj-ss pre cst
L0457 800.84 Tlso flex trnk sj-ss pre ots
L0458 718.11 Tlso 2mod symphis-xipho pre
L0460 808.27 Tlso 2 shl symphys-stern cst
L0462 1005.37 Tlso 3mod sacro-scap pre
L0464 1196.88 Tlso 4mod sacro-scap pre
L0466 290.90 Tlso r fram soft ant pre cst
L0467 290.90 Tlso r fram soft pre ots
L0468 385.40 Tlso rig fram pelvic pre cst
L0469 385.40 Tlso rig fram pelvic pre ots
L0470 491.79 Tlso rigid frame pre subclav
L0472 311.91 Tlso rigid frame hyperex pre
L0480 1098.40 Tlso rigid plastic custom fa
L0482 1275.84 Tlso rigid lined custom fab
L0484 1370.85 Tlso rigid plastic cust fab
L0486 1454.40 Tlso rigidlined cust fab two
L0488 808.27 Tlso rigid lined pre one pie
L0490 227.79 Tlso rigid plastic pre one
L0491 618.40 Tlso 2 piece rigid shell
L0492 406.70 Tlso 3 piece rigid shell
L0621 71.14 Sio flex pelvic/sacr pre ots
L0622 232.98 Sio flex pelvisacral custom
L0623 0.00 Sio rig pnl pelv/sac pre ots
L0624 0.00 Sio panel custom
L0625 44.34 Lo flex l1-below l5 pre ots
L0626 62.76 Lo sag rig pnl stays pre cst
L0627 330.99 Lo sag ri an/pos pnl pre cst
L0628 67.56 Lso flex no ri stays pre ots
L0629 0.00 Lso flex w/rigid stays cust
L0630 130.41 Lso r post pnl sj-t9 pre cst
L0631 826.60 Lso sag r an/pos pnl pre cst
L0632 0.00 Lso sag rigid frame cust
L0633 230.90 Lso sc r pos/lat pnl pre cst
L0634 0.00 Lso flexion control custom
L0635 738.36 Lso sagit rigid panel prefab
L0636 1093.05 Lso sagittal rigid panel cus
L0637 865.01 Lso sc r ant/pos pnl pre cst
L0638 1061.98 Lso sag-coronal panel custom
L0639 865.01 Lso s/c shell/panel prefab
L0640 842.58 Lso s/c shell/panel custom
L0641 62.76 Lo rig pos pnl l1-l5 pre ots
L0642 330.99 Lo sag ri an/pos pnl pre ots
L0643 130.41 Lso sag ctr rigi pos pre ots
L0648 826.60 Lso sag r an/pos pnl pre ots
L0649 230.90 Lso sc r pos/lat pnl pre ots
L0650 865.01 Lso sc r ant/pos pnl pre ots
L0651 865.01 Lso sag-co shell pnl pre ots
L0700 1576.94 Ctlso a-p-l control molded
L0710 1611.04 Ctlso a-p-l control w/ inter
L0810 2014.81 Halo cervical into jckt vest
L0820 1808.43 Halo cervical into body jack
L0830 2548.59 Halo cerv into milwaukee typ
L0859 1062.11 Mri compatible system
L0861 173.54 Halo repl liner/interface
L0970 103.73 Tlso corset front
L0972 93.16 Lso corset front
L0974 138.35 Tlso full corset
L0976 123.34 Lso full corset
L0978 162.81 Axillary crutch extension
L0980 17.77 Peroneal straps pair pre ots
L0982 12.56 Stocking sup grips 4 pre ots
L0984 52.15 Protect body sock ea pre ots
L1000 1582.14 Ctlso milwauke initial model
L1001 0.00 Ctlso infant immobilizer
L1005 2577.17 Tension based scoliosis orth
L1010 51.77 Ctlso axilla sling
L1020 66.67 Kyphosis pad
L1025 127.27 Kyphosis pad floating
L1030 49.07 Lumbar bolster pad
L1040 64.21 Lumbar or lumbar rib pad
L1050 77.42 Sternal pad
L1060 92.85 Thoracic pad
L1070 90.66 Trapezius sling
L1080 51.00 Outrigger
L1085 137.97 Outrigger bil w/ vert extens
L1090 91.27 Lumbar sling
L1100 145.76 Ring flange plastic/leather
L1110 197.01 Ring flange plas/leather mol
L1120 33.32 Covers for upright each
L1200 1208.62 Furnsh initial orthosis only
L1210 201.84 Lateral thoracic extension
L1220 192.81 Anterior thoracic extension
L1230 494.25 Milwaukee type superstructur
L1240 66.82 Lumbar derotation pad
L1250 66.82 Anterior asis pad
L1260 68.21 Anterior thoracic derotation
L1270 69.30 Abdominal pad
L1280 79.71 Rib gusset (elastic) each
L1290 63.10 Lateral trochanteric pad
L1300 1420.84 Body jacket mold to patient
L1310 1459.93 Post-operative body jacket
L1600 99.40 Ho flex frejka w/cov pre cst
L1610 43.86 Ho frejka cov only pre cst
L1620 124.24 Ho flex pavlik harns pre cst
L1630 130.71 Abduct control hip semi-flex
L1640 397.89 Pelv band/spread bar thigh c
L1650 201.35 Ho abduction hip adjustable
L1652 287.02 Ho bi thighcuffs w sprdr bar
L1660 132.01 Ho abduction static plastic
L1680 939.87 Pelvic & hip control thigh c
L1685 959.19 Post-op hip abduct custom fa
L1686 885.68 Ho post-op hip abduction
L1690 1557.06 Combination bilateral ho
L1700 1177.99 Leg perthes orth toronto typ
L1710 1378.96 Legg perthes orth newington
L1720 1016.46 Legg perthes orthosis trilat
L1730 873.04 Legg perthes orth scottish r
L1755 1385.47 Legg perthes patten bottom t
L1810 75.97 Ko elastic with joints
L1812 75.97 Ko elastic w/joints pre ots
L1820 117.70 Ko elas w/ condyle pads & jo
L1830 71.57 Ko immob canvas long pre ots
L1831 236.98 Knee orth pos locking joint
L1832 545.55 Ko adj jnt pos r sup pre cst
L1833 545.55 Ko adj jnt pos r sup pre ots
L1834 598.80 Ko w/0 joint rigid molded to
L1836 107.45 Ko rigid w/o joints pre ots
L1840 797.61 Ko derot ant cruciate custom
L1843 722.48 Ko single upright pre cst
L1844 1252.28 Ko w/adj jt rot cntrl molded
L1845 749.73 Ko double upright pre cst
L1846 919.24 Ko w adj flex/ext rotat mold
L1847 463.13 Ko dbl upright w/air pre cst
L1848 463.13 Ko dbl upright w/air pre ots
L1850 234.48 Ko swedish type pre ots
L1851 722.48 Ko single upright prefab ots
L1852 749.73 Ko double upright prefab ots
L1860 827.74 Ko supracondylar socket mold
L1900 208.10 Afo sprng wir drsflx calf bd
L1902 71.91 Afo ankle gauntlet pre ots
L1904 432.44 Afo molded ankle gauntlet
L1906 92.77 Afo multilig ank sup pre ots
L1907 453.08 Afo supramalleolar custom
L1910 210.68 Afo sing bar clasp attach sh
L1920 269.68 Afo sing upright w/ adjust s
L1930 182.48 Afo plastic
L1932 718.53 Afo rig ant tib prefab tcf/=
L1940 381.49 Afo molded to patient plasti
L1945 912.06 Afo molded plas rig ant tib
L1950 604.74 Afo spiral molded to pt plas
L1951 676.23 Afo spiral prefabricated
L1960 456.11 Afo pos solid ank plastic mo
L1970 548.89 Afo plastic molded w/ankle j
L1971 377.42 Afo w/ankle joint, prefab
L1980 283.10 Afo sing solid stirrup calf
L1990 343.84 Afo doub solid stirrup calf
L2000 814.63 Kafo sing fre stirr thi/calf
L2005 3299.50 Kafo sng/dbl mechanical act
L2010 759.93 Kafo sng solid stirrup w/o j
L2020 956.85 Kafo dbl solid stirrup band/
L2030 868.61 Kafo dbl solid stirrup w/o j
L2034 1640.61 Kafo pla sin up w/wo k/a cus
L2035 140.90 Kafo plastic pediatric size
L2036 1483.11 Kafo plas doub free knee mol
L2037 1383.66 Kafo plas sing free knee mol
L2038 1405.59 Kafo w/o joint multi-axis an
L2040 170.47 Hkafo torsion bil rot straps
L2050 367.46 Hkafo torsion cable hip pelv
L2060 447.87 Hkafo torsion ball bearing j
L2070 115.00 Hkafo torsion unilat rot str
L2080 277.45 Hkafo unilat torsion cable
L2090 338.24 Hkafo unilat torsion ball br
L2106 524.48 Afo tib fx cast plaster mold
L2108 913.21 Afo tib fx cast molded to pt
L2112 420.03 Afo tibial fracture soft
L2114 526.83 Afo tib fx semi-rigid
L2116 606.17 Afo tibial fracture rigid
L2126 1014.02 Kafo fem fx cast thermoplas
L2128 1435.91 Kafo fem fx cast molded to p
L2132 778.50 Kafo femoral fx cast soft
L2134 830.71 Kafo fem fx cast semi-rigid
L2136 991.52 Kafo femoral fx cast rigid
L2180 92.54 Plas shoe insert w ank joint
L2182 76.67 Drop lock knee
L2184 104.81 Limited motion knee joint
L2186 145.38 Adj motion knee jnt lerman t
L2188 278.39 Quadrilateral brim
L2190 71.94 Waist belt
L2192 315.87 Pelvic band & belt thigh fla
L2200 36.68 Limited ankle motion ea jnt
L2210 53.08 Dorsiflexion assist each joi
L2220 63.17 Dorsi & plantar flex ass/res
L2230 59.19 Split flat caliper stirr & p
L2232 80.14 Rocker bottom, contact afo
L2240 73.26 Round caliper and plate atta
L2250 297.01 Foot plate molded stirrup at
L2260 154.63 Reinforced solid stirrup
L2265 90.85 Long tongue stirrup
L2270 42.59 Varus/valgus strap padded/li
L2275 100.42 Plastic mod low ext pad/line
L2280 351.15 Molded inner boot
L2300 220.18 Abduction bar jointed adjust
L2310 110.26 Abduction bar-straight
L2320 158.71 Non-molded lacer
L2330 332.23 Lacer molded to patient mode
L2335 205.12 Anterior swing band
L2340 444.05 Pre-tibial shell molded to p
L2350 766.93 Prosthetic type socket molde
L2360 39.91 Extended steel shank
L2370 258.62 Patten bottom
L2375 109.23 Torsion ank & half solid sti
L2380 94.97 Torsion straight knee joint
L2385 103.32 Straight knee joint heavy du
L2387 148.86 Add le poly knee custom kafo
L2390 86.51 Offset knee joint each
L2395 120.69 Offset knee joint heavy duty
L2397 94.03 Suspension sleeve lower ext
L2405 70.19 Knee joint drop lock ea jnt
L2415 97.79 Knee joint cam lock each joi
L2425 115.42 Knee disc/dial lock/adj flex
L2430 115.42 Knee jnt ratchet lock ea jnt
L2492 104.79 Knee lift loop drop lock rin
L2500 250.70 Thi/glut/ischia wgt bearing
L2510 562.48 Th/wght bear quad-lat brim m
L2520 371.04 Th/wght bear quad-lat brim c
L2525 1001.07 Th/wght bear nar m-l brim mo
L2526 571.27 Th/wght bear nar m-l brim cu
L2530 181.25 Thigh/wght bear lacer non-mo
L2540 326.13 Thigh/wght bear lacer molded
L2550 221.54 Thigh/wght bear high roll cu
L2570 367.42 Hip clevis type 2 posit jnt
L2580 358.00 Pelvic control pelvic sling
L2600 196.04 Hip clevis/thrust bearing fr
L2610 207.65 Hip clevis/thrust bearing lo
L2620 233.48 Pelvic control hip heavy dut
L2622 264.70 Hip joint adjustable flexion
L2624 255.44 Hip adj flex ext abduct cont
L2627 1393.85 Plastic mold recipro hip & c
L2628 1371.07 Metal frame recipro hip & ca
L2630 191.01 Pelvic control band & belt u
L2640 259.22 Pelvic control band & belt b
L2650 110.36 Pelv & thor control gluteal
L2660 143.77 Thoracic control thoracic ba
L2670 139.43 Thorac cont paraspinal uprig
L2680 129.15 Thorac cont lat support upri
L2750 64.47 Plating chrome/nickel pr bar
L2755 105.19 Carbon graphite lamination
L2760 46.87 Extension per extension per
L2768 104.90 Ortho sidebar disconnect
L2780 52.21 Non-corrosive finish
L2785 24.55 Drop lock retainer each
L2795 66.58 Knee control full kneecap
L2800 102.33 Knee cap medial or lateral p
L2810 80.33 Knee control condylar pad
L2820 66.99 Soft interface below knee se
L2830 72.47 Soft interface above knee se
L2840 42.84 Tibial length sock fx or equ
L2850 47.76 Femoral lgth sock fx or equa
L3000 252.94 Ft insert ucb berkeley shell
L3001 106.51 Foot insert remov molded spe
L3002 130.04 Foot insert plastazote or eq
L3003 140.33 Foot insert silicone gel eac
L3010 140.33 Foot longitudinal arch suppo
L3020 159.75 Foot longitud/metatarsal sup
L3030 61.46 Foot arch support remov prem
L3031 98.63 Foot lamin/prepreg composite
L3040 37.88 Ft arch suprt premold longit
L3050 37.88 Foot arch supp premold metat
L3060 59.38 Foot arch supp longitud/meta
L3070 25.58 Arch suprt att to sho longit
L3080 25.58 Arch supp att to shoe metata
L3090 32.78 Arch supp att to shoe long/m
L3100 34.82 Hallus-valgus nt dyn pre ots
L3140 71.70 Abduction rotation bar shoe
L3150 65.54 Abduct rotation bar w/o shoe
L3170 40.98 Foot plas heel stabi pre ots
L3224 51.31 Woman's shoe oxford brace
L3225 52.69 Man's shoe oxford brace
L3300 41.98 Sho lift taper to metatarsal
L3310 65.54 Shoe lift elev heel/sole neo
L3330 455.70 Lifts elevation metal extens
L3332 59.38 Shoe lifts tapered to one-ha
L3334 30.74 Shoe lifts elevation heel /i
L3340 68.64 Shoe wedge sach
L3350 18.45 Shoe heel wedge
L3360 28.67 Shoe sole wedge outside sole
L3370 39.91 Shoe sole wedge between sole
L3380 39.91 Shoe clubfoot wedge
L3390 39.91 Shoe outflare wedge
L3400 32.78 Shoe metatarsal bar wedge ro
L3410 74.75 Shoe metatarsal bar between
L3420 44.05 Full sole/heel wedge btween
L3430 129.03 Sho heel count plast reinfor
L3440 61.46 Heel leather reinforced
L3450 85.01 Shoe heel sach cushion type
L3455 32.78 Shoe heel new leather standa
L3460 27.63 Shoe heel new rubber standar
L3465 47.11 Shoe heel thomas with wedge
L3470 50.18 Shoe heel thomas extend to b
L3480 50.18 Shoe heel pad & depress for
L3500 23.55 Ortho shoe add leather insol
L3510 23.55 Orthopedic shoe add rub insl
L3520 25.58 O shoe add felt w leath insl
L3530 25.58 Ortho shoe add half sole
L3540 40.98 Ortho shoe add full sole
L3550 7.15 O shoe add standard toe tap
L3560 18.45 O shoe add horseshoe toe tap
L3570 68.64 O shoe add instep extension
L3580 52.22 O shoe add instep velcro clo
L3590 43.01 O shoe convert to sof counte
L3595 33.78 Ortho shoe add march bar
L3600 61.46 Trans shoe calip plate exist
L3610 80.89 Trans shoe caliper plate new
L3620 61.46 Trans shoe solid stirrup exi
L3630 80.89 Trans shoe solid stirrup new
L3640 34.82 Shoe dennis browne splint bo
L3650 51.29 So 8 abd restraint pre ots
L3660 77.58 So 8 ab rstr can/web pre ots
L3670 102.53 So acro/clav can web pre ots
L3671 660.32 So cap design w/o jnts cf
L3674 866.21 So airplane w/wo joint cf
L3675 128.61 So vest canvas/web pre ots
L3702 211.60 Eo w/o joints cf
L3710 117.95 Eo elas w/metal jnts pre ots
L3720 526.33 Forearm/arm cuffs free motio
L3730 680.44 Forearm/arm cuffs ext/flex a
L3740 806.73 Cuffs adj lock w/ active con
L3760 366.46 Eo adj jt prefab custom fit
L3761 366.46 Eo, adj lock joint prefab ot
L3762 78.80 Eo rigid w/o joints pre ots
L3763 514.39 Ewho rigid w/o jnts cf
L3764 671.40 Ewho w/joint(s) cf
L3765 939.63 Ewhfo rigid w/o jnts cf
L3766 995.00 Ewhfo w/joint(s) cf
L3806 332.88 Whfo w/joint(s) custom fab
L3807 183.24 Whfo w/o joints pre cst
L3808 274.03 Whfo, rigid w/o joints
L3809 183.24 Whfo w/o joints pre ots
L3900 1068.51 Hinge extension/flex wrist/f
L3901 1213.43 Hinge ext/flex wrist finger
L3904 2210.50 Whfo electric custom fitted
L3905 726.73 Who w/nontorsion jnt(s) cf
L3906 322.67 Who w/o joints cf
L3908 50.78 Who cock-up nonmolde pre ots
L3912 87.97 Hfo flexion glove pre ots
L3913 198.48 Hfo w/o joints cf
L3915 389.53 Who nontorsion jnts pre cst
L3916 389.53 Who nontorsion jnts pre ots
L3917 77.44 Metacarp fx orthosis pre cst
L3918 77.44 Metacarp fx orthosis pre ots
L3919 198.48 Ho w/o joints cf
L3921 235.38 Hfo w/joint(s) cf
L3923 70.73 Hfo without joints pre cst
L3924 70.73 Hfo without joints pre ots
L3925 37.94 Fo pip dip jnt/sprng pre ots
L3927 25.62 Fo pip dip no jt spr pre ots
L3929 67.21 Hfo nontorsion jnts pre cst
L3930 67.21 Hfo nontorsion jnts pre ots
L3931 137.64 Whfo nontorsion joint prefab
L3933 156.34 Fo w/o joints cf
L3935 161.88 Fo nontorsion joint cf
L3956 0.00 Add joint upper ext orthosis
L3960 555.25 Sewho airplan desig abdu pos
L3961 1231.20 Sewho cap design w/o jnts cf
L3962 541.59 Sewho erbs palsey design abd
L3967 1453.63 Sewho airplane w/o jnts cf
L3971 1379.84 Sewho cap design w/jnt(s) cf
L3973 1453.63 Sewho airplane w/jnt(s) cf
L3975 1231.20 Sewhfo cap design w/o jnt cf
L3976 1231.20 Sewhfo airplane w/o jnts cf
L3977 1379.84 Sewhfo cap desgn w/jnt(s) cf
L3978 1453.63 Sewhfo airplane w/jnt(s) cf
L3980 241.71 Up ext fx orthos humeral nos
L3981 737.62 Ue fx orth shoul cap forearm
L3982 281.79 Upper ext fx orthosis rad/ul
L3984 259.80 Upper ext fx orthosis wrist
L3995 26.92 Sock fracture or equal each
L4000 1061.89 Repl girdle milwaukee orth
L4002 0.00 Replace strap, any orthosis
L4010 517.69 Replace trilateral socket br
L4020 724.00 Replace quadlat socket brim
L4030 389.46 Replace socket brim cust fit
L4040 317.81 Replace molded thigh lacer
L4045 253.04 Replace non-molded thigh lac
L4050 318.46 Replace molded calf lacer
L4055 206.21 Replace non-molded calf lace
L4060 245.15 Replace high roll cuff
L4070 217.09 Replace prox & dist upright
L4080 89.05 Repl met band kafo-afo prox
L4090 70.26 Repl met band kafo-afo calf/
L4100 92.26 Repl leath cuff kafo prox th
L4110 69.50 Repl leath cuff kafo-afo cal
L4130 389.74 Replace pretibial shell
L4350 77.21 Ankle control ortho pre ots
L4360 237.36 Pneumat walking boot pre cst
L4361 237.36 Pneuma/vac walk boot pre ots
L4370 156.97 Pneum full leg splnt pre ots
L4386 127.66 Non-pneum walk boot pre cst
L4387 127.66 Non-pneum walk boot pre ots
L4392 18.94 Replace afo soft interface
L4394 13.82 Replace foot drop spint
L4396 135.11 Static or dynami afo pre cst
L4397 135.11 Static or dynami afo pre ots
L4398 62.21 Foot drop splint pre ots
L4631 1283.92 Afo, walk boot type, cus fab
L5000 458.05 Sho insert w arch toe filler
L5010 1000.51 Mold socket ank hgt w/ toe f
L5020 1628.63 Tibial tubercle hgt w/ toe f
L5050 1886.03 Ank symes mold sckt sach ft
L5060 2269.86 Symes met fr leath socket ar
L5100 1964.74 Molded socket shin sach foot
L5105 3118.46 Plast socket jts/thgh lacer
L5150 2885.95 Mold sckt ext knee shin sach
L5160 3138.99 Mold socket bent knee shin s
L5200 2734.33 Kne sing axis fric shin sach
L5210 1994.20 No knee/ankle joints w/ ft b
L5220 2266.77 No knee joint with artic ali
L5230 3126.32 Fem focal defic constant fri
L5250 4264.03 Hip canad sing axi cons fric
L5270 4226.67 Tilt table locking hip sing
L5280 4184.41 Hemipelvect canad sing axis
L5301 1886.91 Bk mold socket sach ft endo
L5312 2710.75 Knee disart, sach ft, endo
L5321 2701.06 Ak open end sach
L5331 3822.10 Hip disart canadian sach ft
L5341 4153.41 Hemipelvectomy canadian sach
L5400 989.09 Postop dress & 1 cast chg bk
L5410 433.35 Postop dsg bk ea add cast ch
L5420 1249.17 Postop dsg & 1 cast chg ak/d
L5430 551.40 Postop dsg ak ea add cast ch
L5450 352.74 Postop app non-wgt bear dsg
L5460 519.91 Postop app non-wgt bear dsg
L5500 1055.48 Init bk ptb plaster direct
L5505 1429.39 Init ak ischal plstr direct
L5510 1196.45 Prep bk ptb plaster molded
L5520 1181.81 Perp bk ptb thermopls direct
L5530 1495.93 Prep bk ptb thermopls molded
L5535 1474.23 Prep bk ptb open end socket
L5540 1556.72 Prep bk ptb laminated socket
L5560 1597.26 Prep ak ischial plast molded
L5570 1660.59 Prep ak ischial direct form
L5580 1938.62 Prep ak ischial thermo mold
L5585 2102.66 Prep ak ischial open end
L5590 1975.59 Prep ak ischial laminated
L5595 3472.56 Hip disartic sach thermopls
L5600 3787.59 Hip disart sach laminat mold
L5610 1701.47 Above knee hydracadence
L5611 1324.09 Ak 4 bar link w/fric swing
L5613 2014.02 Ak 4 bar ling w/hydraul swig
L5614 1361.39 4-bar link above knee w/swng
L5616 1116.15 Ak univ multiplex sys frict
L5617 451.39 Ak/bk self-aligning unit ea
L5618 260.03 Test socket symes
L5620 228.48 Test socket below knee
L5622 348.93 Test socket knee disarticula
L5624 332.91 Test socket above knee
L5626 467.96 Test socket hip disarticulat
L5628 443.22 Test socket hemipelvectomy
L5629 338.46 Below knee acrylic socket
L5630 368.82 Syme typ expandabl wall sckt
L5631 441.06 Ak/knee disartic acrylic soc
L5632 182.48 Symes type ptb brim design s
L5634 249.99 Symes type poster opening so
L5636 209.40 Symes type medial opening so
L5637 279.71 Below knee total contact
L5638 399.94 Below knee leather socket
L5639 938.25 Below knee wood socket
L5640 571.23 Knee disarticulat leather so
L5642 511.41 Above knee leather socket
L5643 1279.11 Hip flex inner socket ext fr
L5644 485.40 Above knee wood socket
L5645 655.72 Bk flex inner socket ext fra
L5646 450.28 Below knee cushion socket
L5647 653.72 Below knee suction socket
L5648 541.06 Above knee cushion socket
L5649 1642.59 Isch containmt/narrow m-l so
L5650 401.20 Tot contact ak/knee disart s
L5651 986.94 Ak flex inner socket ext fra
L5652 358.29 Suction susp ak/knee disart
L5653 478.30 Knee disart expand wall sock
L5654 272.55 Socket insert symes
L5655 230.77 Socket insert below knee
L5656 325.07 Socket insert knee articulat
L5658 316.57 Socket insert above knee
L5661 550.13 Multi-durometer symes
L5665 420.79 Multi-durometer below knee
L5666 62.53 Below knee cuff suspension
L5668 83.49 Bk molded distal cushion
L5670 254.15 Bk molded supracondylar susp
L5671 408.78 Bk/ak locking mechanism
L5672 310.55 Bk removable medial brim sus
L5673 577.38 Socket insert w lock mech
L5676 297.80 Bk knee joints single axis p
L5677 405.20 Bk knee joints polycentric p
L5678 32.63 Bk joint covers pair
L5679 481.13 Socket insert w/o lock mech
L5680 284.63 Bk thigh lacer non-molded
L5681 1061.22 Intl custm cong/latyp insert
L5682 513.95 Bk thigh lacer glut/ischia m
L5683 1061.22 Initial custom socket insert
L5684 39.55 Bk fork strap
L5685 103.33 Below knee sus/seal sleeve
L5686 53.35 Bk back check
L5688 50.20 Bk waist belt webbing
L5690 97.21 Bk waist belt padded and lin
L5692 112.83 Ak pelvic control belt light
L5694 149.09 Ak pelvic control belt pad/l
L5695 156.40 Ak sleeve susp neoprene/equa
L5696 170.92 Ak/knee disartic pelvic join
L5697 69.43 Ak/knee disartic pelvic band
L5698 86.34 Ak/knee disartic silesian ba
L5699 153.23 Shoulder harness
L5700 2367.58 Replace socket below knee
L5701 2937.20 Replace socket above knee
L5702 3701.90 Replace socket hip
L5703 1719.13 Symes ankle w/o (sach) foot
L5704 482.74 Custom shape cover bk
L5705 885.05 Custom shape cover ak
L5706 863.25 Custom shape cvr knee disart
L5707 1159.77 Custom shape cvr hip disart
L5710 295.57 Kne-shin exo sng axi mnl loc
L5711 448.38 Knee-shin exo mnl lock ultra
L5712 354.12 Knee-shin exo frict swg & st
L5714 365.18 Knee-shin exo variable frict
L5716 598.97 Knee-shin exo mech stance ph
L5718 748.65 Knee-shin exo frct swg & sta
L5722 781.24 Knee-shin pneum swg frct exo
L5724 1240.46 Knee-shin exo fluid swing ph
L5726 1628.86 Knee-shin ext jnts fld swg e
L5728 2029.34 Knee-shin fluid swg & stance
L5780 978.44 Knee-shin pneum/hydra pneum
L5781 3228.03 Lower limb pros vacuum pump
L5782 3403.08 Hd low limb pros vacuum pump
L5785 426.97 Exoskeletal bk ultralt mater
L5790 590.90 Exoskeletal ak ultra-light m
L5795 882.37 Exoskel hip ultra-light mate
L5810 410.48 Endoskel knee-shin mnl lock
L5811 599.36 Endo knee-shin mnl lck ultra
L5812 464.57 Endo knee-shin frct swg & st
L5814 2996.23 Endo knee-shin hydral swg ph
L5816 698.91 Endo knee-shin polyc mch sta
L5818 789.21 Endo knee-shin frct swg & st
L5822 1531.13 Endo knee-shin pneum swg frc
L5824 1260.30 Endo knee-shin fluid swing p
L5826 2544.67 Miniature knee joint
L5828 2402.41 Endo knee-shin fluid swg/sta
L5830 1707.01 Endo knee-shin pneum/swg pha
L5840 3010.11 Multi-axial knee/shin system
L5845 1446.04 Knee-shin sys stance flexion
L5848 867.54 Knee-shin sys hydraul stance
L5850 109.16 Endo ak/hip knee extens assi
L5855 253.80 Mech hip extension assist
L5856 19367.29 Elec knee-shin swing/stance
L5857 6872.27 Elec knee-shin swing only
L5858 14994.05 Stance phase only
L5859 11705.74 Knee-shin pro flex/ext cont
L5910 299.75 Endo below knee alignable sy
L5920 436.05 Endo ak/hip alignable system
L5925 276.14 Above knee manual lock
L5930 2715.54 High activity knee frame
L5940 412.22 Endo bk ultra-light material
L5950 696.41 Endo ak ultra-light material
L5960 834.17 Endo hip ultra-light materia
L5961 3738.81 Endo poly hip, pneu/hyd/rot
L5962 483.06 Below knee flex cover system
L5964 865.27 Above knee flex cover system
L5966 1114.59 Hip flexible cover system
L5968 2931.75 Multiaxial ankle w dorsiflex
L5970 180.41 Foot external keel sach foot
L5971 180.41 Sach foot, replacement
L5972 289.63 Flexible keel foot
L5973 14124.43 Ank-foot sys dors-plant flex
L5974 244.37 Foot single axis ankle/foot
L5975 374.01 Combo ankle/foot prosthesis
L5976 460.24 Energy storing foot
L5978 239.83 Ft prosth multiaxial ankl/ft
L5979 1924.47 Multi-axial ankle/ft prosth
L5980 3047.05 Flex foot system
L5981 2633.77 Flex-walk sys low ext prosth
L5982 475.10 Exoskeletal axial rotation u
L5984 470.88 Endoskeletal axial rotation
L5985 227.83 Lwr ext dynamic prosth pylon
L5986 523.53 Multi-axial rotation unit
L5987 5803.71 Shank ft w vert load pylon
L5988 1611.70 Vertical shock reducing pylo
L5990 1463.67 User adjustable heel height
L6000 1091.94 Part hand thumb rem
L6010 1215.14 Part hand little/ring
L6020 1132.93 Part hand no fingers
L6026 3475.37 Part hand myo exclu term dev
L6050 1561.14 Wrst mld sck flx hng tri pad
L6055 2481.48 Wrst mold sock w/exp interfa
L6100 1581.67 Elb mold sock flex hinge pad
L6110 1677.63 Elbow mold sock suspension t
L6120 1955.03 Elbow mold doub splt soc ste
L6130 2127.44 Elbow stump activated lock h
L6200 2241.98 Elbow mold outsid lock hinge
L6205 3736.01 Elbow molded w/ expand inter
L6250 2206.86 Elbow inter loc elbow forarm
L6300 3061.78 Shlder disart int lock elbow
L6310 2517.91 Shoulder passive restor comp
L6320 1404.42 Shoulder passive restor cap
L6350 3218.98 Thoracic intern lock elbow
L6360 2642.61 Thoracic passive restor comp
L6370 1989.47 Thoracic passive restor cap
L6380 1074.49 Postop dsg cast chg wrst/elb
L6382 1285.78 Postop dsg cast chg elb dis/
L6384 1569.00 Postop dsg cast chg shlder/t
L6386 376.26 Postop ea cast chg & realign
L6388 361.28 Postop applicat rigid dsg on
L6400 1910.95 Below elbow prosth tiss shap
L6450 2533.72 Elb disart prosth tiss shap
L6500 2535.80 Above elbow prosth tiss shap
L6550 3133.78 Shldr disar prosth tiss shap
L6570 3802.35 Scap thorac prosth tiss shap
L6580 1327.27 Wrist/elbow bowden cable mol
L6582 1131.07 Wrist/elbow bowden cbl dir f
L6584 1832.13 Elbow fair lead cable molded
L6586 1602.73 Elbow fair lead cable dir fo
L6588 2645.74 Shdr fair lead cable molded
L6590 2420.12 Shdr fair lead cable direct
L6600 163.29 Polycentric hinge pair
L6605 152.43 Single pivot hinge pair
L6610 136.82 Flexible metal hinge pair
L6611 332.18 Additional switch, ext power
L6615 168.71 Disconnect locking wrist uni
L6616 71.08 Disconnect insert locking wr
L6620 264.79 Flexion/extension wrist unit
L6621 1845.34 Flex/ext wrist w/wo friction
L6623 606.09 Spring-ass rot wrst w/ latch
L6624 3038.40 Flex/ext/rotation wrist unit
L6625 441.04 Rotation wrst w/ cable lock
L6628 450.70 Quick disconn hook adapter o
L6629 120.23 Lamination collar w/ couplin
L6630 177.11 Stainless steel any wrist
L6632 59.08 Latex suspension sleeve each
L6635 164.05 Lift assist for elbow
L6637 340.54 Nudge control elbow lock
L6638 2017.53 Elec lock on manual pw elbow
L6640 232.39 Shoulder abduction joint pai
L6641 154.45 Excursion amplifier pulley t
L6642 219.90 Excursion amplifier lever ty
L6645 267.05 Shoulder flexion-abduction j
L6646 2544.56 Multipo locking shoulder jnt
L6647 418.90 Shoulder lock actuator
L6648 2624.35 Ext pwrd shlder lock/unlock
L6650 278.17 Shoulder universal joint
L6655 61.74 Standard control cable extra
L6660 75.43 Heavy duty control cable
L6665 43.12 Teflon or equal cable lining
L6670 40.89 Hook to hand cable adapter
L6672 138.58 Harness chest/shlder saddle
L6675 98.69 Harness figure of 8 sing con
L6676 99.66 Harness figure of 8 dual con
L6677 239.33 Ue triple control harness
L6680 190.66 Test sock wrist disart/bel e
L6682 213.70 Test sock elbw disart/above
L6684 286.46 Test socket shldr disart/tho
L6686 532.71 Suction socket
L6687 474.03 Frame typ socket bel elbow/w
L6688 458.54 Frame typ sock above elb/dis
L6689 553.74 Frame typ socket shoulder di
L6690 599.67 Frame typ sock interscap-tho
L6691 358.63 Removable insert each
L6692 459.59 Silicone gel insert or equal
L6693 2290.44 Lockingelbow forearm cntrbal
L6694 577.38 Elbow socket ins use w/lock
L6695 481.13 Elbow socket ins use w/o lck
L6696 1061.22 Cus elbo skt in for con/atyp
L6697 1061.22 Cus elbo skt in not con/atyp
L6698 408.78 Below/above elbow lock mech
L6703 290.64 Term dev, passive hand mitt
L6704 481.29 Term dev, sport/rec/work att
L6706 286.75 Term dev mech hook vol open
L6707 1208.52 Term dev mech hook vol close
L6708 687.42 Term dev mech hand vol open
L6709 1112.56 Term dev mech hand vol close
L6711 542.39 Ped term dev, hook, vol open
L6712 998.67 Ped term dev, hook, vol clos
L6713 1260.44 Ped term dev, hand, vol open
L6714 1067.57 Ped term dev, hand, vol clos
L6715 2547.08 Term device, multi art digit
L6721 1897.50 Hook/hand, hvy dty, vol open
L6722 1635.79 Hook/hand, hvy dty, vol clos
L6805 295.83 Term dev modifier wrist unit
L6810 161.25 Term dev precision pinch dev
L6880 19275.85 Elec hand ind art digits
L6881 3298.29 Term dev auto grasp feature
L6882 2501.91 Microprocessor control uplmb
L6883 1304.12 Replc sockt below e/w disa
L6884 1834.72 Replc sockt above elbow disa
L6885 2642.61 Replc sockt shldr dis/interc
L6890 139.78 Prefab glove for term device
L6895 508.75 Custom glove for term device
L6900 1320.36 Hand restorat thumb/1 finger
L6905 1296.22 Hand restoration multiple fi
L6910 1330.66 Hand restoration no fingers
L6915 514.47 Hand restoration replacmnt g
L6920 6334.74 Wrist disarticul switch ctrl
L6925 6944.70 Wrist disart myoelectronic c
L6930 5992.81 Below elbow switch control
L6935 7091.46 Below elbow myoelectronic ct
L6940 7812.72 Elbow disarticulation switch
L6945 8738.38 Elbow disart myoelectronic c
L6950 8279.82 Above elbow switch control
L6955 10069.87 Above elbow myoelectronic ct
L6960 10690.70 Shldr disartic switch contro
L6965 12246.15 Shldr disartic myoelectronic
L6970 13162.17 Interscapular-thor switch ct
L6975 14531.20 Interscap-thor myoelectronic
L7007 2980.74 Adult electric hand
L7008 5035.57 Pediatric electric hand
L7009 3048.16 Adult electric hook
L7040 2390.69 Prehensile actuator
L7045 1328.32 Pediatric electric hook
L7170 4818.72 Electronic elbow hosmer swit
L7180 28694.16 Electronic elbow sequential
L7181 32325.89 Electronic elbo simultaneous
L7185 4933.56 Electron elbow adolescent sw
L7186 7533.96 Electron elbow child switch
L7190 6423.31 Elbow adolescent myoelectron
L7191 8114.70 Elbow child myoelectronic ct
L7259 3426.73 Electronic wrist rotator any
L7360 245.56 Six volt bat otto bock/eq ea
L7362 221.21 Battery chrgr six volt otto
L7364 408.91 Twelve volt battery utah/equ
L7366 550.89 Battery chrgr 12 volt utah/e
L7367 314.10 Replacemnt lithium ionbatter
L7368 407.17 Lithium ion battery charger
L7400 247.27 Add ue prost be/wd, ultlite
L7401 276.82 Add ue prost a/e ultlite mat
L7402 298.95 Add ue prost s/d ultlite mat
L7403 297.09 Add ue prost b/e acrylic
L7404 448.43 Add ue prost a/e acrylic
L7405 586.47 Add ue prost s/d acrylic
L7700 118.43 Pros soc insert gasket/seal
L8000 30.01 Mastectomy bra
L8001 101.20 Breast prosthesis bra & form
L8002 133.09 Brst prsth bra & bilat form
L8015 48.37 Ext breastprosthesis garment
L8020 205.61 Mastectomy form
L8030 266.11 Breast prosthes w/o adhesive
L8031 266.11 Breast prosthesis w adhesive
L8032 31.60 Reusable nipple prosthesis
L8035 2955.72 Custom breast prosthesis
L8040 2056.31 Nasal prosthesis
L8040 KM 1953.51 Nasal prosthesis
L8040 KN 822.51 Nasal prosthesis
L8041 2478.54 Midfacial prosthesis
L8041 KM 2354.61 Midfacial prosthesis
L8041 KN 991.43 Midfacial prosthesis
L8042 2784.87 Orbital prosthesis
L8042 KM 2645.61 Orbital prosthesis
L8042 KN 1113.95 Orbital prosthesis
L8043 3119.09 Upper facial prosthesis
L8043 KM 2963.13 Upper facial prosthesis
L8043 KN 1247.63 Upper facial prosthesis
L8044 3453.24 Hemi-facial prosthesis
L8044 KM 3280.59 Hemi-facial prosthesis
L8044 KN 1381.28 Hemi-facial prosthesis
L8045 2410.64 Auricular prosthesis
L8045 KM 2290.11 Auricular prosthesis
L8045 KN 964.26 Auricular prosthesis
L8046 2227.89 Partial facial prosthesis
L8046 KM 2116.51 Partial facial prosthesis
L8046 KN 891.16 Partial facial prosthesis
L8047 1141.81 Nasal septal prosthesis
L8047 KM 1084.72 Nasal septal prosthesis
L8047 KN 456.71 Nasal septal prosthesis
L8300 69.33 Truss single w/ standard pad
L8310 109.45 Truss double w/ standard pad
L8320 49.07 Truss addition to std pad wa
L8330 40.57 Truss add to std pad scrotal
L8400 14.27 Sheath below knee
L8410 19.06 Sheath above knee
L8415 18.74 Sheath upper limb
L8417 60.62 Pros sheath/sock w gel cushn
L8420 16.84 Prosthetic sock multi ply bk
L8430 18.19 Prosthetic sock multi ply ak
L8435 17.28 Pros sock multi ply upper lm
L8440 34.37 Shrinker below knee
L8460 54.77 Shrinker above knee
L8465 48.48 Shrinker upper limb
L8470 5.48 Pros sock single ply bk
L8480 7.57 Pros sock single ply ak
L8485 9.50 Pros sock single ply upper l
L8500 723.15 Artificial larynx
L8501 99.27 Tracheostomy speaking valve
L8507 33.79 Trach-esoph voice pros pt in
L8509 88.11 Trach-esoph voice pros md in
L8510 203.86 Voice amplifier
L8511 58.68 Indwelling trach insert
L8512 1.74 Gel cap for trach voice pros
L8513 4.19 Trach pros cleaning device
L8514 76.08 Repl trach puncture dilator
L8515 50.92 Gel cap app device for trach
L8600 514.38 Implant breast silicone/eq
L8603 359.86 Collagen imp urinary 2.5 ml
L8605 577.84 Inj bulking agent anal canal
L8606 179.14 Synthetic implnt urinary 1ml
L8607 34.60 Inj vocal cord bulking agent
L8609 5256.49 Artificial cornea
L8610 483.51 Ocular implant
L8612 507.77 Aqueous shunt prosthesis
L8613 251.59 Ossicular implant
L8614 16025.31 Cochlear device
L8615 363.87 Coch implant headset replace
L8616 84.75 Coch implant microphone repl
L8617 74.03 Coch implant trans coil repl
L8618 21.16 Coch implant tran cable repl
L8619 6879.55 Coch imp ext proc/contr rplc
L8621 0.50 Repl zinc air battery
L8622 0.26 Repl alkaline battery
L8623 52.18 Lith ion batt cid,non-earlvl
L8624 130.11 Lith ion batt cid, ear level
L8625 152.36 Charger coch impl/aoi battry
L8627 5877.35 Cid ext speech process repl
L8628 1002.18 Cid ext controller repl
L8629 144.46 Cid transmit coil and cable
L8630 276.87 Metacarpophalangeal implant
L8631 1751.43 Mcp joint repl 2 pc or more
L8641 287.67 Metatarsal joint implant
L8642 268.61 Hallux implant
L8658 270.61 Interphalangeal joint spacer
L8659 1556.82 Interphalangeal joint repl
L8670 457.47 Vascular graft, synthetic
L8679 6759.74 Imp neurosti pls gn any type
L8681 886.57 Pt prgrm for implt neurostim
L8682 4829.72 Implt neurostim radiofq rec
L8683 4251.25 Radiofq trsmtr for implt neu
L8684 652.60 Radiof trsmtr implt scrl neu
L8689 1391.64 External recharg sys intern
L8690 3837.98 Aud osseo dev, int/ext comp
L8691 1389.38 Aoi snd proc repl excl actua
L8693 1223.34 Aud osseo dev, abutment
L8694 761.89 Aoi transducer/actuator repl
L8695 13.43 External recharg sys extern
L8696 174.87 Ext antenna phren nerve stim
Q0477 69.19 Pwr module pt cable lvad rpl
Q0478 148.26 Power adapter, combo vad
Q0479 9687.76 Power module combo vad, rep
Q0480 72661.75 Driver pneumatic vad, rep
Q0481 11723.12 Microprcsr cu elec vad, rep
Q0482 3671.91 Microprcsr cu combo vad, rep
Q0483 15126.60 Monitor elec vad, rep
Q0484 2937.55 Monitor elec or comb vad rep
Q0485 283.60 Monitor cable elec vad, rep
Q0486 236.05 Mon cable elec/pneum vad rep
Q0487 275.40 Leads any type vad, rep only
Q0489 13113.94 Pwr pck base combo vad, rep
Q0490 567.26 Emr pwr source elec vad, rep
Q0491 891.78 Emr pwr source combo vad rep
Q0492 71.83 Emr pwr cbl elec vad, rep
Q0493 204.58 Emr pwr cbl combo vad, rep
Q0494 173.12 Emr hd pmp elec/combo, rep
Q0495 3369.94 Charger elec/combo vad, rep
Q0496 1209.52 Battery elec/combo vad, rep
Q0497 377.69 Bat clps elec/comb vad, rep
Q0498 414.41 Holster elec/combo vad, rep
Q0499 134.64 Belt/vest elec/combo vad rep
Q0500 24.64 Filters elec/combo vad, rep
Q0501 412.00 Shwr cov elec/combo vad, rep
Q0502 524.54 Mobility cart pneum vad, rep
Q0503 1049.11 Battery pneum vad replacemnt
Q0504 553.60 Pwr adpt pneum vad, rep veh
Q0506 689.10 Lith-ion batt elec/pneum vad
Q4001 41.87 Cast sup body cast plaster
Q4002 158.19 Cast sup body cast fiberglas
Q4003 30.06 Cast sup shoulder cast plstr
Q4004 104.07 Cast sup shoulder cast fbrgl
Q4005 11.08 Cast sup long arm adult plst
Q4006 24.97 Cast sup long arm adult fbrg
Q4007 5.54 Cast sup long arm ped plster
Q4008 12.48 Cast sup long arm ped fbrgls
Q4009 7.40 Cast sup sht arm adult plstr
Q4010 16.65 Cast sup sht arm adult fbrgl
Q4011 3.69 Cast sup sht arm ped plaster
Q4012 8.34 Cast sup sht arm ped fbrglas
Q4013 13.47 Cast sup gauntlet plaster
Q4014 22.71 Cast sup gauntlet fiberglass
Q4015 6.75 Cast sup gauntlet ped plster
Q4016 11.36 Cast sup gauntlet ped fbrgls
Q4017 7.79 Cast sup lng arm splint plst
Q4018 12.41 Cast sup lng arm splint fbrg
Q4019 3.90 Cast sup lng arm splnt ped p
Q4020 6.22 Cast sup lng arm splnt ped f
Q4021 5.76 Cast sup sht arm splint plst
Q4022 10.40 Cast sup sht arm splint fbrg
Q4023 2.90 Cast sup sht arm splnt ped p
Q4024 5.21 Cast sup sht arm splnt ped f
Q4025 32.31 Cast sup hip spica plaster
Q4026 100.90 Cast sup hip spica fiberglas
Q4027 16.17 Cast sup hip spica ped plstr
Q4028 50.48 Cast sup hip spica ped fbrgl
Q4029 24.72 Cast sup long leg plaster
Q4030 65.06 Cast sup long leg fiberglass
Q4031 12.35 Cast sup lng leg ped plaster
Q4032 32.53 Cast sup lng leg ped fbrgls
Q4033 23.06 Cast sup lng leg cylinder pl
Q4034 57.32 Cast sup lng leg cylinder fb
Q4035 11.53 Cast sup lngleg cylndr ped p
Q4036 28.68 Cast sup lngleg cylndr ped f
Q4037 14.05 Cast sup shrt leg plaster
Q4038 35.22 Cast sup shrt leg fiberglass
Q4039 7.05 Cast sup shrt leg ped plster
Q4040 17.61 Cast sup shrt leg ped fbrgls
Q4041 17.10 Cast sup lng leg splnt plstr
Q4042 29.19 Cast sup lng leg splnt fbrgl
Q4043 8.56 Cast sup lng leg splnt ped p
Q4044 14.60 Cast sup lng leg splnt ped f
Q4045 9.93 Cast sup sht leg splnt plstr
Q4046 15.96 Cast sup sht leg splnt fbrgl
Q4047 4.95 Cast sup sht leg splnt ped p
Q4048 7.98 Cast sup sht leg splnt ped f
Q4049 1.80 Finger splint, static
V2020 51.53 Vision svcs frames purchases
V2100 39.55 Lens spher single plano 4.00
V2101 41.45 Single visn sphere 4.12-7.00
V2102 61.06 Singl visn sphere 7.12-20.00
V2103 37.26 Spherocylindr 4.00d/12-2.00d
V2104 40.38 Spherocylindr 4.00d/2.12-4d
V2105 44.94 Spherocylinder 4.00d/4.25-6d
V2106 49.87 Spherocylinder 4.00d/>6.00d
V2107 46.23 Spherocylinder 4.25d/12-2d
V2108 49.10 Spherocylinder 4.25d/2.12-4d
V2109 54.32 Spherocylinder 4.25d/4.25-6d
V2110 53.61 Spherocylinder 4.25d/over 6d
V2111 54.95 Spherocylindr 7.25d/.25-2.25
V2112 60.99 Spherocylindr 7.25d/2.25-4d
V2113 63.55 Spherocylindr 7.25d/4.25-6d
V2114 74.48 Spherocylinder over 12.00d
V2115 65.92 Lens lenticular bifocal
V2118 80.35 Lens aniseikonic single
V2121 65.03 Lenticular lens, single
V2200 54.48 Lens spher bifoc plano 4.00d
V2201 59.64 Lens sphere bifocal 4.12-7.0
V2202 72.05 Lens sphere bifocal 7.12-20.
V2203 56.20 Lens sphcyl bifocal 4.00d/.1
V2204 59.25 Lens sphcy bifocal 4.00d/2.1
V2205 64.06 Lens sphcy bifocal 4.00d/4.2
V2206 68.82 Lens sphcy bifocal 4.00d/ove
V2207 60.83 Lens sphcy bifocal 4.25-7d/.
V2208 65.25 Lens sphcy bifocal 4.25-7/2.
V2209 69.79 Lens sphcy bifocal 4.25-7/4.
V2210 78.04 Lens sphcy bifocal 4.25-7/ov
V2211 72.19 Lens sphcy bifo 7.25-12/.25-
V2212 75.23 Lens sphcyl bifo 7.25-12/2.2
V2213 71.11 Lens sphcyl bifo 7.25-12/4.2
V2214 91.76 Lens sphcyl bifocal over 12.
V2215 78.10 Lens lenticular bifocal
V2218 110.84 Lens aniseikonic bifocal
V2219 48.79 Lens bifocal seg width over
V2220 39.57 Lens bifocal add over 3.25d
V2221 77.88 Lenticular lens, bifocal
V2300 65.10 Lens sphere trifocal 4.00d
V2301 76.31 Lens sphere trifocal 4.12-7.
V2302 89.86 Lens sphere trifocal 7.12-20
V2303 59.64 Lens sphcy trifocal 4.0/.12-
V2304 69.72 Lens sphcy trifocal 4.0/2.25
V2305 80.74 Lens sphcy trifocal 4.0/4.25
V2306 85.72 Lens sphcyl trifocal 4.00/>6
V2307 79.10 Lens sphcy trifocal 4.25-7/.
V2308 82.22 Lens sphc trifocal 4.25-7/2.
V2309 85.94 Lens sphc trifocal 4.25-7/4.
V2310 91.19 Lens sphc trifocal 4.25-7/>6
V2311 82.35 Lens sphc trifo 7.25-12/.25-
V2312 82.84 Lens sphc trifo 7.25-12/2.25
V2313 85.93 Lens sphc trifo 7.25-12/4.25
V2314 110.38 Lens sphcyl trifocal over 12
V2315 98.06 Lens lenticular trifocal
V2318 153.42 Lens aniseikonic trifocal
V2319 54.42 Lens trifocal seg width > 28
V2320 57.40 Lens trifocal add over 3.25d
V2321 96.65 Lenticular lens, trifocal
V2410 85.56 Lens variab asphericity sing
V2430 95.59 Lens variable asphericity bi
V2500 89.06 Contact lens pmma spherical
V2501 121.07 Cntct lens pmma-toric/prism
V2502 159.32 Contact lens pmma bifocal
V2503 153.61 Cntct lens pmma color vision
V2510 120.40 Cntct gas permeable sphericl
V2511 156.13 Cntct toric prism ballast
V2512 192.10 Cntct lens gas permbl bifocl
V2513 156.54 Contact lens extended wear
V2520 111.55 Contact lens hydrophilic
V2521 176.02 Cntct lens hydrophilic toric
V2522 157.06 Cntct lens hydrophil bifocl
V2523 155.23 Cntct lens hydrophil extend
V2530 209.70 Contact lens gas impermeable
V2531 436.84 Contact lens gas permeable
V2623 1257.00 Plastic eye prosth custom
V2624 66.71 Polishing artifical eye
V2625 304.17 Enlargemnt of eye prosthesis
V2626 163.97 Reduction of eye prosthesis
V2627 1446.00 Scleral cover shell
V2628 250.04 Fabrication & fitting
V2630 97.82 Anter chamber intraocul lens
V2631 97.82 Iris support intraoclr lens
V2632 97.82 Post chmbr intraocular lens
V2700 44.24 Balance lens
V2710 61.80 Glass/plastic slab off prism
V2715 10.11 Prism lens/es
V2718 24.34 Fresnell prism press-on lens
V2730 17.33 Special base curve
V2744 13.48 Tint photochromatic lens/es
V2745 9.58 Tint, any color/solid/grad
V2750 17.87 Anti-reflective coating
V2755 13.65 Uv lens/es
V2760 16.89 Scratch resistant coating
V2762 48.08 Polarization, any lens
V2770 16.04 Occluder lens/es
V2780 10.30 Oversize lens/es
V2782 51.94 Lens, 1.54-1.65 p/1.60-1.79g
V2783 58.56 Lens, >= 1.66 p/>=1.80 g
V2784 38.08 Lens polycarb or equal
V2786 0.00 Occupational multifocal lens