Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 2011 Fee Schedule 12/7/2010 The inclusion or exclusion of a fee for an item/service does not imply coverage

HCPCS Mod Mod2 PEIA Rate Description Comments A4216 $0.38 Sterile water/saline, 10 ml A4217 $2.76 Sterile water/saline, 500 ml A4217 AU $2.76 Sterile water/saline, 500 ml A4221 $19.95 Maint drug infus cath per wk A4222 $39.60 Infusion supplies with pump A4233 NU $0.71 Alkalin batt for glucose mon A4233 NU KL $0.60 Alkalin batt for glucose mon A4234 NU $3.20 J‐cell batt for glucose mon A4234 NU KL $2.76 J‐cell batt for glucose mon A4235 NU $2.07 Lithium batt for glucose mon A4235 NU KL $1.78 Lithium batt for glucose mon A4236 NU $1.48 Silvr oxide batt glucose mon A4236 NU KL $1.28 Silvr oxide batt glucose mon A4253 NU $32.55 Blood glucose/reagent strips A4253 NU KL $28.06 Blood glucose/reagent strips A4255 $3.45 Glucose monitor platforms A4256 $10.08 Calibrator solution/chips A4256 KL $8.69 Calibrator solution/chips A4257 $11.24 Replace Lensshield Cartridge A4258 $15.90 Lancet device each A4258 KL $13.71 Lancet device each A4259 $10.11 Lancets per box A4259 KL $8.72 Lancets per box A4265 $2.99 Paraffin A4280 $4.57 Brst prsths adhsv attchmnt A4310 $6.80 Insert tray w/o bag/cath A4311 $13.07 Catheter w/o bag 2‐way latex A4312 $15.89 Cath w/o bag 2‐way silicone A4313 $16.32 Catheter w/bag 3‐way A4314 $22.28 Cath w/drainage 2‐way latex A4315 $23.25 Cath w/drainage 2‐way silcne A4316 $25.02 Cath w/drainage 3‐way A4320 $4.19 Irrigation tray A4321 $0.00 Cath therapeutic irrig agent A4322 $2.56 Irrigation syringe A4326 $9.14 Male external catheter A4327 $37.25 Fem urinary collect dev cup A4328 $8.92 Fem urinary collect pouch A4330 $5.36 Stool collection pouch A4331 $2.81 Extension drainage tubing A4332 $0.11 Lube sterile packet A4333 $1.94 Urinary cath anchor device A4334 $4.34 Urinary cath leg strap A4336 $1.27 Urethral insert A4338 $10.80 Indwelling catheter latex A4340 $23.78 Indwelling catheter special A4344 $14.11 Cath indw foley 2 way silicn A4346 $17.26 Cath indw foley 3 way A4349 $1.78 Disposable male external cat A4351 $1.51 Straight tip urine catheter A4352 $4.80 Coude tip urinary catheter A4353 $6.16 Intermittent urinary cath A4354 $10.40 Cath insertion tray w/bag A4355 $7.74 Bladder irrigation tubing A4356 $40.20 Ext ureth clmp or compr dvc A4357 $8.55 Bedside drainage bag A4358 $5.84 Urinary leg or abdomen bag A4360 $0.43 Disposable ext urethral dev A4361 $16.19 Ostomy face plate A4362 $2.98 Solid skin barrier A4363 $2.08 Ostomy clamp, replacement A4364 $2.20 Adhesive, liquid or equal A4366 $1.15 Ostomy vent A4367 $6.48 Ostomy belt A4368 $0.23 Ostomy filter A4369 $2.13 Skin barrier liquid per oz A4371 $3.22 Skin barrier powder per oz A4372 $3.69 Skin barrier solid 4x4 equiv A4373 $5.53 Skin barrier with flange A4375 $15.14 Drainable plastic pch w fcpl A4376 $41.92 Drainable rubber pch w fcplt A4377 $3.78 Drainable plstic pch w/o fp A4378 $27.10 Drainable rubber pch w/o fp A4379 $13.23 Urinary plastic pouch w fcpl A4380 $32.89 Urinary rubber pouch w fcplt A4381 $4.07 Urinary plastic pouch w/o fp A4382 $21.69 Urinary hvy plstc pch w/o fp A4383 $24.84 Urinary rubber pouch w/o fp A4384 $8.48 Ostomy faceplt/silicone ring A4385 $4.49 Ost skn barrier sld ext wear A4387 $0.00 Ost clsd pouch w att st barr A4388 $3.85 Drainable pch w ex wear barr A4389 $5.48 Drainable pch w st wear barr A4390 $8.47 Drainable pch ex wear convex A4391 $6.22 Urinary pouch w ex wear barr A4392 $7.21 Urinary pouch w st wear barr A4393 $7.96 Urine pch w ex wear bar conv A4394 $2.28 Ostomy pouch liq deodorant A4395 $0.04 Ostomy pouch solid deodorant A4396 $35.67 Peristomal hernia supprt blt A4397 $4.22 Irrigation supply sleeve A4398 $12.17 Ostomy irrigation bag A4399 $9.18 Ostomy irrig cone/cath w brs A4400 $43.06 Ostomy irrigation set A4402 $1.41 Lubricant per ounce A4404 $1.36 Ostomy ring each A4405 $3.00 Nonpectin based ostomy paste A4406 $5.06 Pectin based ostomy paste A4407 $7.72 Ext wear ost skn barr <=4sq" A4408 $8.69 Ext wear ost skn barr >4sq" A4409 $5.48 Ost skn barr convex <=4 sq i A4410 $7.96 Ost skn barr extnd >4 sq A4411 $4.49 Ost skn barr extnd =4sq A4412 $2.39 Ost pouch drain high output A4413 $4.85 2 pc drainable ost pouch A4414 $4.34 Ost sknbar w/o conv<=4 sq in A4415 $5.28 Ost skn barr w/o conv >4 sqi A4416 $2.43 Ost pch clsd w barrier/filtr A4417 $3.28 Ost pch w bar/bltinconv/fltr A4418 $1.60 Ost pch clsd w/o bar w filtr A4419 $1.54 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 $1.64 Ost pch for bar w lk fl/fltr A4424 $4.19 Ost pch drain w bar & filter A4425 $3.16 Ost pch drain for barrier fl A4426 $2.41 Ost pch drain 2 piece system A4427 $2.45 Ost pch drain/barr lk flng/f A4428 $5.74 Urine ost pouch w faucet/tap A4429 $7.27 Urine ost pouch w bltinconv A4430 $7.51 Ost urine pch w b/bltin conv A4431 $5.48 Ost pch urine w barrier/tapv A4432 $3.17 Os pch urine w bar/fange/tap A4433 $2.95 Urine ost pch bar w lock fln A4434 $3.32 Ost pch urine w lock flng/ft A4450 AU $0.08 Non‐waterproof tape A4450 AV $0.08 Non‐waterproof tape A4450 AW $0.10 Non‐waterproof tape A4452 AU $0.32 Waterproof tape A4452 AV $0.32 Waterproof tape A4452 AW $0.35 Waterproof tape A4455 $1.26 Adhesive remover per ounce A4456 $0.22 Adhesive remover, wipes A4461 $2.90 Surgicl dress hold non‐reuse A4463 $11.73 Surgical dress holder reuse A4481 $0.33 Tracheostoma filter A4483 $0.00 Moisture exchanger A4556 $9.10 Electrodes, pair A4557 $15.81 Lead wires, pair A4558 $4.80 Conductive gel or paste A4559 $0.09 Coupling gel or paste A4561 $17.58 Pessary rubber, any type A4562 $43.77 Pessary, non rubber,any type A4595 $25.38 TENS suppl 2 lead per month A4604 NU $50.74 Tubing with heating element A4605 NU $14.45 Trach suction cath close sys A4608 $44.17 Transtracheal oxygen cath A4611 NU $173.09 Heavy duty battery A4611 RR $17.30 Heavy duty battery A4611 UE $129.83 Heavy duty battery A4612 NU $59.87 Battery cables A4612 RR $6.10 Battery cables A4612 UE $45.65 Battery cables A4613 NU $127.07 Battery charger A4613 RR $12.71 Battery charger A4613 UE $78.10 Battery charger A4614 $20.96 Hand‐held PEFR meter A4615 $0.63 Cannula nasal A4616 $0.06 Tubing (oxygen) per foot A4617 $2.73 Mouth piece A4618 NU $6.65 Breathing circuits A4618 RR $0.76 Breathing circuits A4618 UE $4.99 Breathing circuits A4619 $1.07 Face tent A4620 $0.55 Variable concentration mask A4623 $4.91 Tracheostomy inner cannula A4624 NU $2.32 Tracheal suction tube A4625 $6.11 Trach care kit for new trach A4626 $2.81 Tracheostomy cleaning brush A4628 NU $3.30 Oropharyngeal suction cath A4629 $4.08 Tracheostomy care kit A4630 NU $4.68 Repl bat t.e.n.s. own by pt A4633 NU $36.16 Uvl replacement bulb A4635 NU $4.51 Underarm crutch pad A4635 RR $0.54 Underarm crutch pad A4635 UE $2.99 Underarm crutch pad A4636 NU $2.72 Handgrip for cane etc A4636 NU KE $3.16 Handgrip for cane etc A4636 RR $0.28 Handgrip for cane etc A4636 RR KE $0.32 Handgrip for cane etc A4636 UE $1.98 Handgrip for cane etc A4636 UE KE $2.30 Handgrip for cane etc A4637 NU $1.62 Repl tip cane/crutch/walker A4637 NU KE $1.88 Repl tip cane/crutch/walker A4637 RR $0.23 Repl tip cane/crutch/walker A4637 RR KE $0.27 Repl tip cane/crutch/walker A4637 UE $1.23 Repl tip cane/crutch/walker A4637 UE KE $1.42 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 NU $253.07 Infrared ht sys replcmnt pad A4640 NU $47.79 Alternating pressure pad A4640 RR $4.83 Alternating pressure pad A4640 UE $35.84 Alternating pressure pad A5051 $1.82 Pouch clsd w barr attached A5052 $1.31 Clsd ostomy pouch w/o barr A5053 $1.54 Clsd ostomy pouch faceplate A5054 $1.58 Clsd ostomy pouch w/flange A5055 $1.18 Stoma cap A5061 $3.11 Pouch drainable w barrier at A5062 $1.84 Drnble ostomy pouch w/o barr A5063 $2.39 Drain ostomy pouch w/flange A5071 $5.29 Urinary pouch w/barrier A5072 $3.11 Urinary pouch w/o barrier A5073 $2.76 Urinary pouch on barr w/flng A5081 $2.91 Continent stoma plug A5082 $10.47 Continent stoma catheter A5083 $0.55 Stoma absorptive cover A5093 $1.46 Ostomy accessory convex inse A5102 $19.76 Bedside drain btl w/wo tube A5105 $35.92 Urinary suspensory A5112 $27.76 Urinary leg bag A5113 $3.53 Latex leg strap A5114 $6.69 Foam/fabric leg strap A5120 AU $0.19 Skin barrier, wipe or swab A5120 AV $0.20 Skin barrier, wipe or swab A5121 $6.28 Solid skin barrier 6x6 A5122 $11.32 Solid skin barrier 8x8 A5126 $0.99 Disk/foam pad +or‐ adhesive A5131 $11.88 Appliance cleaner A5200 $9.95 Percutaneous catheter anchor A5500 $56.02 Diab shoe for density insert A5501 $168.04 Diabetic custom molded shoe A5503 $27.38 Diabetic shoe w/roller/rockr A5504 $27.38 Diabetic shoe with wedge A5505 $27.38 Diab shoe w/metatarsal bar A5506 $27.38 Diabetic shoe w/off set heel A5507 $27.38 Modification diabetic shoe A5512 $22.86 Multi den insert direct form A5513 $34.11 Multi den insert custom mold A6010 $27.28 Collagen based wound filler A6011 $2.01 Collagen gel/paste wound fil A6021 $18.52 Collagen dressing <=16 sq in A6022 $18.52 Collagen drsg>16<=48 sq in A6023 $167.68 Collagen dressing >48 sq in A6024 $5.45 Collagen dsg wound filler A6154 $12.28 Wound pouch each A6196 $6.48 Alginate dressing <=16 sq in A6197 $14.48 Alginate drsg >16 <=48 sq in A6199 $4.65 Alginate drsg wound filler A6203 $2.96 Composite drsg <= 16 sq in A6204 $5.49 Composite drsg >16<=48 sq in A6207 $6.47 Contact layer >16<= 48 sq in A6209 $6.59 Foam drsg <=16 sq in w/o bdr A6210 $17.56 Foam drg >16<=48 sq in w/o b A6211 $25.88 Foam drg > 48 sq in w/o brdr A6212 $8.55 Foam drg <=16 sq in w/border A6214 $9.06 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 $0.84 Gauze <= 16 sq in w/border A6220 $2.28 Gauze >16 <=48 sq in w/bordr A6222 $1.88 Gauze <=16 in no w/sal w/o b A6223 $2.13 Gauze >16<=48 no w/sal w/o b A6224 $3.18 Gauze > 48 in no w/sal w/o b A6229 $3.18 Gauze >16<=48 sq in watr/sal A6231 $4.11 Hydrogel dsg<=16 sq in A6232 $6.06 Hydrogel dsg>16<=48 sq in A6233 $16.91 Hydrogel dressing >48 sq in A6234 $5.76 Hydrocolld drg <=16 w/o bdr A6235 $14.82 Hydrocolld drg >16<=48 w/o b A6236 $24.01 Hydrocolld drg > 48 in w/o b A6237 $6.97 Hydrocolld drg <=16 in w/bdr A6238 $20.08 Hydrocolld drg >16<=48 w/bdr A6240 $10.79 Hydrocolld drg filler paste A6241 $2.27 Hydrocolloid drg filler dry A6242 $5.34 Hydrogel drg <=16 in w/o bdr A6243 $10.85 Hydrogel drg >16<=48 w/o bdr A6244 $34.61 Hydrogel drg >48 in w/o bdr A6245 $6.40 Hydrogel drg <= 16 in w/bdr A6246 $8.74 Hydrogel drg >16<=48 in w/b A6247 $20.96 Hydrogel drg > 48 sq in w/b A6248 $14.31 Hydrogel drsg gel filler A6251 $1.76 Absorpt drg <=16 sq in w/o b A6252 $2.86 Absorpt drg >16 <=48 w/o bdr A6253 $5.59 Absorpt drg > 48 sq in w/o b A6254 $1.07 Absorpt drg <=16 sq in w/bdr A6255 $2.67 Absorpt drg >16<=48 in w/bdr A6257 $1.35 Transparent film <= 16 sq in A6258 $3.80 Transparent film >16<=48 in A6259 $9.64 Transparent film > 48 sq in A6266 $1.70 Impreg gauze no h20/sal/yard A6402 $0.11 Sterile gauze <= 16 sq in A6403 $0.38 Sterile gauze>16 <= 48 sq in A6407 $1.65 Packing strips, non‐impreg A6410 $0.34 Sterile eye pad A6411 $0.00 Non‐sterile eye pad A6441 $0.59 Pad band w>=3" <5"/yd A6442 $0.15 Conform band n/s w<3"/yd A6443 $0.25 Conform band n/s w>=3"<5"/yd A6444 $0.50 Conform band n/s w>=5"/yd A6445 $0.29 Conform band s w <3"/yd A6446 $0.36 Conform band s w>=3" <5"/yd A6447 $0.59 Conform band s w >=5"/yd A6448 $1.02 Lt compres band <3"/yd A6449 $1.55 Lt compres band >=3" <5"/yd A6450 $0.00 Lt compres band >=5"/yd A6451 $0.00 Mod compres band w>=3"<5"/yd A6452 $5.21 High compres band w>=3"<5"yd A6453 $0.54 Self‐adher band w <3"/yd A6454 $0.68 Self‐adher band w>=3" <5"/yd A6455 $1.23 Self‐adher band >=5"/yd A6456 $1.13 Zinc paste band w >=3"<5"/yd A6457 $1.01 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 $38.12 Compression stocking BK30‐40 A6532 AW $53.72 Compression stocking BK40‐50 A6545 $0.00 Grad comp non‐elastic BK A6545 AW $75.06 Grad comp non‐elastic BK A6550 $20.83 Neg pres wound ther drsg set A7000 NU $6.46 Disposable canister for pump A7000 NU KE $7.50 Disposable canister for pump A7001 NU $29.15 Nondisposable pump canister A7002 NU $3.38 Tubing used w suction pump A7003 NU $2.06 Nebulizer administration set A7004 NU $1.59 Disposable nebulizer sml vol A7005 NU $27.17 Nondisposable nebulizer set A7006 NU $8.41 Filtered nebulizer admin set A7007 NU $4.07 Lg vol nebulizer disposable A7008 NU $9.69 Disposable nebulizer prefill A7009 NU $37.04 Nebulizer reservoir bottle A7010 NU $20.79 Disposable corrugated tubing A7012 NU $2.83 Nebulizer water collec devic A7013 NU $0.73 Disposable compressor filter A7014 NU $3.96 Compressor nondispos filter A7015 NU $1.44 Aerosol mask used w nebulize A7016 NU $6.38 Nebulizer dome & mouthpiece A7017 NU $118.10 Nebulizer not used w oxygen A7017 RR $11.81 Nebulizer not used w oxygen A7017 UE $88.57 Nebulizer not used w oxygen A7018 $0.34 Water distilled w/nebulizer A7020 NU $0.00 Interface, cough stim device A7020 RR $0.00 Interface, cough stim device A7020 UE $0.00 Interface, cough stim device A7025 NU $383.23 Replace chest compress vest A7026 NU $25.33 Replace chst cmprss sys hose A7027 NU $164.35 Combination oral/nasal mask A7028 NU $43.65 Repl oral cushion combo mask A7029 NU $17.83 Repl nasal pillow comb mask A7030 NU $143.26 CPAP full face mask A7031 NU $52.99 Replacement facemask interfa A7032 NU $30.78 Replacement nasal cushion A7033 NU $21.57 Replacement nasal pillows A7034 NU $89.33 Nasal application device A7035 NU $30.18 Pos airway press headgear A7036 NU $11.74 Pos airway press chinstrap A7037 NU $31.04 Pos airway pressure tubing A7038 NU $3.49 Pos airway pressure filter A7039 NU $10.63 Filter, non disposable w pap A7040 $34.78 One way chest drain valve A7041 $65.37 Water seal drain container A7042 $178.90 Implanted pleural catheter A7043 $24.77 Vacuum drainagebottle/tubing A7044 NU $91.82 PAP oral interface A7045 NU $14.78 Repl exhalation port for PAP A7045 RR $1.48 Repl exhalation port for PAP A7045 UE $11.09 Repl exhalation port for PAP A7046 NU $14.82 Repl water chamber, PAP dev A7501 $92.54 Tracheostoma valve w diaphra A7502 $43.98 Replacement diaphragm/fplate A7503 $9.99 HMES filter holder or cap A7504 $0.59 Tracheostoma HMES filter A7505 $4.12 HMES or trach valve housing A7506 $0.29 HMES/trachvalve adhesivedisk A7507 $2.19 Integrated filter & holder A7508 $2.53 Housing & Integrated Adhesiv A7509 $1.24 Heat & moisture exchange sys A7520 $41.83 Trach/laryn tube non‐cuffed A7521 $41.45 Trach/laryn tube cuffed A7522 $39.79 Trach/laryn tube stainless A7524 $68.20 Tracheostoma stent/stud/bttn A7525 $1.82 Tracheostomy mask A7526 $2.97 Tracheostomy tube collar A7527 $3.16 Trach/laryn tube plug/stop A8000 NU $135.12 Soft protect helmet prefab A8000 RR $13.51 Soft protect helmet prefab A8000 UE $101.35 Soft protect helmet prefab A8001 NU $135.12 Hard protect helmet prefab A8001 RR $13.51 Hard protect helmet prefab A8001 UE $101.35 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 $17.21 Cane adjust/fixed with tip E0100 RR $5.23 Cane adjust/fixed with tip E0100 UE $13.89 Cane adjust/fixed with tip E0105 NU $40.02 Cane adjust/fixed quad/3 pro E0105 RR $7.80 Cane adjust/fixed quad/3 pro E0105 UE $31.32 Cane adjust/fixed quad/3 pro E0110 NU $58.11 Crutch forearm pair E0110 RR $14.09 Crutch forearm pair E0110 UE $43.58 Crutch forearm pair E0111 NU $42.66 Crutch forearm each E0111 RR $7.43 Crutch forearm each E0111 UE $36.22 Crutch forearm each E0112 NU $29.57 Crutch underarm pair wood E0112 RR $8.75 Crutch underarm pair wood E0112 UE $22.16 Crutch underarm pair wood E0113 NU $15.83 Crutch underarm each wood E0113 RR $4.54 Crutch underarm each wood E0113 UE $11.88 Crutch underarm each wood E0114 NU $35.35 Crutch underarm pair no wood E0114 RR $7.55 Crutch underarm pair no wood E0114 UE $31.42 Crutch underarm pair no wood E0116 NU $20.78 Crutch underarm each no wood E0116 RR $4.75 Crutch underarm each no wood E0116 UE $15.64 Crutch underarm each no wood E0117 NU $169.81 Underarm springassist crutch E0117 RR $16.97 Underarm springassist crutch E0117 UE $127.37 Underarm springassist crutch E0130 NU $53.34 Walker rigid adjust/fixed ht E0130 RR $12.77 Walker rigid adjust/fixed ht E0130 UE $41.56 Walker rigid adjust/fixed ht E0135 NU $58.08 Walker folding adjust/fixed E0135 RR $13.10 Walker folding adjust/fixed E0135 UE $44.82 Walker folding adjust/fixed E0140 NU $273.93 Walker w trunk support E0140 RR $27.40 Walker w trunk support E0140 UE $205.46 Walker w trunk support E0141 NU $74.42 Rigid wheeled walker adj/fix E0141 RR $16.98 Rigid wheeled walker adj/fix E0141 UE $55.82 Rigid wheeled walker adj/fix E0143 NU $77.62 Walker folding wheeled w/o s E0143 RR $16.40 Walker folding wheeled w/o s E0143 UE $58.09 Walker folding wheeled w/o s E0144 NU $241.84 Enclosed walker w rear seat E0144 RR $24.19 Enclosed walker w rear seat E0144 UE $181.37 Enclosed walker w rear seat E0147 NU $436.53 Walker variable wheel resist E0147 RR $43.65 Walker variable wheel resist E0147 UE $327.42 Walker variable wheel resist E0148 NU $96.49 Heavyduty walker no wheels E0148 RR $9.66 Heavyduty walker no wheels E0148 UE $72.36 Heavyduty walker no wheels E0149 NU $169.51 Heavy duty wheeled walker E0149 RR $16.95 Heavy duty wheeled walker E0149 UE $127.13 Heavy duty wheeled walker E0153 NU $51.96 Forearm crutch platform atta E0153 RR $5.87 Forearm crutch platform atta E0153 UE $38.97 Forearm crutch platform atta E0154 NU $45.52 Walker platform attachment E0154 RR $5.53 Walker platform attachment E0154 UE $34.58 Walker platform attachment E0155 NU $23.97 Walker wheel attachment,pair E0155 RR $2.92 Walker wheel attachment,pair E0155 UE $18.27 Walker wheel attachment,pair E0156 NU $17.07 Walker seat attachment E0156 RR $2.18 Walker seat attachment E0156 UE $12.81 Walker seat attachment E0157 NU $52.89 Walker crutch attachment E0157 RR $5.80 Walker crutch attachment E0157 UE $39.66 Walker crutch attachment E0158 NU $24.44 Walker leg extenders set of4 E0158 RR $2.70 Walker leg extenders set of4 E0158 UE $18.45 Walker leg extenders set of4 E0159 NU $13.57 Brake for wheeled walker E0159 RR $1.40 Brake for wheeled walker E0159 UE $10.18 Brake for wheeled walker E0160 NU $24.76 Sitz type bath or equipment E0160 RR $3.82 Sitz type bath or equipment E0160 UE $18.55 Sitz type bath or equipment E0161 NU $23.11 Sitz bath/equipment w/faucet E0161 RR $3.15 Sitz bath/equipment w/faucet E0161 UE $17.30 Sitz bath/equipment w/faucet E0162 NU $123.28 Sitz bath chair E0162 RR $13.47 Sitz bath chair E0162 UE $90.04 Sitz bath chair E0163 NU $93.73 Commode chair with fixed arm E0163 RR $21.52 Commode chair with fixed arm E0163 UE $74.94 Commode chair with fixed arm E0165 RR $13.92 Commode chair with detacharm E0167 NU $10.58 Commode chair pail or pan E0167 RR $1.11 Commode chair pail or pan E0167 UE $7.96 Commode chair pail or pan E0168 NU $132.98 Heavyduty/wide commode chair E0168 RR $13.29 Heavyduty/wide commode chair E0168 UE $99.72 Heavyduty/wide commode chair E0170 RR $141.62 Commode chair electric E0171 RR $25.49 Commode chair non‐electric E0175 NU $53.57 Commode chair foot rest E0175 RR $5.35 Commode chair foot rest E0175 UE $40.17 Commode chair foot rest E0181 RR $22.96 Press pad alternating w/ pum E0182 RR $19.61 Replace pump, alt press pad E0184 NU $145.82 Dry pressure mattress E0184 RR $21.65 Dry pressure mattress E0184 UE $131.57 Dry pressure mattress E0185 NU $239.55 Gel pressure mattress pad E0185 RR $39.60 Gel pressure mattress pad E0185 UE $183.85 Gel pressure mattress pad E0186 RR $17.89 Air pressure mattress E0187 RR $20.45 Water pressure mattress E0188 NU $23.28 Synthetic sheepskin pad E0188 RR $2.74 Synthetic sheepskin pad E0188 UE $17.49 Synthetic sheepskin pad E0189 NU $45.79 Lambswool sheepskin pad E0189 RR $4.96 Lambswool sheepskin pad E0189 UE $34.35 Lambswool sheepskin pad E0191 NU $8.75 Protector heel or elbow E0191 RR $0.90 Protector heel or elbow E0191 UE $6.55 Protector heel or elbow E0193 RR $662.47 Powered air flotation bed E0194 RR $2,503.30 Air fluidized bed E0196 RR $27.82 Gel pressure mattress E0197 NU $195.24 Air pressure pad for mattres E0197 RR $26.94 Air pressure pad for mattres E0197 UE $171.50 Air pressure pad for mattres E0198 NU $195.24 Water pressure pad for mattr E0198 RR $20.23 Water pressure pad for mattr E0198 UE $148.15 Water pressure pad for mattr E0199 NU $24.01 Dry pressure pad for mattres E0199 RR $2.39 Dry pressure pad for mattres E0199 UE $18.00 Dry pressure pad for mattres E0200 NU $69.85 Heat lamp without stand E0200 RR $9.48 Heat lamp without stand E0200 UE $52.42 Heat lamp without stand E0202 RR $55.16 Phototherapy light w/ photom E0205 NU $170.99 Heat lamp with stand E0205 RR $18.81 Heat lamp with stand E0205 UE $128.24 Heat lamp with stand E0210 NU $28.76 Electric heat pad standard E0210 RR $2.70 Electric heat pad standard E0210 UE $21.56 Electric heat pad standard E0215 NU $62.42 Electric heat pad moist E0215 RR $6.53 Electric heat pad moist E0215 UE $46.82 Electric heat pad moist E0217 NU $371.83 Water circ heat pad w pump E0217 RR $41.40 Water circ heat pad w pump E0217 UE $278.85 Water circ heat pad w pump E0225 NU $291.08 Hydrocollator unit E0225 RR $28.69 Hydrocollator unit E0225 UE $218.30 Hydrocollator unit E0235 RR $12.93 Paraffin bath unit portable E0236 RR $33.14 Pump for water circulating p E0239 NU $336.90 Hydrocollator unit portable E0239 RR $33.69 Hydrocollator unit portable E0239 UE $252.69 Hydrocollator unit portable E0249 NU $74.60 Pad water circulating heat u E0249 RR $8.21 Pad water circulating heat u E0249 UE $55.95 Pad water circulating heat u E0250 RR $74.24 Hosp bed fixed ht w/ mattres E0251 RR $52.09 Hosp bed fixd ht w/o mattres E0255 RR $89.22 Hospital bed var ht w/ mattr E0256 RR $53.80 Hospital bed var ht w/o matt E0260 RR $106.67 Hosp bed semi‐electr w/ matt E0261 RR $92.80 Hosp bed semi‐electr w/o mat E0265 RR $135.37 Hosp bed total electr w/ mat E0266 RR $127.29 Hosp bed total elec w/o matt E0271 NU $143.34 Mattress innerspring E0271 RR $14.88 Mattress innerspring E0271 UE $111.97 Mattress innerspring E0272 NU $144.76 Mattress foam rubber E0272 RR $16.04 Mattress foam rubber E0272 UE $108.56 Mattress foam rubber E0275 NU $13.49 Bed pan standard E0275 RR $1.41 Bed pan standard E0275 UE $10.11 Bed pan standard E0276 NU $11.73 Bed pan fracture E0276 RR $1.39 Bed pan fracture E0276 UE $9.27 Bed pan fracture E0277 RR $534.22 Powered pres‐redu air mattrs E0280 NU $24.66 Bed cradle E0280 RR $2.65 Bed cradle E0280 UE $18.50 Bed cradle E0290 RR $48.24 Hosp bed fx ht w/o rails w/m E0291 RR $35.05 Hosp bed fx ht w/o rail w/o E0292 RR $54.25 Hosp bed var ht w/o rail w/o E0293 RR $46.17 Hosp bed var ht w/o rail w/ E0294 RR $89.29 Hosp bed semi‐elect w/ mattr E0295 RR $83.19 Hosp bed semi‐elect w/o matt E0296 RR $105.99 Hosp bed total elect w/ matt E0297 RR $90.80 Hosp bed total elect w/o mat E0300 NU $2,155.76 Enclosed ped crib hosp grade E0300 RR $215.57 Enclosed ped crib hosp grade E0300 UE $1,616.82 Enclosed ped crib hosp grade E0301 RR $198.24 HD hosp bed, 350‐600 lbs E0302 RR $543.33 Ex hd hosp bed > 600 lbs E0303 RR $223.50 Hosp bed hvy dty xtra wide E0304 RR $585.28 Hosp bed xtra hvy dty x wide E0305 RR $11.48 Rails bed side half length E0310 NU $140.43 Rails bed side full length E0310 RR $17.29 Rails bed side full length E0310 UE $105.32 Rails bed side full length E0316 RR $160.46 Bed safety enclosure E0325 NU $7.58 Urinal male jug‐type E0325 RR $1.13 Urinal male jug‐type E0325 UE $5.01 Urinal male jug‐type E0326 NU $9.26 Urinal female jug‐type E0326 RR $0.93 Urinal female jug‐type E0326 UE $6.93 Urinal female jug‐type E0371 RR $326.15 Nonpower mattress overlay E0372 RR $395.75 Powered air mattress overlay E0373 RR $453.33 Nonpowered pressure mattress E0424 RR $145.58 Stationary compressed gas 02 E0431 RR $24.14 Portable gaseous 02 E0433 RR $43.37 Portable liquid oxygen sys E0434 RR $24.14 Portable liquid 02 E0439 RR $145.58 Stationary liquid 02 E0441 $65.06 Stationary O2 contents, gas E0442 $65.06 Stationary O2 contents, liq E0443 $65.06 Portable 02 contents, gas E0444 $65.06 Portable 02 contents, liquid E0450 RR $841.05 Vol control vent invasiv int E0457 NU $541.46 Chest shell E0457 RR $54.15 Chest shell E0457 UE $406.06 Chest shell E0459 RR $44.44 Chest wrap E0460 RR $646.36 Neg press vent portabl/statn E0461 RR $841.05 Vol control vent noninv int E0462 RR $242.26 Rocking bed w/ or w/o side r E0463 RR $1,239.18 Press supp vent invasive int PEIA will allow monthly, w/o purchase E0464 RR $1,239.18 Press supp vent noninv int PEIA will allow monthly, w/o purchase E0470 RR $194.87 RAD w/o backup non‐inv intfc PEIA will allow monthly, w/o purchase E0471 RR $487.69 RAD w/backup non inv intrfc E0472 RR $487.69 RAD w backup invasive intrfc E0480 RR $35.52 Percussor elect/pneum home m E0482 RR $366.08 Cough stimulating device E0483 RR $936.74 Chest compression gen system E0484 NU $32.53 Non‐elec oscillatory pep dvc E0484 RR $3.25 Non‐elec oscillatory pep dvc E0484 UE $24.41 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 $96.72 Ippb all types E0550 RR $37.55 Humidif extens supple w ippb E0560 NU $130.26 Humidifier supplemental w/ i E0560 RR $15.26 Humidifier supplemental w/ i E0560 UE $97.69 Humidifier supplemental w/ i E0561 NU $81.26 Humidifier nonheated w PAP E0561 RR $8.11 Humidifier nonheated w PAP E0561 UE $60.94 Humidifier nonheated w PAP E0562 NU $228.76 Humidifier heated used w PAP E0562 RR $22.86 Humidifier heated used w PAP E0562 UE $171.57 Humidifier heated used w PAP E0565 RR $45.70 Compressor air power source E0570 RR $14.19 Nebulizer with compression E0571 RR $25.67 Aerosol compressor for svneb E0572 RR $32.60 Aerosol compressor adjust pr E0574 RR $34.47 Ultrasonic generator w svneb E0575 RR $90.56 Nebulizer ultrasonic E0580 NU $101.80 Nebulizer for use w/ regulat E0580 RR $10.18 Nebulizer for use w/ regulat E0580 UE $76.34 Nebulizer for use w/ regulat E0585 RR $30.90 Nebulizer w/ compressor & he E0600 RR $40.35 Suction pump portab hom modl E0601 RR $82.39 Cont airway pressure device E0602 NU $26.01 Manual breast pump E0602 RR $2.61 Manual breast pump E0602 UE $19.51 Manual breast pump E0605 NU $22.05 Vaporizer room type E0605 RR $2.70 Vaporizer room type E0605 UE $16.53 Vaporizer room type E0606 RR $20.22 Drainage board postural E0607 NU $58.88 Blood glucose monitor home E0607 RR $5.88 Blood glucose monitor home E0607 UE $44.15 Blood glucose monitor home E0610 NU $209.58 Pacemaker monitr audible/vis E0610 RR $22.10 Pacemaker monitr audible/vis E0610 UE $157.21 Pacemaker monitr audible/vis E0615 NU $391.23 Pacemaker monitr digital/vis E0615 RR $51.55 Pacemaker monitr digital/vis E0615 UE $293.40 Pacemaker monitr digital/vis E0617 RR $267.90 Automatic ext defibrillator E0617 RR KF $297.44 Automatic ext defibrillator E0618 RR $240.56 Apnea monitor E0619 RR $0.00 Apnea monitor w recorder E0620 NU $770.44 Cap bld skin piercing laser E0620 RR $77.04 Cap bld skin piercing laser E0620 UE $577.83 Cap bld skin piercing laser E0621 NU $71.90 Patient lift sling or seat E0621 RR $6.93 Patient lift sling or seat E0621 UE $54.20 Patient lift sling or seat E0627 NU $291.40 Seat lift incorp lift‐chair E0627 RR $29.15 Seat lift incorp lift‐chair E0627 UE $218.53 Seat lift incorp lift‐chair E0628 NU $291.40 Seat lift for pt furn‐electr E0628 RR $29.15 Seat lift for pt furn‐electr E0628 UE $218.53 Seat lift for pt furn‐electr E0629 NU $291.40 Seat lift for pt furn‐non‐el E0629 RR $29.15 Seat lift for pt furn‐non‐el E0629 UE $218.53 Seat lift for pt furn‐non‐el E0630 RR $86.62 Patient lift hydraulic E0635 RR $91.64 Patient lift electric E0636 RR $929.19 PT support & positioning sys E0650 NU $581.26 Pneuma compresor non‐segment E0650 RR $78.30 Pneuma compresor non‐segment E0650 UE $435.93 Pneuma compresor non‐segment E0651 NU $687.85 Pneum compressor segmental E0651 RR $70.27 Pneum compressor segmental E0651 UE $515.89 Pneum compressor segmental E0652 NU $4,616.72 Pneum compres w/cal pressure E0652 RR $461.66 Pneum compres w/cal pressure E0652 UE $3,462.55 Pneum compres w/cal pressure E0655 NU $95.10 Pneumatic appliance half arm E0655 RR $11.17 Pneumatic appliance half arm E0655 UE $71.41 Pneumatic appliance half arm E0656 NU $509.03 Segmental pneumatic trunk E0656 RR $50.85 Segmental pneumatic trunk E0656 UE $381.82 Segmental pneumatic trunk E0657 NU $478.22 Segmental pneumatic chest E0657 RR $47.74 Segmental pneumatic chest E0657 UE $358.69 Segmental pneumatic chest E0660 NU $140.76 Pneumatic appliance full leg E0660 RR $14.65 Pneumatic appliance full leg E0660 UE $105.55 Pneumatic appliance full leg E0665 NU $102.61 Pneumatic appliance full arm E0665 RR $10.54 Pneumatic appliance full arm E0665 UE $77.04 Pneumatic appliance full arm E0666 NU $121.67 Pneumatic appliance half leg E0666 RR $12.54 Pneumatic appliance half leg E0666 UE $91.27 Pneumatic appliance half leg E0667 NU $285.27 Seg pneumatic appl full leg E0667 RR $28.53 Seg pneumatic appl full leg E0667 UE $213.96 Seg pneumatic appl full leg E0668 NU $330.94 Seg pneumatic appl full arm E0668 RR $32.66 Seg pneumatic appl full arm E0668 UE $248.21 Seg pneumatic appl full arm E0669 NU $153.36 Seg pneumatic appli half leg E0669 RR $15.34 Seg pneumatic appli half leg E0669 UE $115.02 Seg pneumatic appli half leg E0671 NU $365.97 Pressure pneum appl full leg E0671 RR $36.61 Pressure pneum appl full leg E0671 UE $274.47 Pressure pneum appl full leg E0672 NU $284.37 Pressure pneum appl full arm E0672 RR $28.44 Pressure pneum appl full arm E0672 UE $213.28 Pressure pneum appl full arm E0673 NU $236.29 Pressure pneum appl half leg E0673 RR $23.63 Pressure pneum appl half leg E0673 UE $177.24 Pressure pneum appl half leg E0675 RR $338.84 Pneumatic compression device E0691 NU $791.77 Uvl pnl 2 sq ft or less E0691 RR $79.18 Uvl pnl 2 sq ft or less E0691 UE $593.82 Uvl pnl 2 sq ft or less E0692 NU $994.23 Uvl sys panel 4 ft E0692 RR $95.99 Uvl sys panel 4 ft E0692 UE $745.68 Uvl sys panel 4 ft E0693 NU $1,225.62 Uvl sys panel 6 ft E0693 RR $122.56 Uvl sys panel 6 ft E0693 UE $919.21 Uvl sys panel 6 ft E0694 NU $3,901.01 Uvl md cabinet sys 6 ft E0694 RR $390.10 Uvl md cabinet sys 6 ft E0694 UE $2,925.78 Uvl md cabinet sys 6 ft E0705 NU $41.29 Transfer device E0705 RR $4.20 Transfer device E0705 UE $30.23 Transfer device E0720 NU $323.88 Tens two lead E0730 NU $323.75 Tens four lead E0731 NU $267.15 Conductive garment for tens/ E0740 NU $460.71 Incontinence treatment systm E0740 RR $46.07 Incontinence treatment systm E0740 UE $345.56 Incontinence treatment systm E0744 RR $68.58 Neuromuscular stim for scoli E0745 RR $78.88 Neuromuscular stim for shock E0747 NU KF $3,450.52 Elec osteogen stim not spine E0747 RR KF $342.89 Elec osteogen stim not spine E0747 UE KF $2,563.67 Elec osteogen stim not spine E0748 NU KF $3,428.17 Elec osteogen stim spinal E0748 RR KF $342.81 Elec osteogen stim spinal E0748 UE KF $2,571.14 Elec osteogen stim spinal E0749 RR KF $212.98 Elec osteogen stim implanted E0760 NU KF $2,848.75 Osteogen ultrasound stimltor E0760 RR KF $284.89 Osteogen ultrasound stimltor E0760 UE KF $2,136.56 Osteogen ultrasound stimltor E0762 NU $823.52 Trans elec jt stim dev sys E0762 RR $82.35 Trans elec jt stim dev sys E0762 UE $617.62 Trans elec jt stim dev sys E0764 NU KF $9,751.17 Functional neuromuscularstim E0764 RR KF $975.11 Functional neuromuscularstim E0764 UE KF $7,313.38 Functional neuromuscularstim E0765 NU $74.13 Nerve stimulator for tx n&v E0765 RR $7.43 Nerve stimulator for tx n&v E0765 UE $55.62 Nerve stimulator for tx n&v E0776 NU $126.14 Iv pole E0776 RR $16.43 Iv pole E0776 UE $92.81 Iv pole E0779 RR $14.32 Amb infusion pump mechanical E0780 NU $9.14 Mech amb infusion pump <8hrs E0781 RR $219.45 External ambulatory infus pu E0782 NU KF $3,569.54 Non‐programble infusion pump E0782 RR KF $356.94 Non‐programble infusion pump E0782 UE KF $2,677.16 Non‐programble infusion pump E0783 NU KF $7,213.63 Programmable infusion pump E0783 RR KF $721.38 Programmable infusion pump E0783 UE KF $5,410.23 Programmable infusion pump E0784 RR $367.85 Ext amb infusn pump insulin E0785 KF $416.33 Replacement impl pump cathet E0786 NU KF $7,036.46 Implantable pump replacement E0786 RR KF $703.63 Implantable pump replacement E0786 UE KF $5,277.34 Implantable pump replacement E0791 RR $236.82 Parenteral infusion pump sta E0840 NU $64.56 Tract frame attach headboard E0840 RR $14.38 Tract frame attach headboard E0840 UE $48.40 Tract frame attach headboard E0849 NU $454.05 Cervical pneum trac equip E0849 RR $45.41 Cervical pneum trac equip E0849 UE $340.51 Cervical pneum trac equip E0850 NU $92.57 Traction stand free standing E0850 RR $12.71 Traction stand free standing E0850 UE $69.43 Traction stand free standing E0855 NU $435.46 Cervical traction equipment E0855 RR $43.56 Cervical traction equipment E0855 UE $326.58 Cervical traction equipment E0856 NU $135.72 Cervic collar w air bladder E0856 RR $13.56 Cervic collar w air bladder E0856 UE $101.80 Cervic collar w air bladder E0860 NU $32.78 Tract equip cervical tract E0860 RR $5.74 Tract equip cervical tract E0860 UE $24.56 Tract equip cervical tract E0870 NU $102.49 Tract frame attach footboard E0870 RR $11.40 Tract frame attach footboard E0870 UE $77.20 Tract frame attach footboard E0880 NU $110.62 Trac stand free stand extrem E0880 RR $17.37 Trac stand free stand extrem E0880 UE $83.72 Trac stand free stand extrem E0890 NU $99.26 Traction frame attach pelvic E0890 RR $28.93 Traction frame attach pelvic E0890 UE $85.46 Traction frame attach pelvic E0900 NU $95.96 Trac stand free stand pelvic E0900 RR $24.33 Trac stand free stand pelvic E0900 UE $72.00 Trac stand free stand pelvic E0910 RR $14.03 Trapeze bar attached to bed E0911 RR $37.85 HD trapeze bar attach to bed E0912 RR $86.94 HD trapeze bar free standing E0920 RR $34.56 Fracture frame attached to b E0930 RR $38.58 Fracture frame free standing E0935 RR $20.03 Cont pas motion exercise dev E0940 RR $22.44 Trapeze bar free standing E0941 RR $32.51 Gravity assisted traction de E0942 NU $15.57 Cervical head harness/halter E0942 RR $1.76 Cervical head harness/halter E0942 UE $11.68 Cervical head harness/halter E0944 NU $40.42 Pelvic belt/harness/boot E0944 RR $4.06 Pelvic belt/harness/boot E0944 UE $30.31 Pelvic belt/harness/boot E0945 NU $39.05 Belt/harness extremity E0945 RR $3.91 Belt/harness extremity E0945 UE $30.23 Belt/harness extremity E0946 RR $44.31 Fracture frame dual w cross E0947 NU $454.20 Fracture frame attachmnts pe E0947 RR $47.10 Fracture frame attachmnts pe E0947 UE $340.65 Fracture frame attachmnts pe E0948 NU $439.33 Fracture frame attachmnts ce E0948 RR $43.92 Fracture frame attachmnts ce E0948 UE $309.85 Fracture frame attachmnts ce E0950 NU $67.10 Tray E0950 NU KE $77.85 Tray E0950 RR $6.72 Tray E0950 RR KE $7.80 Tray E0950 UE $50.33 Tray E0950 UE KE $58.40 Tray E0951 NU $12.26 Loop heel E0951 NU KE $14.21 Loop heel E0951 RR $1.26 Loop heel E0951 RR KE $1.47 Loop heel E0951 UE $9.18 Loop heel E0951 UE KE $10.65 Loop heel E0952 NU $12.15 Toe loop/holder, each E0952 NU KE $14.10 Toe loop/holder, each E0952 RR $1.26 Toe loop/holder, each E0952 RR KE $1.47 Toe loop/holder, each E0952 UE $9.12 Toe loop/holder, each E0952 UE KE $10.59 Toe loop/holder, each E0955 NU $153.54 Cushioned headrest E0955 NU KE $178.15 Cushioned headrest E0955 RR $15.36 Cushioned headrest E0955 RR KE $17.82 Cushioned headrest E0955 UE $115.16 Cushioned headrest E0955 UE KE $133.60 Cushioned headrest E0956 NU $74.86 W/c lateral trunk/hip suppor E0956 NU KE $86.86 W/c lateral trunk/hip suppor E0956 RR $7.49 W/c lateral trunk/hip suppor E0956 RR KE $8.69 W/c lateral trunk/hip suppor E0956 UE $56.15 W/c lateral trunk/hip suppor E0956 UE KE $65.14 W/c lateral trunk/hip suppor E0957 NU $104.76 W/c medial thigh support E0957 NU KE $121.54 W/c medial thigh support E0957 RR $10.47 W/c medial thigh support E0957 RR KE $12.15 W/c medial thigh support E0957 UE $78.57 W/c medial thigh support E0957 UE KE $91.15 W/c medial thigh support E0958 RR $38.44 Whlchr att‐ conv 1 arm drive E0959 NU $33.10 Amputee adapter E0959 RR $3.33 Amputee adapter E0959 UE $25.06 Amputee adapter E0960 NU $69.10 W/c shoulder harness/straps E0960 NU KE $80.16 W/c shoulder harness/straps E0960 RR $6.91 W/c shoulder harness/straps E0960 RR KE $8.02 W/c shoulder harness/straps E0960 UE $51.83 W/c shoulder harness/straps E0960 UE KE $60.13 W/c shoulder harness/straps E0961 NU $26.21 Wheelchair brake extension E0961 RR $2.74 Wheelchair brake extension E0961 UE $11.12 Wheelchair brake extension E0966 NU $54.57 Wheelchair head rest extensi E0966 RR $5.47 Wheelchair head rest extensi E0966 UE $40.93 Wheelchair head rest extensi E0967 NU $57.88 Manual wc hand rim w project E0967 RR $5.79 Manual wc hand rim w project E0967 UE $43.39 Manual wc hand rim w project E0968 RR $15.80 Wheelchair commode seat E0969 NU $130.99 Wheelchair narrowing device E0969 RR $13.09 Wheelchair narrowing device E0969 UE $98.22 Wheelchair narrowing device E0971 NU $38.23 Wheelchair anti‐tipping devi E0971 RR $3.83 Wheelchair anti‐tipping devi E0971 UE $28.69 Wheelchair anti‐tipping devi E0973 NU $74.22 W/Ch access det adj armrest E0973 NU KE $86.11 W/Ch access det adj armrest E0973 RR $7.07 W/Ch access det adj armrest E0973 RR KE $8.21 W/Ch access det adj armrest E0973 UE $55.67 W/Ch access det adj armrest E0973 UE KE $64.58 W/Ch access det adj armrest E0974 NU $69.09 W/Ch access anti‐rollback E0974 RR $7.32 W/Ch access anti‐rollback E0974 UE $52.21 W/Ch access anti‐rollback E0978 NU $31.88 W/C acc,saf belt pelv strap E0978 NU KE $36.99 W/C acc,saf belt pelv strap E0978 RR $3.18 W/C acc,saf belt pelv strap E0978 RR KE $3.70 W/C acc,saf belt pelv strap E0978 UE $23.91 W/C acc,saf belt pelv strap E0978 UE KE $27.75 W/C acc,saf belt pelv strap E0980 NU $28.17 Wheelchair safety vest E0980 RR $2.81 Wheelchair safety vest E0980 UE $21.13 Wheelchair safety vest E0981 NU $30.44 Seat upholstery, replacement E0981 NU KE $35.31 Seat upholstery, replacement E0981 RR $3.10 Seat upholstery, replacement E0981 RR KE $3.60 Seat upholstery, replacement E0981 UE $23.05 Seat upholstery, replacement E0981 UE KE $26.74 Seat upholstery, replacement E0982 NU $33.26 Back upholstery, replacement E0982 NU KE $38.60 Back upholstery, replacement E0982 RR $3.33 Back upholstery, replacement E0982 RR KE $3.86 Back upholstery, replacement E0982 UE $24.95 Back upholstery, replacement E0982 UE KE $28.94 Back upholstery, replacement E0983 RR $213.23 Add pwr joystick E0984 NU $1,490.33 Add pwr tiller E0984 RR $156.48 Add pwr tiller E0984 UE $1,117.75 Add pwr tiller E0985 NU $178.74 W/c seat lift mechanism E0985 RR $17.89 W/c seat lift mechanism E0985 UE $134.04 W/c seat lift mechanism E0986 NU $4,285.97 Man w/c push‐rim pow assist E0986 RR $428.60 Man w/c push‐rim pow assist E0986 UE $3,214.50 Man w/c push‐rim pow assist E0990 NU $75.80 Wheelchair elevating leg res E0990 NU KE $87.95 Wheelchair elevating leg res E0990 RR $8.53 Wheelchair elevating leg res E0990 RR KE $9.90 Wheelchair elevating leg res E0990 UE $59.23 Wheelchair elevating leg res E0990 UE KE $68.71 Wheelchair elevating leg res E0992 NU $71.27 Wheelchair solid seat insert E0992 RR $6.93 Wheelchair solid seat insert E0992 UE $53.46 Wheelchair solid seat insert E0994 NU $15.46 Wheelchair arm rest E0994 RR $1.55 Wheelchair arm rest E0994 UE $11.60 Wheelchair arm rest E0995 NU $19.62 Wheelchair calf rest E0995 NU KE $22.77 Wheelchair calf rest E0995 RR $1.97 Wheelchair calf rest E0995 RR KE $2.28 Wheelchair calf rest E0995 UE $14.71 Wheelchair calf rest E0995 UE KE $17.07 Wheelchair calf rest E1002 NU $3,078.17 Pwr seat tilt E1002 NU KE $3,571.35 Pwr seat tilt E1002 RR $307.81 Pwr seat tilt E1002 RR KE $357.13 Pwr seat tilt E1002 UE $2,308.62 Pwr seat tilt E1002 UE KE $2,678.52 Pwr seat tilt E1003 NU $3,334.93 Pwr seat recline E1003 NU KE $3,869.26 Pwr seat recline E1003 RR $333.50 Pwr seat recline E1003 RR KE $386.94 Pwr seat recline E1003 UE $2,501.20 Pwr seat recline E1003 UE KE $2,901.94 Pwr seat recline E1004 NU $3,697.75 Pwr seat recline mech E1004 NU KE $4,290.21 Pwr seat recline mech E1004 RR $369.77 Pwr seat recline mech E1004 RR KE $429.02 Pwr seat recline mech E1004 UE $2,773.30 Pwr seat recline mech E1004 UE KE $3,217.65 Pwr seat recline mech E1005 NU $4,002.52 Pwr seat recline pwr E1005 NU KE $4,643.81 Pwr seat recline pwr E1005 RR $400.24 Pwr seat recline pwr E1005 RR KE $464.38 Pwr seat recline pwr E1005 UE $3,001.90 Pwr seat recline pwr E1005 UE KE $3,482.87 Pwr seat recline pwr E1006 NU $4,902.72 Pwr seat combo w/o shear E1006 NU KE $5,688.24 Pwr seat combo w/o shear E1006 RR $490.26 Pwr seat combo w/o shear E1006 RR KE $568.81 Pwr seat combo w/o shear E1006 UE $3,677.04 Pwr seat combo w/o shear E1006 UE KE $4,266.18 Pwr seat combo w/o shear E1007 NU $6,638.47 Pwr seat combo w/shear E1007 NU KE $7,702.09 Pwr seat combo w/shear E1007 RR $663.85 Pwr seat combo w/shear E1007 RR KE $770.21 Pwr seat combo w/shear E1007 UE $4,978.85 Pwr seat combo w/shear E1007 UE KE $5,776.56 Pwr seat combo w/shear E1008 NU $6,639.07 Pwr seat combo pwr shear E1008 NU KE $7,702.77 Pwr seat combo pwr shear E1008 RR $663.90 Pwr seat combo pwr shear E1008 RR KE $770.27 Pwr seat combo pwr shear E1008 UE $4,979.31 Pwr seat combo pwr shear E1008 UE KE $5,777.10 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 NU $868.64 Add pwr leg elevation E1010 NU KE $1,007.82 Add pwr leg elevation E1010 RR $86.86 Add pwr leg elevation E1010 RR KE $100.78 Add pwr leg elevation E1010 UE $651.49 Add pwr leg elevation E1010 UE KE $755.87 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 E1014 NU $321.74 Reclining back add ped w/c E1014 RR $32.18 Reclining back add ped w/c E1014 UE $241.29 Reclining back add ped w/c E1015 NU $101.07 Shock absorber for man w/c E1015 RR $10.10 Shock absorber for man w/c E1015 UE $75.79 Shock absorber for man w/c E1016 NU $99.72 Shock absorber for power w/c E1016 NU KE $115.70 Shock absorber for power w/c E1016 RR $9.98 Shock absorber for power w/c E1016 RR KE $11.58 Shock absorber for power w/c E1016 UE $74.79 Shock absorber for power w/c E1016 UE KE $86.77 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 NU $184.86 Residual limb support system E1020 NU KE $214.47 Residual limb support system E1020 RR $18.47 Residual limb support system E1020 RR KE $21.43 Residual limb support system E1020 UE $138.63 Residual limb support system E1020 UE KE $160.85 Residual limb support system E1028 NU $156.85 W/c manual swingaway E1028 NU KE $181.99 W/c manual swingaway E1028 RR $15.68 W/c manual swingaway E1028 RR KE $18.19 W/c manual swingaway E1028 UE $117.63 W/c manual swingaway E1028 UE KE $136.47 W/c manual swingaway E1029 NU $280.64 W/c vent tray fixed E1029 NU KE $325.61 W/c vent tray fixed E1029 RR $28.06 W/c vent tray fixed E1029 RR KE $32.56 W/c vent tray fixed E1029 UE $210.48 W/c vent tray fixed E1029 UE KE $244.20 W/c vent tray fixed E1030 NU $884.96 W/c vent tray gimbaled E1030 NU KE $1,026.74 W/c vent tray gimbaled E1030 RR $88.49 W/c vent tray gimbaled E1030 RR KE $102.68 W/c vent tray gimbaled E1030 UE $663.72 W/c vent tray gimbaled E1030 UE KE $770.06 W/c vent tray gimbaled E1031 RR $44.51 Rollabout chair with casters E1035 RR $540.30 Patient transfer system <300 E1036 RR $757.45 Patient transfer system >300 E1037 RR $95.59 Transport chair, ped size E1038 RR $15.88 Transport chair pt wt<=300lb E1039 RR $30.13 Transport chair pt wt >300lb E1050 RR $76.27 Whelchr fxd full length arms E1060 RR $101.76 Wheelchair detachable arms E1070 RR $96.51 Wheelchair detachable foot r E1083 RR $59.92 Hemi‐wheelchair fixed arms E1084 RR $86.44 Hemi‐wheelchair detachable a E1087 RR $103.47 Wheelchair lightwt fixed arm E1088 RR $125.15 Wheelchair lightweight det a E1092 RR $96.26 Wheelchair wide w/ leg rests E1093 RR $97.38 Wheelchair wide w/ foot rest E1100 RR $77.75 Whchr s‐recl fxd arm leg res E1110 RR $85.94 Wheelchair semi‐recl detach E1150 RR $71.88 Wheelchair standard w/ leg r E1160 RR $55.07 Wheelchair fixed arms E1161 NU $2,084.80 Manual adult wc w tiltinspac E1161 RR $208.48 Manual adult wc w tiltinspac E1161 UE $1,563.61 Manual adult wc w tiltinspac E1170 RR $66.90 Whlchr ampu fxd arm leg rest E1171 RR $60.03 Wheelchair amputee w/o leg r E1172 RR $73.37 Wheelchair amputee detach ar E1180 RR $75.90 Wheelchair amputee w/ foot r E1190 RR $87.68 Wheelchair amputee w/ leg re E1195 RR $94.09 Wheelchair amputee heavy dut E1200 RR $65.17 Wheelchair amputee fixed arm E1221 RR $41.65 Wheelchair spec size w foot E1222 RR $56.99 Wheelchair spec size w/ leg E1223 RR $65.22 Wheelchair spec size w foot E1224 RR $62.18 Wheelchair spec size w/ leg E1225 RR $39.82 Manual semi‐reclining back E1226 NU $465.74 Manual fully reclining back E1226 RR $46.58 Manual fully reclining back E1226 UE $349.31 Manual fully reclining back E1227 NU $244.52 Wheelchair spec sz spec ht a E1227 RR $24.45 Wheelchair spec sz spec ht a E1227 UE $183.41 Wheelchair spec sz spec ht a E1228 RR $24.69 Wheelchair spec sz spec ht b E1230 NU $1,975.44 Power operated vehicle E1230 RR $196.01 Power operated vehicle E1230 UE $1,481.56 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 NU $1,884.19 Folding ped wc tilt‐in‐space E1232 RR $188.43 Folding ped wc tilt‐in‐space E1232 UE $1,413.16 Folding ped wc tilt‐in‐space E1233 NU $1,952.32 Rig ped wc tltnspc w/o seat E1233 RR $195.23 Rig ped wc tltnspc w/o seat E1233 UE $1,464.24 Rig ped wc tltnspc w/o seat E1234 NU $1,699.63 Fld ped wc tltnspc w/o seat E1234 RR $169.98 Fld ped wc tltnspc w/o seat E1234 UE $1,274.72 Fld ped wc tltnspc w/o seat E1235 NU $1,636.61 Rigid ped wc adjustable E1235 RR $163.67 Rigid ped wc adjustable E1235 UE $1,227.46 Rigid ped wc adjustable E1236 NU $1,443.92 Folding ped wc adjustable E1236 RR $144.39 Folding ped wc adjustable E1236 UE $1,082.94 Folding ped wc adjustable E1237 NU $1,456.53 Rgd ped wc adjstabl w/o seat E1237 RR $145.66 Rgd ped wc adjstabl w/o seat E1237 UE $1,092.41 Rgd ped wc adjstabl w/o seat E1238 NU $1,443.92 Fld ped wc adjstabl w/o seat E1238 RR $144.39 Fld ped wc adjstabl w/o seat E1238 UE $1,082.94 Fld ped wc adjstabl w/o seat E1240 RR $90.77 Whchr litwt det arm leg rest E1270 RR $59.13 Wheelchair lightweight leg r E1280 RR $98.31 Whchr h‐duty det arm leg res E1295 RR $90.97 Wheelchair heavy duty fixed E1296 NU $368.23 Wheelchair special seat heig E1296 RR $37.41 Wheelchair special seat heig E1296 UE $276.18 Wheelchair special seat heig E1297 NU $78.35 Wheelchair special seat dept E1297 RR $8.70 Wheelchair special seat dept E1297 UE $58.76 Wheelchair special seat dept E1298 NU $373.29 Wheelchair spec seat depth/w E1298 RR $38.19 Wheelchair spec seat depth/w E1298 UE $279.96 Wheelchair spec seat depth/w E1310 NU $1,608.30 Whirlpool non‐portable E1310 RR $145.55 Whirlpool non‐portable E1310 UE $1,206.22 Whirlpool non‐portable E1353 $24.96 Oxygen supplies regulator E1355 $18.80 Oxygen supplies stand/rack E1372 NU $122.10 Oxy suppl heater for nebuliz E1372 RR $17.74 Oxy suppl heater for nebuliz E1372 UE $90.38 Oxy suppl heater for nebuliz E1390 RR $145.58 Oxygen concentrator E1391 RR $145.58 Oxygen concentrator, dual E1392 RR $43.37 Portable oxygen concentrator E1405 RR $176.48 O2/water vapor enrich w/heat E1406 RR $159.77 O2/water vapor enrich w/o he E1700 NU $258.27 Jaw motion rehab system E1700 RR $25.42 Jaw motion rehab system E1700 UE $193.70 Jaw motion rehab system E1701 $9.35 Repl cushions for jaw motion E1702 $19.89 Repl measr scales jaw motion E1800 RR $107.94 Adjust elbow ext/flex device E1801 RR $109.85 SPS elbow device E1802 RR $287.95 Adjst forearm pro/sup device E1805 RR $111.33 Adjust wrist ext/flex device E1806 RR $90.17 SPS wrist device E1810 RR $109.77 Adjust knee ext/flex device E1811 RR $114.20 SPS knee device E1812 RR $75.77 Knee ext/flex w act res ctrl E1815 RR $111.33 Adjust ankle ext/flex device E1816 RR $115.99 SPS ankle device E1818 RR $118.41 SPS forearm device E1820 NU $67.95 Soft interface material E1820 RR $6.80 Soft interface material E1820 UE $50.95 Soft interface material E1821 NU $92.74 Replacement interface SPSD E1821 RR $9.27 Replacement interface SPSD E1821 UE $69.57 Replacement interface SPSD E1825 RR $111.33 Adjust finger ext/flex devc E1830 RR $111.33 Adjust toe ext/flex device E1831 RR $0.00 Static str toe dev ext/flex E1840 RR $336.03 Adj shoulder ext/flex device E1841 RR $399.14 Static str shldr dev rom adj E2000 RR $44.11 Gastric suction pump hme mdl E2100 NU $566.72 Bld glucose monitor w voice E2100 RR $56.67 Bld glucose monitor w voice E2100 UE $425.05 Bld glucose monitor w voice E2101 NU $166.14 Bld glucose monitor w lance E2101 RR $16.62 Bld glucose monitor w lance E2101 UE $124.61 Bld glucose monitor w lance E2120 RR $249.82 Pulse gen sys tx endolymp fl E2201 NU $328.75 Man w/ch acc seat w>=20"<24" E2201 RR $32.88 Man w/ch acc seat w>=20"<24" E2201 UE $246.57 Man w/ch acc seat w>=20"<24" E2202 NU $417.63 Seat width 24‐27 in E2202 RR $41.76 Seat width 24‐27 in E2202 UE $313.24 Seat width 24‐27 in E2203 NU $422.10 Frame depth less than 22 in E2203 RR $42.19 Frame depth less than 22 in E2203 UE $316.56 Frame depth less than 22 in E2204 NU $716.70 Frame depth 22 to 25 in E2204 RR $71.68 Frame depth 22 to 25 in E2204 UE $537.52 Frame depth 22 to 25 in E2205 NU $28.79 Manual wc accessory, handrim E2205 RR $2.86 Manual wc accessory, handrim E2205 UE $21.60 Manual wc accessory, handrim E2206 NU $35.84 Complete wheel lock assembly E2206 RR $3.58 Complete wheel lock assembly E2206 UE $26.88 Complete wheel lock assembly E2207 NU $38.19 Crutch and cane holder E2207 RR $3.83 Crutch and cane holder E2207 UE $28.65 Crutch and cane holder E2208 NU $90.21 Cylinder tank carrier E2208 NU KE $104.66 Cylinder tank carrier E2208 RR $9.01 Cylinder tank carrier E2208 RR KE $10.46 Cylinder tank carrier E2208 UE $67.66 Cylinder tank carrier E2208 UE KE $78.50 Cylinder tank carrier E2209 NU $81.38 Arm trough each E2209 NU KE $94.42 Arm trough each E2209 RR $8.16 Arm trough each E2209 RR KE $9.47 Arm trough each E2209 UE $61.04 Arm trough each E2209 UE KE $70.83 Arm trough each E2210 NU $4.97 Wheelchair bearings E2210 NU KE $5.77 Wheelchair bearings E2210 RR $0.50 Wheelchair bearings E2210 RR KE $0.58 Wheelchair bearings E2210 UE $3.74 Wheelchair bearings E2210 UE KE $4.33 Wheelchair bearings E2211 NU $30.64 Pneumatic propulsion tire E2211 RR $3.01 Pneumatic propulsion tire E2211 UE $21.95 Pneumatic propulsion tire E2212 NU $5.17 Pneumatic prop tire tube E2212 RR $0.54 Pneumatic prop tire tube E2212 UE $3.90 Pneumatic prop tire tube E2213 NU $26.80 Pneumatic prop tire insert E2213 RR $2.69 Pneumatic prop tire insert E2213 UE $20.08 Pneumatic prop tire insert E2214 NU $26.96 Pneumatic caster tire each E2214 RR $2.97 Pneumatic caster tire each E2214 UE $20.21 Pneumatic caster tire each E2215 NU $8.46 Pneumatic caster tire tube E2215 RR $0.84 Pneumatic caster tire tube E2215 UE $6.33 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 $36.88 Foam caster tire any size ea E2219 RR $4.17 Foam caster tire any size ea E2219 UE $27.66 Foam caster tire any size ea E2220 NU $22.70 Solid propulsion tire each E2220 RR $2.28 Solid propulsion tire each E2220 UE $17.02 Solid propulsion tire each E2221 NU $22.51 Solid caster tire each E2221 RR $2.28 Solid caster tire each E2221 UE $16.90 Solid caster tire each E2222 NU $18.56 Solid caster integrated whl E2222 RR $1.84 Solid caster integrated whl E2222 UE $13.93 Solid caster integrated whl E2224 NU $73.44 Propulsion whl excludes tire E2224 RR $7.70 Propulsion whl excludes tire E2224 UE $55.09 Propulsion whl excludes tire E2225 NU $15.33 Caster wheel excludes tire E2225 RR $1.54 Caster wheel excludes tire E2225 UE $11.49 Caster wheel excludes tire E2226 NU $33.43 Caster fork replacement only E2226 RR $3.34 Caster fork replacement only E2226 UE $25.07 Caster fork replacement only E2227 NU $1,648.26 Gear reduction drive wheel E2227 RR $164.83 Gear reduction drive wheel E2227 UE $1,236.21 Gear reduction drive wheel E2228 NU $824.96 Mwc acc, wheelchair brake E2228 RR $82.49 Mwc acc, wheelchair brake E2228 UE $618.74 Mwc acc, wheelchair brake E2231 NU $135.41 Solid seat support base E2231 RR $13.54 Solid seat support base E2231 UE $101.55 Solid seat support base E2310 NU $888.73 Electro connect btw control E2310 NU KE $1,031.12 Electro connect btw control E2310 RR $88.86 Electro connect btw control E2310 RR KE $103.11 Electro connect btw control E2310 UE $666.55 Electro connect btw control E2310 UE KE $773.34 Electro connect btw control E2311 NU $1,799.27 Electro connect btw 2 sys E2311 NU KE $2,087.54 Electro connect btw 2 sys E2311 RR $179.94 Electro connect btw 2 sys E2311 RR KE $208.77 Electro connect btw 2 sys E2311 UE $1,349.44 Electro connect btw 2 sys E2311 UE KE $1,565.66 Electro connect btw 2 sys E2312 NU $1,776.96 Mini‐prop remote joystick E2312 NU KC $2,266.33 Mini‐prop remote joystick E2312 RR $177.69 Mini‐prop remote joystick E2312 RR KC $226.62 Mini‐prop remote joystick E2312 UE $1,332.74 Mini‐prop remote joystick E2312 UE KC $1,699.73 Mini‐prop remote joystick E2313 NU $282.18 PWC harness, expand control E2313 RR $28.22 PWC harness, expand control E2313 UE $211.64 PWC harness, expand control E2321 NU $1,206.83 Hand interface joystick E2321 NU KC $1,965.78 Hand interface joystick E2321 NU KE $1,400.19 Hand interface joystick E2321 RR $120.69 Hand interface joystick E2321 RR KC $196.59 Hand interface joystick E2321 RR KE $140.03 Hand interface joystick E2321 UE $905.13 Hand interface joystick E2321 UE KC $1,474.33 Hand interface joystick E2321 UE KE $1,050.15 Hand interface joystick E2322 NU $1,071.08 Mult mech switches E2322 NU KC $2,081.72 Mult mech switches E2322 NU KE $1,242.70 Mult mech switches E2322 RR $107.10 Mult mech switches E2322 RR KC $208.17 Mult mech switches E2322 RR KE $124.26 Mult mech switches E2322 UE $803.32 Mult mech switches E2322 UE KC $1,561.29 Mult mech switches E2322 UE KE $932.03 Mult mech switches E2323 NU $52.53 Special joystick handle E2323 NU KE $60.94 Special joystick handle E2323 RR $5.25 Special joystick handle E2323 RR KE $6.10 Special joystick handle E2323 UE $39.39 Special joystick handle E2323 UE KE $45.70 Special joystick handle E2324 NU $33.28 Chin cup interface E2324 NU KE $38.61 Chin cup interface E2324 RR $3.32 Chin cup interface E2324 RR KE $3.86 Chin cup interface E2324 UE $24.96 Chin cup interface E2324 UE KE $28.96 Chin cup interface E2325 NU $1,022.83 Sip and puff interface E2325 NU KE $1,186.72 Sip and puff interface E2325 RR $102.30 Sip and puff interface E2325 RR KE $118.69 Sip and puff interface E2325 UE $767.14 Sip and puff interface E2325 UE KE $890.05 Sip and puff interface E2326 NU $263.63 Breath tube kit E2326 NU KE $305.88 Breath tube kit E2326 RR $26.38 Breath tube kit E2326 RR KE $30.60 Breath tube kit E2326 UE $197.71 Breath tube kit E2326 UE KE $229.40 Breath tube kit E2327 NU $1,983.95 Head control interface mech E2327 NU KC $3,014.10 Head control interface mech E2327 NU KE $2,301.82 Head control interface mech E2327 RR $198.39 Head control interface mech E2327 RR KC $301.41 Head control interface mech E2327 RR KE $230.19 Head control interface mech E2327 UE $1,487.96 Head control interface mech E2327 UE KC $2,260.57 Head control interface mech E2327 UE KE $1,726.35 Head control interface mech E2328 NU $3,763.27 Head/extremity control inter E2328 NU KE $4,366.23 Head/extremity control inter E2328 RR $376.32 Head/extremity control inter E2328 RR KE $436.62 Head/extremity control inter E2328 UE $2,822.46 Head/extremity control inter E2328 UE KE $3,274.68 Head/extremity control inter E2329 NU $1,341.27 Head control nonproportional E2329 NU KE $1,556.18 Head control nonproportional E2329 RR $134.12 Head control nonproportional E2329 RR KE $155.61 Head control nonproportional E2329 UE $1,005.95 Head control nonproportional E2329 UE KE $1,167.13 Head control nonproportional E2330 NU $2,598.87 Head control proximity switc E2330 NU KE $3,015.26 Head control proximity switc E2330 RR $259.88 Head control proximity switc E2330 RR KE $301.52 Head control proximity switc E2330 UE $1,949.16 Head control proximity switc E2330 UE KE $2,261.46 Head control proximity switc E2340 NU $315.76 W/c wdth 20‐23 in seat frame E2340 RR $31.58 W/c wdth 20‐23 in seat frame E2340 UE $236.84 W/c wdth 20‐23 in seat frame E2341 NU $473.68 W/c wdth 24‐27 in seat frame E2341 RR $47.37 W/c wdth 24‐27 in seat frame E2341 UE $355.26 W/c wdth 24‐27 in seat frame E2342 NU $394.72 W/c dpth 20‐21 in seat frame E2342 RR $39.47 W/c dpth 20‐21 in seat frame E2342 UE $296.05 W/c dpth 20‐21 in seat frame E2343 NU $631.57 W/c dpth 22‐25 in seat frame E2343 RR $63.14 W/c dpth 22‐25 in seat frame E2343 UE $473.68 W/c dpth 22‐25 in seat frame E2351 NU $530.57 Electronic SGD interface E2351 NU KE $615.58 Electronic SGD interface E2351 RR $53.07 Electronic SGD interface E2351 RR KE $61.57 Electronic SGD interface E2351 UE $397.92 Electronic SGD interface E2351 UE KE $461.67 Electronic SGD interface E2360 NU $98.99 22nf nonsealed leadacid E2360 RR $9.95 22nf nonsealed leadacid E2360 UE $74.24 22nf nonsealed leadacid E2361 NU $105.92 22nf sealed leadacid battery E2361 NU KE $122.88 22nf sealed leadacid battery E2361 RR $10.59 22nf sealed leadacid battery E2361 RR KE $12.30 22nf sealed leadacid battery E2361 UE $79.46 22nf sealed leadacid battery E2361 UE KE $92.18 22nf sealed leadacid battery E2362 NU $81.04 Gr24 nonsealed leadacid E2362 RR $8.11 Gr24 nonsealed leadacid E2362 UE $60.78 Gr24 nonsealed leadacid E2363 NU $141.25 Gr24 sealed leadacid battery E2363 NU KE $163.88 Gr24 sealed leadacid battery E2363 RR $14.13 Gr24 sealed leadacid battery E2363 RR KE $16.40 Gr24 sealed leadacid battery E2363 UE $105.94 Gr24 sealed leadacid battery E2363 UE KE $122.92 Gr24 sealed leadacid battery E2364 NU $98.99 U1nonsealed leadacid battery E2364 RR $9.95 U1nonsealed leadacid battery E2364 UE $74.24 U1nonsealed leadacid battery E2365 NU $85.18 U1 sealed leadacid battery E2365 NU KE $98.83 U1 sealed leadacid battery E2365 RR $8.52 U1 sealed leadacid battery E2365 RR KE $9.89 U1 sealed leadacid battery E2365 UE $63.91 U1 sealed leadacid battery E2365 UE KE $74.15 U1 sealed leadacid battery E2366 NU $200.21 Battery charger, single mode E2366 NU KE $232.28 Battery charger, single mode E2366 RR $20.08 Battery charger, single mode E2366 RR KE $23.28 Battery charger, single mode E2366 UE $150.16 Battery charger, single mode E2366 UE KE $174.22 Battery charger, single mode E2367 NU $318.27 Battery charger, dual mode E2367 NU KE $369.26 Battery charger, dual mode E2367 RR $31.83 Battery charger, dual mode E2367 RR KE $36.93 Battery charger, dual mode E2367 UE $238.70 Battery charger, dual mode E2367 UE KE $276.95 Battery charger, dual mode E2368 NU $392.31 Power wc motor replacement E2368 NU KE $455.16 Power wc motor replacement E2368 RR $39.24 Power wc motor replacement E2368 RR KE $45.53 Power wc motor replacement E2368 UE $294.24 Power wc motor replacement E2368 UE KE $341.38 Power wc motor replacement E2369 NU $341.70 Pwr wc gear box replacement E2369 NU KE $396.45 Pwr wc gear box replacement E2369 RR $34.18 Pwr wc gear box replacement E2369 RR KE $39.65 Pwr wc gear box replacement E2369 UE $256.27 Pwr wc gear box replacement E2369 UE KE $297.33 Pwr wc gear box replacement E2370 NU $609.71 Pwr wc motor/gear box combo E2370 NU KE $707.40 Pwr wc motor/gear box combo E2370 RR $60.98 Pwr wc motor/gear box combo E2370 RR KE $70.74 Pwr wc motor/gear box combo E2370 UE $457.28 Pwr wc motor/gear box combo E2370 UE KE $530.54 Pwr wc motor/gear box combo E2371 NU $114.48 Gr27 sealed leadacid battery E2371 NU KE $132.82 Gr27 sealed leadacid battery E2371 RR $11.46 Gr27 sealed leadacid battery E2371 RR KE $13.28 Gr27 sealed leadacid battery E2371 UE $85.86 Gr27 sealed leadacid battery E2371 UE KE $99.62 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 NU $619.41 Hand/chin ctrl spec joystick E2373 NU KC $955.64 Hand/chin ctrl spec joystick E2373 NU KE $619.41 Hand/chin ctrl spec joystick E2373 RR $61.93 Hand/chin ctrl spec joystick E2373 RR KC $95.57 Hand/chin ctrl spec joystick E2373 RR KE $61.93 Hand/chin ctrl spec joystick E2373 UE $464.56 Hand/chin ctrl spec joystick E2373 UE KC $716.75 Hand/chin ctrl spec joystick E2373 UE KE $464.56 Hand/chin ctrl spec joystick E2374 NU $405.56 Hand/chin ctrl std joystick E2374 NU KE $470.53 Hand/chin ctrl std joystick E2374 RR $40.56 Hand/chin ctrl std joystick E2374 RR KE $47.05 Hand/chin ctrl std joystick E2374 UE $304.18 Hand/chin ctrl std joystick E2374 UE KE $352.92 Hand/chin ctrl std joystick E2375 NU $650.50 Non‐expandable controller E2375 NU KE $754.73 Non‐expandable controller E2375 RR $65.04 Non‐expandable controller E2375 RR KE $75.47 Non‐expandable controller E2375 UE $487.86 Non‐expandable controller E2375 UE KE $566.03 Non‐expandable controller E2376 NU $1,019.37 Expandable controller, repl E2376 NU KE $1,182.69 Expandable controller, repl E2376 RR $101.94 Expandable controller, repl E2376 RR KE $118.27 Expandable controller, repl E2376 UE $764.54 Expandable controller, repl E2376 UE KE $887.04 Expandable controller, repl E2377 NU $368.87 Expandable controller, initl E2377 NU KE $427.97 Expandable controller, initl E2377 RR $36.88 Expandable controller, initl E2377 RR KE $42.79 Expandable controller, initl E2377 UE $276.66 Expandable controller, initl E2377 UE KE $321.00 Expandable controller, initl E2381 NU $57.85 Pneum drive wheel tire E2381 NU KE $67.12 Pneum drive wheel tire E2381 RR $5.80 Pneum drive wheel tire E2381 RR KE $6.72 Pneum drive wheel tire E2381 UE $43.39 Pneum drive wheel tire E2381 UE KE $50.35 Pneum drive wheel tire E2382 NU $15.78 Tube, pneum wheel drive tire E2382 NU KE $18.30 Tube, pneum wheel drive tire E2382 RR $1.57 Tube, pneum wheel drive tire E2382 RR KE $1.82 Tube, pneum wheel drive tire E2382 UE $11.83 Tube, pneum wheel drive tire E2382 UE KE $13.72 Tube, pneum wheel drive tire E2383 NU $115.34 Insert, pneum wheel drive E2383 NU KE $133.82 Insert, pneum wheel drive E2383 RR $11.54 Insert, pneum wheel drive E2383 RR KE $13.38 Insert, pneum wheel drive E2383 UE $86.51 Insert, pneum wheel drive E2383 UE KE $100.37 Insert, pneum wheel drive E2384 NU $61.45 Pneumatic caster tire E2384 NU KE $71.30 Pneumatic caster tire E2384 RR $6.16 Pneumatic caster tire E2384 RR KE $7.15 Pneumatic caster tire E2384 UE $46.09 Pneumatic caster tire E2384 UE KE $53.47 Pneumatic caster tire E2385 NU $37.60 Tube, pneumatic caster tire E2385 NU KE $43.62 Tube, pneumatic caster tire E2385 RR $3.77 Tube, pneumatic caster tire E2385 RR KE $4.37 Tube, pneumatic caster tire E2385 UE $28.18 Tube, pneumatic caster tire E2385 UE KE $32.70 Tube, pneumatic caster tire E2386 NU $114.30 Foam filled drive wheel tire E2386 NU KE $132.62 Foam filled drive wheel tire E2386 RR $11.43 Foam filled drive wheel tire E2386 RR KE $13.26 Foam filled drive wheel tire E2386 UE $85.72 Foam filled drive wheel tire E2386 UE KE $99.45 Foam filled drive wheel tire E2387 NU $49.31 Foam filled caster tire E2387 NU KE $57.21 Foam filled caster tire E2387 RR $4.94 Foam filled caster tire E2387 RR KE $5.74 Foam filled caster tire E2387 UE $36.99 Foam filled caster tire E2387 UE KE $42.92 Foam filled caster tire E2388 NU $38.26 Foam drive wheel tire E2388 NU KE $44.40 Foam drive wheel tire E2388 RR $3.83 Foam drive wheel tire E2388 RR KE $4.44 Foam drive wheel tire E2388 UE $28.71 Foam drive wheel tire E2388 UE KE $33.31 Foam drive wheel tire E2389 NU $20.78 Foam caster tire E2389 NU KE $24.11 Foam caster tire E2389 RR $2.08 Foam caster tire E2389 RR KE $2.42 Foam caster tire E2389 UE $15.57 Foam caster tire E2389 UE KE $18.08 Foam caster tire E2390 NU $32.49 Solid drive wheel tire E2390 NU KE $37.71 Solid drive wheel tire E2390 RR $3.25 Solid drive wheel tire E2390 RR KE $3.77 Solid drive wheel tire E2390 UE $24.35 Solid drive wheel tire E2390 UE KE $28.26 Solid drive wheel tire E2391 NU $15.57 Solid caster tire E2391 NU KE $18.07 Solid caster tire E2391 RR $1.56 Solid caster tire E2391 RR KE $1.81 Solid caster tire E2391 UE $11.68 Solid caster tire E2391 UE KE $13.55 Solid caster tire E2392 NU $40.92 Solid caster tire, integrate E2392 NU KE $47.47 Solid caster tire, integrate E2392 RR $4.11 Solid caster tire, integrate E2392 RR KE $4.75 Solid caster tire, integrate E2392 UE $30.69 Solid caster tire, integrate E2392 UE KE $35.61 Solid caster tire, integrate E2394 NU $58.29 Drive wheel excludes tire E2394 NU KE $67.63 Drive wheel excludes tire E2394 RR $5.84 Drive wheel excludes tire E2394 RR KE $6.77 Drive wheel excludes tire E2394 UE $43.72 Drive wheel excludes tire E2394 UE KE $50.73 Drive wheel excludes tire E2395 NU $41.43 Caster wheel excludes tire E2395 NU KE $48.06 Caster wheel excludes tire E2395 RR $4.15 Caster wheel excludes tire E2395 RR KE $4.80 Caster wheel excludes tire E2395 UE $31.08 Caster wheel excludes tire E2395 UE KE $36.07 Caster wheel excludes tire E2396 NU $46.89 Caster fork E2396 NU KE $54.42 Caster fork E2396 RR $4.70 Caster fork E2396 RR KE $5.45 Caster fork E2396 UE $35.19 Caster fork E2396 UE KE $40.82 Caster fork E2397 NU $364.90 Pwc acc, lith‐based battery E2397 RR $36.49 Pwc acc, lith‐based battery E2397 UE $273.66 Pwc acc, lith‐based battery E2402 RR $1,303.55 Neg press wound therapy pump E2500 NU $344.57 SGD digitized pre‐rec <=8min E2500 RR $34.47 SGD digitized pre‐rec <=8min E2500 UE $258.42 SGD digitized pre‐rec <=8min E2502 NU $1,053.64 SGD prerec msg >8min <=20min E2502 RR $105.37 SGD prerec msg >8min <=20min E2502 UE $790.24 SGD prerec msg >8min <=20min E2504 NU $1,389.89 SGD prerec msg>20min <=40min E2504 RR $139.00 SGD prerec msg>20min <=40min E2504 UE $1,042.41 SGD prerec msg>20min <=40min E2506 NU $2,037.99 SGD prerec msg > 40 min E2506 RR $203.79 SGD prerec msg > 40 min E2506 UE $1,528.46 SGD prerec msg > 40 min E2508 NU $3,151.41 SGD spelling phys contact E2508 RR $315.14 SGD spelling phys contact E2508 UE $2,363.57 SGD spelling phys contact E2510 NU $5,963.62 SGD w multi methods msg/accs E2510 RR $596.36 SGD w multi methods msg/accs E2510 UE $4,472.71 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 $46.44 Gen w/c cushion wdth < 22 in E2601 NU KE $53.89 Gen w/c cushion wdth < 22 in E2601 RR $4.65 Gen w/c cushion wdth < 22 in E2601 RR KE $5.40 Gen w/c cushion wdth < 22 in E2601 UE $34.83 Gen w/c cushion wdth < 22 in E2601 UE KE $40.41 Gen w/c cushion wdth < 22 in E2602 NU $90.68 Gen w/c cushion wdth >=22 in E2602 NU KE $105.20 Gen w/c cushion wdth >=22 in E2602 RR $9.07 Gen w/c cushion wdth >=22 in E2602 RR KE $10.53 Gen w/c cushion wdth >=22 in E2602 UE $68.01 Gen w/c cushion wdth >=22 in E2602 UE KE $78.91 Gen w/c cushion wdth >=22 in E2603 NU $115.12 Skin protect wc cus wd <22in E2603 NU KE $133.57 Skin protect wc cus wd <22in E2603 RR $11.52 Skin protect wc cus wd <22in E2603 RR KE $13.36 Skin protect wc cus wd <22in E2603 UE $86.34 Skin protect wc cus wd <22in E2603 UE KE $100.17 Skin protect wc cus wd <22in E2604 NU $143.09 Skin protect wc cus wd>=22in E2604 NU KE $166.01 Skin protect wc cus wd>=22in E2604 RR $14.30 Skin protect wc cus wd>=22in E2604 RR KE $16.59 Skin protect wc cus wd>=22in E2604 UE $107.33 Skin protect wc cus wd>=22in E2604 UE KE $124.53 Skin protect wc cus wd>=22in E2605 NU $204.42 Position wc cush wdth <22 in E2605 NU KE $237.17 Position wc cush wdth <22 in E2605 RR $20.45 Position wc cush wdth <22 in E2605 RR KE $23.73 Position wc cush wdth <22 in E2605 UE $153.34 Position wc cush wdth <22 in E2605 UE KE $177.91 Position wc cush wdth <22 in E2606 NU $318.91 Position wc cush wdth>=22 in E2606 NU KE $370.01 Position wc cush wdth>=22 in E2606 RR $31.90 Position wc cush wdth>=22 in E2606 RR KE $37.02 Position wc cush wdth>=22 in E2606 UE $239.17 Position wc cush wdth>=22 in E2606 UE KE $277.50 Position wc cush wdth>=22 in E2607 NU $220.12 Skin pro/pos wc cus wd <22in E2607 NU KE $255.39 Skin pro/pos wc cus wd <22in E2607 RR $22.02 Skin pro/pos wc cus wd <22in E2607 RR KE $25.54 Skin pro/pos wc cus wd <22in E2607 UE $165.09 Skin pro/pos wc cus wd <22in E2607 UE KE $191.55 Skin pro/pos wc cus wd <22in E2608 NU $264.35 Skin pro/pos wc cus wd>=22in E2608 NU KE $306.70 Skin pro/pos wc cus wd>=22in E2608 RR $26.43 Skin pro/pos wc cus wd>=22in E2608 RR KE $30.66 Skin pro/pos wc cus wd>=22in E2608 UE $198.27 Skin pro/pos wc cus wd>=22in E2608 UE KE $230.03 Skin pro/pos wc cus wd>=22in E2611 NU $237.22 Gen use back cush wdth <22in E2611 NU KE $275.22 Gen use back cush wdth <22in E2611 RR $23.71 Gen use back cush wdth <22in E2611 RR KE $27.52 Gen use back cush wdth <22in E2611 UE $177.93 Gen use back cush wdth <22in E2611 UE KE $206.43 Gen use back cush wdth <22in E2612 NU $320.90 Gen use back cush wdth>=22in E2612 NU KE $372.31 Gen use back cush wdth>=22in E2612 RR $32.09 Gen use back cush wdth>=22in E2612 RR KE $37.23 Gen use back cush wdth>=22in E2612 UE $240.66 Gen use back cush wdth>=22in E2612 UE KE $279.22 Gen use back cush wdth>=22in E2613 NU $298.49 Position back cush wd <22in E2613 NU KE $346.32 Position back cush wd <22in E2613 RR $29.85 Position back cush wd <22in E2613 RR KE $34.64 Position back cush wd <22in E2613 UE $223.87 Position back cush wd <22in E2613 UE KE $259.74 Position back cush wd <22in E2614 NU $413.09 Position back cush wd>=22in E2614 NU KE $479.27 Position back cush wd>=22in E2614 RR $41.31 Position back cush wd>=22in E2614 RR KE $47.93 Position back cush wd>=22in E2614 UE $309.83 Position back cush wd>=22in E2614 UE KE $359.47 Position back cush wd>=22in E2615 NU $343.51 Pos back post/lat wdth <22in E2615 NU KE $398.55 Pos back post/lat wdth <22in E2615 RR $34.36 Pos back post/lat wdth <22in E2615 RR KE $39.86 Pos back post/lat wdth <22in E2615 UE $257.62 Pos back post/lat wdth <22in E2615 UE KE $298.90 Pos back post/lat wdth <22in E2616 NU $462.18 Pos back post/lat wdth>=22in E2616 NU KE $536.23 Pos back post/lat wdth>=22in E2616 RR $46.22 Pos back post/lat wdth>=22in E2616 RR KE $53.63 Pos back post/lat wdth>=22in E2616 UE $346.65 Pos back post/lat wdth>=22in E2616 UE KE $402.18 Pos back post/lat wdth>=22in E2619 NU $38.97 Replace cover w/c seat cush E2619 NU KE $45.23 Replace cover w/c seat cush E2619 RR $3.90 Replace cover w/c seat cush E2619 RR KE $4.52 Replace cover w/c seat cush E2619 UE $29.25 Replace cover w/c seat cush E2619 UE KE $33.94 Replace cover w/c seat cush E2620 NU $415.94 WC planar back cush wd <22in E2620 NU KE $482.59 WC planar back cush wd <22in E2620 RR $41.60 WC planar back cush wd <22in E2620 RR KE $48.26 WC planar back cush wd <22in E2620 UE $311.97 WC planar back cush wd <22in E2620 UE KE $361.96 WC planar back cush wd <22in E2621 NU $436.50 WC planar back cush wd>=22in E2621 NU KE $506.44 WC planar back cush wd>=22in E2621 RR $43.65 WC planar back cush wd>=22in E2621 RR KE $50.64 WC planar back cush wd>=22in E2621 UE $327.38 WC planar back cush wd>=22in E2621 UE KE $379.83 WC planar back cush wd>=22in E2622 NU $251.73 Adj skin pro w/c cus wd<22in E2622 NU KE $292.06 Adj skin pro w/c cus wd<22in E2622 RR $25.17 Adj skin pro w/c cus wd<22in E2622 RR KE $29.22 Adj skin pro w/c cus wd<22in E2622 UE $188.80 Adj skin pro w/c cus wd<22in E2622 UE KE $219.05 Adj skin pro w/c cus wd<22in E2623 NU $320.32 Adj skin pro wc cus wd>=22in E2623 NU KE $371.64 Adj skin pro wc cus wd>=22in E2623 RR $32.04 Adj skin pro wc cus wd>=22in E2623 RR KE $37.18 Adj skin pro wc cus wd>=22in E2623 UE $240.23 Adj skin pro wc cus wd>=22in E2623 UE KE $278.73 Adj skin pro wc cus wd>=22in E2624 NU $253.80 Adj skin pro/pos cus<22in E2624 NU KE $294.46 Adj skin pro/pos cus<22in E2624 RR $25.38 Adj skin pro/pos cus<22in E2624 RR KE $29.44 Adj skin pro/pos cus<22in E2624 UE $190.36 Adj skin pro/pos cus<22in E2624 UE KE $220.86 Adj skin pro/pos cus<22in E2625 NU $321.29 Adj skin pro/pos wc cus>=22 E2625 NU KE $372.77 Adj skin pro/pos wc cus>=22 E2625 RR $32.12 Adj skin pro/pos wc cus>=22 E2625 RR KE $37.28 Adj skin pro/pos wc cus>=22 E2625 UE $240.96 Adj skin pro/pos wc cus>=22 E2625 UE KE $279.57 Adj skin pro/pos wc cus>=22 K0001 RR $46.93 Standard wheelchair K0002 RR $61.52 Stnd hemi (low seat) whlchr K0003 RR $78.94 Lightweight wheelchair K0004 RR $108.45 High strength ltwt whlchr K0005 NU $1,628.98 Ultralightweight wheelchair K0005 RR $162.88 Ultralightweight wheelchair K0005 UE $1,221.71 Ultralightweight wheelchair K0006 RR $93.93 Heavy duty wheelchair K0007 RR $154.06 Extra heavy duty wheelchair K0010 RR $336.26 Stnd wt frame power whlchr K0011 RR $450.90 Stnd wt pwr whlchr w control K0011 RR KF $500.61 Stnd wt pwr whlchr w control K0012 RR $276.62 Ltwt portbl power whlchr K0015 NU $138.00 Detach non‐adjus hght armrst K0015 NU KE $160.10 Detach non‐adjus hght armrst K0015 RR $13.74 Detach non‐adjus hght armrst K0015 RR KE $15.95 Detach non‐adjus hght armrst K0015 UE $103.49 Detach non‐adjus hght armrst K0015 UE KE $120.07 Detach non‐adjus hght armrst K0017 NU $38.81 Detach adjust armrest base K0017 NU KE $45.04 Detach adjust armrest base K0017 RR $3.88 Detach adjust armrest base K0017 RR KE $4.50 Detach adjust armrest base K0017 UE $29.11 Detach adjust armrest base K0017 UE KE $33.78 Detach adjust armrest base K0018 NU $21.67 Detach adjust armrst upper K0018 NU KE $25.15 Detach adjust armrst upper K0018 RR $2.16 Detach adjust armrst upper K0018 RR KE $2.50 Detach adjust armrst upper K0018 UE $16.27 Detach adjust armrst upper K0018 UE KE $18.87 Detach adjust armrst upper K0019 NU $12.42 Arm pad each K0019 NU KE $14.41 Arm pad each K0019 RR $1.24 Arm pad each K0019 RR KE $1.44 Arm pad each K0019 UE $9.31 Arm pad each K0019 UE KE $10.79 Arm pad each K0020 NU $35.29 Fixed adjust armrest pair K0020 NU KE $40.93 Fixed adjust armrest pair K0020 RR $3.54 Fixed adjust armrest pair K0020 RR KE $4.10 Fixed adjust armrest pair K0020 UE $26.45 Fixed adjust armrest pair K0020 UE KE $30.69 Fixed adjust armrest pair K0037 NU $31.09 High mount flip‐up footrest K0037 NU KE $36.07 High mount flip‐up footrest K0037 RR $2.85 High mount flip‐up footrest K0037 RR KE $3.31 High mount flip‐up footrest K0037 UE $23.33 High mount flip‐up footrest K0037 UE KE $27.06 High mount flip‐up footrest K0038 NU $18.43 Leg strap each K0038 NU KE $21.37 Leg strap each K0038 RR $1.85 Leg strap each K0038 RR KE $2.14 Leg strap each K0038 UE $13.82 Leg strap each K0038 UE KE $16.04 Leg strap each K0039 NU $40.92 Leg strap h style each K0039 NU KE $47.47 Leg strap h style each K0039 RR $4.11 Leg strap h style each K0039 RR KE $4.75 Leg strap h style each K0039 UE $30.69 Leg strap h style each K0039 UE KE $35.61 Leg strap h style each K0040 NU $56.71 Adjustable angle footplate K0040 NU KE $65.79 Adjustable angle footplate K0040 RR $5.65 Adjustable angle footplate K0040 RR KE $6.56 Adjustable angle footplate K0040 UE $42.52 Adjustable angle footplate K0040 UE KE $49.33 Adjustable angle footplate K0041 NU $40.19 Large size footplate each K0041 NU KE $46.63 Large size footplate each K0041 RR $4.04 Large size footplate each K0041 RR KE $4.68 Large size footplate each K0041 UE $30.14 Large size footplate each K0041 UE KE $34.97 Large size footplate each K0042 NU $27.67 Standard size footplate each K0042 NU KE $32.10 Standard size footplate each K0042 RR $2.76 Standard size footplate each K0042 RR KE $3.20 Standard size footplate each K0042 UE $20.75 Standard size footplate each K0042 UE KE $24.07 Standard size footplate each K0043 NU $14.83 Ftrst lower extension tube K0043 NU KE $17.21 Ftrst lower extension tube K0043 RR $1.48 Ftrst lower extension tube K0043 RR KE $1.72 Ftrst lower extension tube K0043 UE $11.12 Ftrst lower extension tube K0043 UE KE $12.89 Ftrst lower extension tube K0044 NU $12.63 Ftrst upper hanger bracket K0044 NU KE $14.66 Ftrst upper hanger bracket K0044 RR $1.27 Ftrst upper hanger bracket K0044 RR KE $1.47 Ftrst upper hanger bracket K0044 UE $9.48 Ftrst upper hanger bracket K0044 UE KE $11.00 Ftrst upper hanger bracket K0045 NU $43.00 Footrest complete assembly K0045 NU KE $49.89 Footrest complete assembly K0045 RR $4.30 Footrest complete assembly K0045 RR KE $4.99 Footrest complete assembly K0045 UE $32.26 Footrest complete assembly K0045 UE KE $37.42 Footrest complete assembly K0046 NU $14.83 Elevat legrst low extension K0046 NU KE $17.21 Elevat legrst low extension K0046 RR $1.48 Elevat legrst low extension K0046 RR KE $1.72 Elevat legrst low extension K0046 UE $11.14 Elevat legrst low extension K0046 UE KE $12.91 Elevat legrst low extension K0047 NU $58.08 Elevat legrst up hangr brack K0047 NU KE $67.38 Elevat legrst up hangr brack K0047 RR $5.82 Elevat legrst up hangr brack K0047 RR KE $6.75 Elevat legrst up hangr brack K0047 UE $43.55 Elevat legrst up hangr brack K0047 UE KE $50.53 Elevat legrst up hangr brack K0050 NU $24.68 Ratchet assembly K0050 NU KE $28.64 Ratchet assembly K0050 RR $2.46 Ratchet assembly K0050 RR KE $2.86 Ratchet assembly K0050 UE $18.52 Ratchet assembly K0050 UE KE $21.49 Ratchet assembly K0051 NU $39.95 Cam relese assem ftrst/lgrst K0051 NU KE $46.35 Cam relese assem ftrst/lgrst K0051 RR $4.02 Cam relese assem ftrst/lgrst K0051 RR KE $4.65 Cam relese assem ftrst/lgrst K0051 UE $29.95 Cam relese assem ftrst/lgrst K0051 UE KE $34.75 Cam relese assem ftrst/lgrst K0052 NU $70.21 Swingaway detach footrest K0052 NU KE $81.45 Swingaway detach footrest K0052 RR $7.01 Swingaway detach footrest K0052 RR KE $8.14 Swingaway detach footrest K0052 UE $52.64 Swingaway detach footrest K0052 UE KE $61.08 Swingaway detach footrest K0053 NU $77.47 Elevate footrest articulate K0053 NU KE $89.88 Elevate footrest articulate K0053 RR $7.74 Elevate footrest articulate K0053 RR KE $8.98 Elevate footrest articulate K0053 UE $58.10 Elevate footrest articulate K0053 UE KE $67.42 Elevate footrest articulate K0056 NU $83.80 Seat ht <17 or >=21 ltwt wc K0056 RR $8.38 Seat ht <17 or >=21 ltwt wc K0056 UE $62.87 Seat ht <17 or >=21 ltwt wc K0065 NU $39.17 Spoke protectors K0065 RR $3.92 Spoke protectors K0065 UE $29.37 Spoke protectors K0069 NU $88.05 Rear whl complete solid tire K0069 RR $9.17 Rear whl complete solid tire K0069 UE $66.03 Rear whl complete solid tire K0070 NU $161.39 Rear whl compl pneum tire K0070 RR $16.15 Rear whl compl pneum tire K0070 UE $121.04 Rear whl compl pneum tire K0071 NU $96.26 Front castr compl pneum tire K0071 RR $9.63 Front castr compl pneum tire K0071 UE $72.18 Front castr compl pneum tire K0072 NU $57.94 Frnt cstr cmpl sem‐pneum tir K0072 RR $5.79 Frnt cstr cmpl sem‐pneum tir K0072 UE $43.46 Frnt cstr cmpl sem‐pneum tir K0073 NU $29.48 Caster pin lock each K0073 RR $2.97 Caster pin lock each K0073 UE $22.10 Caster pin lock each K0077 NU $51.85 Front caster assem complete K0077 RR $5.17 Front caster assem complete K0077 UE $38.88 Front caster assem complete K0098 NU $20.06 Drive belt power wheelchair K0098 NU KE $23.27 Drive belt power wheelchair K0098 RR $2.02 Drive belt power wheelchair K0098 RR KE $2.34 Drive belt power wheelchair K0098 UE $15.04 Drive belt power wheelchair K0098 UE KE $17.46 Drive belt power wheelchair K0105 NU $87.61 Iv hanger K0105 RR $8.75 Iv hanger K0105 UE $65.70 Iv hanger K0195 RR $15.80 Elevating whlchair leg rests K0195 RR KE $18.34 Elevating whlchair leg rests K0455 RR $219.45 Pump uninterrupted infusion K0552 $2.30 Supply/ext inf pump syr type K0601 NU $0.97 Repl batt silver oxide 1.5 v K0602 NU $5.60 Repl batt silver oxide 3 v K0603 NU $0.50 Repl batt alkaline 1.5 v K0604 NU $5.36 Repl batt lithium 3.6 v K0605 NU $12.86 Repl batt lithium 4.5 v K0606 RR KF $2,218.89 AED garment w elec analysis K0607 NU $171.14 Repl batt for AED K0607 NU KF $190.00 Repl batt for AED K0607 RR $17.12 Repl batt for AED K0607 RR KF $19.01 Repl batt for AED K0607 UE $128.35 Repl batt for AED K0607 UE KF $142.51 Repl batt for AED K0608 NU $106.80 Repl garment for AED K0608 NU KF $118.58 Repl garment for AED K0608 RR $10.70 Repl garment for AED K0608 RR KF $11.87 Repl garment for AED K0608 UE $80.10 Repl garment for AED K0608 UE KF $88.93 Repl garment for AED K0609 $710.25 Repl electrode for AED K0609 KF $788.57 Repl electrode for AED K0672 $62.87 Removable soft interface LE K0730 NU $1,519.06 Ctrl dose inh drug deliv sys K0730 RR $151.91 Ctrl dose inh drug deliv sys K0730 UE $1,139.29 Ctrl dose inh drug deliv sys K0733 NU $22.94 12‐24hr sealed lead acid K0733 NU KE $26.62 12‐24hr sealed lead acid K0733 RR $2.31 12‐24hr sealed lead acid K0733 RR KE $2.68 12‐24hr sealed lead acid K0733 UE $17.22 12‐24hr sealed lead acid K0733 UE KE $19.98 12‐24hr sealed lead acid K0738 RR $43.37 Portable gas oxygen system K0800 NU $981.78 POV group 1 std up to 300lbs K0800 RR $98.18 POV group 1 std up to 300lbs K0800 UE $736.34 POV group 1 std up to 300lbs K0801 NU $1,582.84 POV group 1 hd 301‐450 lbs K0801 RR $158.26 POV group 1 hd 301‐450 lbs K0801 UE $1,187.12 POV group 1 hd 301‐450 lbs K0802 NU $1,791.27 POV group 1 vhd 451‐600 lbs K0802 RR $179.12 POV group 1 vhd 451‐600 lbs K0802 UE $1,343.45 POV group 1 vhd 451‐600 lbs K0806 NU $1,187.69 POV group 2 std up to 300lbs K0806 RR $118.77 POV group 2 std up to 300lbs K0806 UE $890.77 POV group 2 std up to 300lbs K0807 NU $1,802.19 POV group 2 hd 301‐450 lbs K0807 RR $180.22 POV group 2 hd 301‐450 lbs K0807 UE $1,351.65 POV group 2 hd 301‐450 lbs K0808 NU $2,788.36 POV group 2 vhd 451‐600 lbs K0808 RR $278.83 POV group 2 vhd 451‐600 lbs K0808 UE $2,091.26 POV group 2 vhd 451‐600 lbs K0813 RR $274.81 PWC gp 1 std port seat/back K0814 RR $351.78 PWC gp 1 std port cap chair K0815 RR $400.55 PWC gp 1 std seat/back K0816 RR $383.61 PWC gp 1 std cap chair K0820 RR $293.53 PWC gp 2 std port seat/back K0821 RR $376.80 PWC gp 2 std port cap chair K0822 RR $455.38 PWC gp 2 std seat/back K0823 RR $458.38 PWC gp 2 std cap chair K0824 RR $551.65 PWC gp 2 hd seat/back K0825 RR $505.03 PWC gp 2 hd cap chair K0826 RR $714.18 PWC gp 2 vhd seat/back K0827 RR $607.27 PWC gp vhd cap chair K0828 RR $786.96 PWC gp 2 xtra hd seat/back K0829 RR $722.66 PWC gp 2 xtra hd cap chair K0835 RR $462.20 PWC gp2 std sing pow opt s/b K0836 RR $479.33 PWC gp2 std sing pow opt cap K0837 RR $551.65 PWC gp 2 hd sing pow opt s/b K0838 RR $493.51 PWC gp 2 hd sing pow opt cap K0839 RR $714.18 PWC gp2 vhd sing pow opt s/b K0840 RR $1,081.99 PWC gp2 xhd sing pow opt s/b K0841 RR $491.96 PWC gp2 std mult pow opt s/b K0842 RR $491.96 PWC gp2 std mult pow opt cap K0843 RR $592.32 PWC gp2 hd mult pow opt s/b K0848 RR $601.97 PWC gp 3 std seat/back K0849 RR $578.78 PWC gp 3 std cap chair K0850 RR $698.28 PWC gp 3 hd seat/back K0851 RR $671.39 PWC gp 3 hd cap chair K0852 RR $806.81 PWC gp 3 vhd seat/back K0853 RR $828.80 PWC gp 3 vhd cap chair K0854 RR $1,097.97 PWC gp 3 xhd seat/back K0855 RR $1,037.20 PWC gp 3 xhd cap chair K0856 RR $646.16 PWC gp3 std sing pow opt s/b K0857 RR $659.11 PWC gp3 std sing pow opt cap K0858 RR $801.70 PWC gp3 hd sing pow opt s/b K0859 RR $764.57 PWC gp3 hd sing pow opt cap K0860 RR $1,145.32 PWC gp3 vhd sing pow opt s/b K0861 RR $647.19 PWC gp3 std mult pow opt s/b K0861 RR KF $833.67 PWC gp3 std mult pow opt s/b K0862 RR $801.70 PWC gp3 hd mult pow opt s/b K0863 RR $1,145.32 PWC gp3 vhd mult pow opt s/b K0864 RR $1,362.94 PWC gp3 xhd mult pow opt s/b L0112 $1,037.98 Cranial cervical orthosis L0113 $211.49 Cranial cervical torticollis L0120 $19.87 Cerv flexible non‐adjustable L0130 $140.43 Flex thermoplastic collar mo L0140 $46.44 Cervical semi‐rigid adjustab L0150 $85.19 Cerv semi‐rig adj molded chn L0160 $111.27 Cerv semi‐rig wire occ/mand L0170 $458.19 Cervical collar molded to pt L0172 $99.35 Cerv col thermplas foam 2 pi L0174 $195.17 Cerv col foam 2 piece w thor L0180 $270.63 Cer post col occ/man sup adj L0190 $351.93 Cerv collar supp adj cerv ba L0200 $366.89 Cerv col supp adj bar & thor L0220 $100.20 Thor rib belt custom fabrica L0430 $1,022.66 Dewall posture protector L0450 $125.80 TLSO flex prefab thoracic L0452 $0.00 tlso flex custom fab thoraci L0454 $257.21 TLSO flex prefab sacrococ‐T9 L0456 $737.60 TLSO flex prefab L0458 $661.39 TLSO 2Mod symphis‐xipho pre L0460 $744.43 TLSO2Mod symphysis‐stern pre L0462 $925.97 TLSO 3Mod sacro‐scap pre L0464 $1,102.35 TLSO 4Mod sacro‐scap pre L0466 $267.93 TLSO rigid frame pre soft ap L0468 $354.97 TLSO rigid frame prefab pelv L0470 $452.96 TLSO rigid frame pre subclav L0472 $287.27 TLSO rigid frame hyperex pre L0480 $1,011.66 TLSO rigid plastic custom fa L0482 $1,175.08 TLSO rigid lined custom fab L0484 $1,262.59 TLSO rigid plastic cust fab L0486 $1,339.54 TLSO rigidlined cust fab two L0488 $744.43 TLSO rigid lined pre one pie L0490 $209.80 TLSO rigid plastic pre one L0491 $569.57 TLSO 2 piece rigid shell L0492 $374.59 TLSO 3 piece rigid shell L0621 $65.51 SIO flex pelvisacral prefab L0622 $214.59 SIO flex pelvisacral custom L0623 $0.00 SIO panel prefab L0624 $0.00 SIO panel custom L0625 $40.84 LO flexibl L1‐below L5 pre L0626 $57.80 LO sag stays/panels pre‐fab L0627 $304.84 LO sagitt rigid panel prefab L0628 $62.22 LO flex w/o rigid stays pre L0629 $0.00 LSO flex w/rigid stays cust L0630 $120.11 LSO post rigid panel pre L0631 $761.33 LSO sag‐coro rigid frame pre L0632 $0.00 LSO sag rigid frame cust L0633 $212.66 LSO flexion control prefab L0634 $0.00 LSO flexion control custom L0635 $680.06 LSO sagit rigid panel prefab L0636 $1,006.73 LSO sagittal rigid panel cus L0637 $796.71 LSO sag‐coronal panel prefab L0638 $978.11 LSO sag‐coronal panel custom L0639 $796.71 LSO s/c shell/panel prefab L0640 $776.03 LSO s/c shell/panel custom L0700 $1,452.39 Ctlso a‐p‐l control molded L0710 $1,483.81 Ctlso a‐p‐l control w/ inter L0810 $1,855.69 Halo cervical into jckt vest L0820 $1,665.60 Halo cervical into body jack L0830 $2,347.32 Halo cerv into milwaukee typ L0859 $978.23 MRI compatible system L0861 $159.84 Halo repl liner/interface L0970 $95.53 Tlso corset front L0972 $85.81 Lso corset front L0974 $127.42 Tlso full corset L0976 $113.60 Lso full corset L0978 $149.97 Axillary crutch extension L0980 $16.37 Peroneal straps pair L0982 $11.57 Stocking supp grips set of f L0984 $48.03 Protective body sock each L1000 $1,457.19 Ctlso milwauke initial model L1001 $0.00 CTLSO infant immobilizer L1005 $2,373.63 Tension based scoliosis orth L1010 $47.68 Ctlso axilla sling L1020 $61.40 Kyphosis pad L1025 $117.22 Kyphosis pad floating L1030 $45.20 Lumbar bolster pad L1040 $59.14 Lumbar or lumbar rib pad L1050 $71.29 Sternal pad L1060 $85.52 Thoracic pad L1070 $83.50 Trapezius sling L1080 $46.98 Outrigger L1085 $127.07 Outrigger bil w/ vert extens L1090 $84.07 Lumbar sling L1100 $134.24 Ring flange plastic/leather L1110 $181.45 Ring flange plas/leather mol L1120 $30.68 Covers for upright each L1200 $1,113.18 Furnsh initial orthosis only L1210 $185.90 Lateral thoracic extension L1220 $177.58 Anterior thoracic extension L1230 $455.21 Milwaukee type superstructur L1240 $61.53 Lumbar derotation pad L1250 $61.53 Anterior asis pad L1260 $62.83 Anterior thoracic derotation L1270 $63.83 Abdominal pad L1280 $73.42 Rib gusset (elastic) each L1290 $58.12 Lateral trochanteric pad L1300 $1,308.64 Body jacket mold to patient L1310 $1,344.64 Post‐operative body jacket L1500 $1,349.50 Thkao mobility frame L1510 $853.76 Thkao standing frame L1520 $1,620.83 Thkao swivel walker L1600 $91.55 Abduct hip flex frejka w cvr L1610 $40.40 Abduct hip flex frejka covr L1620 $114.42 Abduct hip flex pavlik harne L1630 $120.39 Abduct control hip semi‐flex L1640 $366.48 Pelv band/spread bar thigh c L1650 $185.44 HO abduction hip adjustable L1652 $264.36 HO bi thighcuffs w sprdr bar L1660 $121.59 HO abduction static plastic L1680 $865.65 Pelvic & hip control thigh c L1685 $883.43 Post‐op hip abduct custom fa L1686 $815.73 HO post‐op hip abduction L1690 $1,434.09 Combination bilateral HO L1700 $1,084.96 Leg perthes orth toronto typ L1710 $1,270.06 Legg perthes orth newington L1720 $936.19 Legg perthes orthosis trilat L1730 $804.10 Legg perthes orth scottish r L1755 $1,276.05 Legg perthes patten bottom t L1810 $69.97 Ko elastic with joints L1820 $108.40 Ko elas w/ condyle pads & jo L1830 $65.91 Ko immobilizer canvas longit L1831 $218.27 Knee orth pos locking joint L1832 $502.47 KO adj jnt pos rigid support L1834 $551.51 Ko w/0 joint rigid molded to L1836 $98.95 Rigid KO wo joints L1840 $734.62 Ko derot ant cruciate custom L1843 $665.42 KO single upright custom fit L1844 $1,153.39 Ko w/adj jt rot cntrl molded L1845 $690.52 Ko w/ adj flex/ext rotat cus L1846 $846.64 Ko w adj flex/ext rotat mold L1847 $426.55 KO adjustable w air chambers L1850 $215.96 Ko swedish type L1860 $762.37 Ko supracondylar socket mold L1900 $191.66 Afo sprng wir drsflx calf bd L1902 $66.23 Afo ankle gauntlet L1904 $398.29 Afo molded ankle gauntlet L1906 $85.44 Afo multiligamentus ankle su L1907 $417.30 AFO supramalleolar custom L1910 $194.06 Afo sing bar clasp attach sh L1920 $248.38 Afo sing upright w/ adjust s L1930 $168.08 Afo plastic L1932 $661.79 Afo rig ant tib prefab TCF/= L1940 $351.36 Afo molded to patient plasti L1945 $840.03 Afo molded plas rig ant tib L1950 $557.00 Afo spiral molded to pt plas L1951 $622.83 AFO spiral prefabricated L1960 $420.09 Afo pos solid ank plastic mo L1970 $505.55 Afo plastic molded w/ankle j L1971 $347.62 AFO w/ankle joint, prefab L1980 $260.74 Afo sing solid stirrup calf L1990 $316.69 Afo doub solid stirrup calf L2000 $750.29 Kafo sing fre stirr thi/calf L2005 $3,038.93 KAFO sng/dbl mechanical act L2010 $699.90 Kafo sng solid stirrup w/o j L2020 $881.29 Kafo dbl solid stirrup band/ L2030 $800.01 Kafo dbl solid stirrup w/o j L2034 $1,511.04 KAFO pla sin up w/wo k/a cus L2035 $129.76 KAFO plastic pediatric size L2036 $1,365.97 Kafo plas doub free knee mol L2037 $1,274.39 Kafo plas sing free knee mol L2038 $1,294.57 Kafo w/o joint multi‐axis an L2040 $157.00 Hkafo torsion bil rot straps L2050 $338.44 Hkafo torsion cable hip pelv L2060 $412.49 Hkafo torsion ball bearing j L2070 $105.92 Hkafo torsion unilat rot str L2080 $255.54 Hkafo unilat torsion cable L2090 $311.53 Hkafo unilat torsion ball br L2106 $483.06 Afo tib fx cast plaster mold L2108 $841.09 Afo tib fx cast molded to pt L2112 $386.86 Afo tibial fracture soft L2114 $485.23 Afo tib fx semi‐rigid L2116 $558.31 Afo tibial fracture rigid L2126 $933.94 Kafo fem fx cast thermoplas L2128 $1,322.50 Kafo fem fx cast molded to p L2132 $717.01 Kafo femoral fx cast soft L2134 $765.12 Kafo fem fx cast semi‐rigid L2136 $913.21 Kafo femoral fx cast rigid L2180 $85.23 Plas shoe insert w ank joint L2182 $70.62 Drop lock knee L2184 $96.52 Limited motion knee joint L2186 $133.89 Adj motion knee jnt lerman t L2188 $256.41 Quadrilateral brim L2190 $66.26 Waist belt L2192 $290.93 Pelvic band & belt thigh fla L2200 $33.78 Limited ankle motion ea jnt L2210 $48.89 Dorsiflexion assist each joi L2220 $58.19 Dorsi & plantar flex ass/res L2230 $54.52 Split flat caliper stirr & p L2232 $73.80 Rocker bottom, contact AFO L2240 $67.47 Round caliper and plate atta L2250 $273.55 Foot plate molded stirrup at L2260 $142.42 Reinforced solid stirrup L2265 $83.67 Long tongue stirrup L2270 $39.24 Varus/valgus strap padded/li L2275 $92.49 Plastic mod low ext pad/line L2280 $323.43 Molded inner boot L2300 $202.79 Abduction bar jointed adjust L2310 $101.56 Abduction bar‐straight L2320 $146.18 Non‐molded lacer L2330 $306.00 Lacer molded to patient mode L2335 $188.92 Anterior swing band L2340 $408.98 Pre‐tibial shell molded to p L2350 $706.36 Prosthetic type socket molde L2360 $36.76 Extended steel shank L2370 $238.20 Patten bottom L2375 $100.62 Torsion ank & half solid sti L2380 $87.46 Torsion straight knee joint L2385 $95.16 Straight knee joint heavy du L2387 $137.10 Add LE poly knee custom KAFO L2390 $79.67 Offset knee joint each L2395 $111.16 Offset knee joint heavy duty L2397 $86.62 Suspension sleeve lower ext L2405 $64.65 Knee joint drop lock ea jnt L2415 $90.06 Knee joint cam lock each joi L2425 $106.30 Knee disc/dial lock/adj flex L2430 $106.30 Knee jnt ratchet lock ea jnt L2492 $96.51 Knee lift loop drop lock rin L2500 $230.89 Thi/glut/ischia wgt bearing L2510 $518.06 Th/wght bear quad‐lat brim m L2520 $341.75 Th/wght bear quad‐lat brim c L2525 $922.03 Th/wght bear nar m‐l brim mo L2526 $526.15 Th/wght bear nar m‐l brim cu L2530 $166.93 Thigh/wght bear lacer non‐mo L2540 $300.38 Thigh/wght bear lacer molded L2550 $204.04 Thigh/wght bear high roll cu L2570 $338.40 Hip clevis type 2 posit jnt L2580 $329.73 Pelvic control pelvic sling L2600 $180.56 Hip clevis/thrust bearing fr L2610 $191.24 Hip clevis/thrust bearing lo L2620 $215.04 Pelvic control hip heavy dut L2622 $243.78 Hip joint adjustable flexion L2624 $235.27 Hip adj flex ext abduct cont L2627 $1,283.77 Plastic mold recipro hip & c L2628 $1,262.78 Metal frame recipro hip & ca L2630 $175.93 Pelvic control band & belt u L2640 $238.75 Pelvic control band & belt b L2650 $101.66 Pelv & thor control gluteal L2660 $132.42 Thoracic control thoracic ba L2670 $128.42 Thorac cont paraspinal uprig L2680 $118.96 Thorac cont lat support upri L2750 $59.39 Plating chrome/nickel pr bar L2755 $96.89 Carbon graphite lamination L2760 $43.17 Extension per extension per L2768 $96.62 Ortho sidebar disconnect L2780 $48.08 Non‐corrosive finish L2785 $22.60 Drop lock retainer each L2795 $61.33 Knee control full kneecap L2800 $94.25 Knee cap medial or lateral p L2810 $73.99 Knee control condylar pad L2820 $61.70 Soft interface below knee se L2830 $66.75 Soft interface above knee se L2840 $39.46 Tibial length sock fx or equ L2850 $43.99 Femoral lgth sock fx or equa L3000 $232.96 Ft insert ucb berkeley shell L3001 $98.09 Foot insert remov molded spe L3002 $119.78 Foot insert plastazote or eq L3003 $129.23 Foot insert silicone gel eac L3010 $129.23 Foot longitudinal arch suppo L3020 $147.14 Foot longitud/metatarsal sup L3030 $56.60 Foot arch support remov prem L3031 $0.00 Foot lamin/prepreg composite L3040 $34.89 Ft arch suprt premold longit L3050 $34.89 Foot arch supp premold metat L3060 $54.70 Foot arch supp longitud/meta L3070 $23.55 Arch suprt att to sho longit L3080 $23.55 Arch supp att to shoe metata L3090 $30.19 Arch supp att to shoe long/m L3100 $32.06 Hallus‐valgus nght dynamic s L3140 $66.03 Abduction rotation bar shoe L3150 $60.37 Abduct rotation bar w/o shoe L3170 $37.75 Foot plastic heel stabilizer L3224 $47.26 Woman's shoe oxford brace L3225 $48.53 Man's shoe oxford brace L3300 $38.66 Sho lift taper to metatarsal L3310 $60.37 Shoe lift elev heel/sole neo L3330 $419.71 Lifts elevation metal extens L3332 $54.70 Shoe lifts tapered to one‐ha L3334 $28.30 Shoe lifts elevation heel /i L3340 $63.20 Shoe wedge sach L3350 $16.98 Shoe heel wedge L3360 $26.41 Shoe sole wedge outside sole L3370 $36.77 Shoe sole wedge between sole L3380 $36.77 Shoe clubfoot wedge L3390 $36.77 Shoe outflare wedge L3400 $30.19 Shoe metatarsal bar wedge ro L3410 $68.85 Shoe metatarsal bar between L3420 $40.56 Full sole/heel wedge btween L3430 $118.84 Sho heel count plast reinfor L3440 $56.60 Heel leather reinforced L3450 $78.29 Shoe heel sach cushion type L3455 $30.19 Shoe heel new leather standa L3460 $25.45 Shoe heel new rubber standar L3465 $43.39 Shoe heel thomas with wedge L3470 $46.21 Shoe heel thomas extend to b L3480 $46.21 Shoe heel pad & depress for L3500 $21.69 Ortho shoe add leather insol L3510 $21.69 Orthopedic shoe add rub insl L3520 $23.55 O shoe add felt w leath insl L3530 $23.55 Ortho shoe add half sole L3540 $37.75 Ortho shoe add full sole L3550 $6.59 O shoe add standard toe tap L3560 $16.98 O shoe add horseshoe toe tap L3570 $63.20 O shoe add instep extension L3580 $48.10 O shoe add instep velcro clo L3590 $39.61 O shoe convert to sof counte L3595 $31.12 Ortho shoe add march bar L3600 $56.60 Trans shoe calip plate exist L3610 $74.50 Trans shoe caliper plate new L3620 $56.60 Trans shoe solid stirrup exi L3630 $74.50 Trans shoe solid stirrup new L3640 $32.06 Shoe dennis browne splint bo L3650 $47.24 Shlder fig 8 abduct restrain L3671 $608.18 SO cap design w/o jnts CF L3674 $797.81 SO airplane w/wo joint CF L3702 $194.89 EO w/o joints CF L3710 $108.65 Elbow elastic with metal joi L3720 $484.76 Forearm/arm cuffs free motio L3730 $626.72 Forearm/arm cuffs ext/flex a L3740 $743.02 Cuffs adj lock w/ active con L3760 $337.53 EO withjoint, Prefabricated L3762 $72.58 Rigid EO wo joints L3763 $473.77 EWHO rigid w/o jnts CF L3764 $618.38 EWHO w/joint(s) CF L3765 $865.43 EWHFO rigid w/o jnts CF L3766 $916.42 EWHFO w/joint(s) CF L3806 $306.58 WHFO w/joint(s) custom fab L3807 $168.77 WHFO,no joint, prefabricated L3808 $252.39 WHFO, rigid w/o joints L3900 $984.13 Hinge extension/flex wrist/f L3901 $1,117.59 Hinge ext/flex wrist finger L3904 $2,035.93 Whfo electric custom fitted L3905 $669.35 WHO w/nontorsion jnt(s) CF L3906 $297.19 WHO w/o joints CF L3908 $46.77 Wrist cock‐up non‐molded L3912 $81.02 Flex glove w/elastic finger L3913 $182.80 HFO w/o joints CF L3915 $358.76 WHO w nontor jnt(s) prefab L3917 $71.31 Prefab metacarpl fx orthosis L3919 $182.80 HO w/o joints CF L3921 $216.80 HFO w/joint(s) CF L3923 $65.14 HFO w/o joints PF L3925 $34.94 FO pip/dip with joint/spring L3927 $23.60 FO pip/dip w/o joint/spring L3929 $61.91 HFO nontorsion joint, prefab L3931 $126.77 WHFO nontorsion joint prefab L3933 $144.01 FO w/o joints CF L3935 $149.10 FO nontorsion joint CF L3956 $0.00 Add joint upper ext orthosis L3960 $511.41 Sewho airplan desig abdu pos L3961 $1,133.97 SEWHO cap design w/o jnts CF L3962 $498.82 Sewho erbs palsey design abd L3964 NU $539.69 Seo mobile arm sup att to wc L3964 RR $53.98 Seo mobile arm sup att to wc L3964 UE $404.75 Seo mobile arm sup att to wc L3965 NU $742.30 Arm supp att to wc rancho ty L3965 RR $74.25 Arm supp att to wc rancho ty L3965 UE $556.72 Arm supp att to wc rancho ty L3966 NU $559.20 Mobile arm supports reclinin L3966 RR $55.92 Mobile arm supports reclinin L3966 UE $419.40 Mobile arm supports reclinin L3967 $1,338.83 SEWHO airplane w/o jnts CF L3968 NU $832.53 Friction dampening arm supp L3968 RR $83.24 Friction dampening arm supp L3968 UE $624.41 Friction dampening arm supp L3969 NU $494.87 Monosuspension arm/hand supp L3969 RR $49.48 Monosuspension arm/hand supp L3969 UE $371.14 Monosuspension arm/hand supp L3970 NU $197.95 Elevat proximal arm support L3970 RR $19.79 Elevat proximal arm support L3970 UE $148.46 Elevat proximal arm support L3971 $1,270.87 SEWHO cap design w/jnt(s) CF L3972 NU $125.87 Offset/lat rocker arm w/ ela L3972 RR $12.59 Offset/lat rocker arm w/ ela L3972 UE $94.41 Offset/lat rocker arm w/ ela L3973 $1,338.83 SEWHO airplane w/jnt(s) CF L3974 NU $106.76 Mobile arm support supinator L3974 RR $10.68 Mobile arm support supinator L3974 UE $80.08 Mobile arm support supinator L3975 $1,133.97 SEWHFO cap design w/o jnt CF L3976 $1,133.97 SEWHFO airplane w/o jnts CF L3977 $1,270.87 SEWHFO cap desgn w/jnt(s) CF L3978 $1,338.83 SEWHFO airplane w/jnt(s) CF L3980 $222.62 Upp ext fx orthosis humeral L3982 $259.53 Upper ext fx orthosis rad/ul L3984 $239.29 Upper ext fx orthosis wrist L3995 $24.80 Sock fracture or equal each L4000 $978.03 Repl girdle milwaukee orth L4002 $0.00 Replace strap, any orthosis L4010 $476.81 Replace trilateral socket br L4020 $666.83 Replace quadlat socket brim L4030 $358.71 Replace socket brim cust fit L4040 $292.71 Replace molded thigh lacer L4045 $233.06 Replace non‐molded thigh lac L4050 $293.31 Replace molded calf lacer L4055 $189.93 Replace non‐molded calf lace L4060 $225.78 Replace high roll cuff L4070 $199.95 Replace prox & dist upright L4080 $82.01 Repl met band kafo‐afo prox L4090 $64.71 Repl met band kafo‐afo calf/ L4100 $84.97 Repl leath cuff kafo prox th L4110 $64.02 Repl leath cuff kafo‐afo cal L4130 $358.97 Replace pretibial shell L4350 $71.12 Ankle control orthosi prefab L4360 $218.61 Pneumati walking boot prefab L4370 $144.57 Pneumatic full leg splint L4380 $81.58 Pneumatic knee splint L4386 $117.58 Non‐pneum walk boot prefab L4392 $17.46 Replace AFO soft interface L4394 $12.73 Replace foot drop spint L4396 $124.44 Static AFO L4398 $57.30 Foot drop splint recumbent L4631 $1,182.53 Afo, walk boot type, cus fab L5000 $421.89 Sho insert w arch toe filler L5010 $921.50 Mold socket ank hgt w/ toe f L5020 $1,500.01 Tibial tubercle hgt w/ toe f L5050 $1,737.09 Ank symes mold sckt sach ft L5060 $2,090.60 Symes met fr leath socket ar L5100 $1,809.58 Molded socket shin sach foot L5105 $2,872.19 Plast socket jts/thgh lacer L5150 $2,658.05 Mold sckt ext knee shin sach L5160 $2,891.10 Mold socket bent knee shin s L5200 $2,518.40 Kne sing axis fric shin sach L5210 $1,836.71 No knee/ankle joints w/ ft b L5220 $2,087.75 No knee joint with artic ali L5230 $2,879.43 Fem focal defic constant fri L5250 $3,927.29 Hip canad sing axi cons fric L5270 $3,892.88 Tilt table locking hip sing L5280 $3,853.95 Hemipelvect canad sing axis L5301 $1,737.89 BK mold socket SACH ft endo L5311 $2,496.67 Knee disart, SACH ft, endo L5321 $2,487.75 AK open end SACH L5331 $3,520.26 Hip disart canadian SACH ft L5341 $3,825.41 Hemipelvectomy canadian SACH L5400 $910.97 Postop dress & 1 cast chg bk L5410 $399.13 Postop dsg bk ea add cast ch L5420 $1,150.52 Postop dsg & 1 cast chg ak/d L5430 $507.85 Postop dsg ak ea add cast ch L5450 $324.89 Postop app non‐wgt bear dsg L5460 $478.85 Postop app non‐wgt bear dsg L5500 $972.12 Init bk ptb plaster direct L5505 $1,316.52 Init ak ischal plstr direct L5510 $1,101.97 Prep BK ptb plaster molded L5520 $1,088.48 Perp BK ptb thermopls direct L5530 $1,377.78 Prep BK ptb thermopls molded L5535 $1,357.81 Prep BK ptb open end socket L5540 $1,433.78 Prep BK ptb laminated socket L5560 $1,471.13 Prep AK ischial plast molded L5570 $1,529.45 Prep AK ischial direct form L5580 $1,785.52 Prep AK ischial thermo mold L5585 $1,936.61 Prep AK ischial open end L5590 $1,819.57 Prep AK ischial laminated L5595 $3,198.33 Hip disartic sach thermopls L5600 $3,488.48 Hip disart sach laminat mold L5610 $1,567.10 Above knee hydracadence L5611 $1,219.52 Ak 4 bar link w/fric swing L5613 $1,854.96 Ak 4 bar ling w/hydraul swig L5614 $1,253.88 4‐bar link above knee w/swng L5616 $1,028.01 Ak univ multiplex sys frict L5617 $415.74 AK/BK self‐aligning unit ea L5618 $239.50 Test socket symes L5620 $210.44 Test socket below knee L5622 $321.38 Test socket knee disarticula L5624 $306.62 Test socket above knee L5626 $431.00 Test socket hip disarticulat L5628 $408.22 Test socket hemipelvectomy L5629 $311.73 Below knee acrylic socket L5630 $339.70 Syme typ expandabl wall sckt L5631 $406.22 Ak/knee disartic acrylic soc L5632 $168.07 Symes type ptb brim design s L5634 $230.24 Symes type poster opening so L5636 $192.86 Symes type medial opening so L5637 $257.62 Below knee total contact L5638 $368.37 Below knee leather socket L5639 $864.14 Below knee wood socket L5640 $526.13 Knee disarticulat leather so L5642 $471.01 Above knee leather socket L5643 $1,178.09 Hip flex inner socket ext fr L5644 $447.06 Above knee wood socket L5645 $603.93 Bk flex inner socket ext fra L5646 $414.72 Below knee cushion socket L5647 $602.10 Below knee suction socket L5648 $498.33 Above knee cushion socket L5649 $1,512.87 Isch containmt/narrow m‐l so L5650 $369.51 Tot contact ak/knee disart s L5651 $908.99 Ak flex inner socket ext fra L5652 $329.99 Suction susp ak/knee disart L5653 $440.52 Knee disart expand wall sock L5654 $251.03 Socket insert symes L5655 $212.55 Socket insert below knee L5656 $299.40 Socket insert knee articulat L5658 $291.57 Socket insert above knee L5661 $506.68 Multi‐durometer symes L5665 $387.56 Multi‐durometer below knee L5666 $57.58 Below knee cuff suspension L5668 $76.89 Socket insert w/o lock lower L5670 $234.07 Bk molded supracondylar susp L5671 $376.50 BK/AK locking mechanism L5672 $286.03 Bk removable medial brim sus L5673 $531.79 Socket insert w lock mech L5676 $274.29 Bk knee joints single axis p L5677 $373.20 Bk knee joints polycentric p L5678 $30.06 Bk joint covers pair L5679 $443.13 Socket insert w/o lock mech L5680 $262.16 Bk thigh lacer non‐molded L5681 $977.41 Intl custm cong/latyp insert L5682 $473.37 Bk thigh lacer glut/ischia m L5683 $977.41 Initial custom socket insert L5684 $36.43 Bk fork strap L5685 $95.17 Below knee sus/seal sleeve L5686 $49.15 Bk back check L5688 $46.23 Bk waist belt webbing L5690 $89.53 Bk waist belt padded and lin L5692 $103.92 Ak pelvic control belt light L5694 $137.31 Ak pelvic control belt pad/l L5695 $144.05 Ak sleeve susp neoprene/equa L5696 $157.42 Ak/knee disartic pelvic join L5697 $63.94 Ak/knee disartic pelvic band L5698 $79.51 Ak/knee disartic silesian ba L5699 $141.13 Shoulder harness L5700 $2,180.61 Replace socket below knee L5701 $2,705.25 Replace socket above knee L5702 $3,409.55 Replace socket hip L5703 $1,583.36 Symes ankle w/o (SACH) foot L5704 $444.62 Custom shape cover BK L5705 $815.15 Custom shape cover AK L5706 $795.09 Custom shape cvr knee disart L5707 $1,068.17 Custom shape cvr hip disart L5710 $272.24 Kne‐shin exo sng axi mnl loc L5711 $412.96 Knee‐shin exo mnl lock ultra L5712 $326.15 Knee‐shin exo frict swg & st L5714 $336.34 Knee‐shin exo variable frict L5716 $551.67 Knee‐shin exo mech stance ph L5718 $689.53 Knee‐shin exo frct swg & sta L5722 $719.54 Knee‐shin pneum swg frct exo L5724 $1,142.49 Knee‐shin exo fluid swing ph L5726 $1,500.22 Knee‐shin ext jnts fld swg e L5728 $1,869.07 Knee‐shin fluid swg & stance L5780 $901.18 Knee‐shin pneum/hydra pneum L5781 $2,973.10 Lower limb pros vacuum pump L5782 $3,134.33 HD low limb pros vacuum pump L5785 $393.25 Exoskeletal bk ultralt mater L5790 $544.24 Exoskeletal ak ultra‐light m L5795 $812.69 Exoskel hip ultra‐light mate L5810 $378.07 Endoskel knee‐shin mnl lock L5811 $552.03 Endo knee‐shin mnl lck ultra L5812 $427.88 Endo knee‐shin frct swg & st L5814 $2,759.62 Endo knee‐shin hydral swg ph L5816 $643.71 Endo knee‐shin polyc mch sta L5818 $726.88 Endo knee‐shin frct swg & st L5822 $1,410.22 Endo knee‐shin pneum swg frc L5824 $1,160.78 Endo knee‐shin fluid swing p L5826 $2,343.72 Miniature knee joint L5828 $2,212.69 Endo knee‐shin fluid swg/sta L5830 $1,572.20 Endo knee‐shin pneum/swg pha L5840 $2,772.39 Multi‐axial knee/shin system L5845 $1,331.84 Knee‐shin sys stance flexion L5848 $799.03 Knee‐shin sys hydraul stance L5850 $100.54 Endo ak/hip knee extens assi L5855 $233.76 Mech hip extension assist L5856 $17,837.81 Elec knee‐shin swing/stance L5857 $6,329.54 Elec knee‐shin swing only L5858 $13,809.93 Stance phase only L5910 $276.08 Endo below knee alignable sy L5920 $401.61 Endo ak/hip alignable system L5925 $254.33 Above knee manual lock L5930 $2,501.08 High activity knee frame L5940 $379.67 Endo bk ultra‐light material L5950 $641.41 Endo ak ultra‐light material L5960 $768.30 Endo hip ultra‐light materia L5961 $0.00 Endo poly hip, pneu/hyd/rot L5962 $444.91 Below knee flex cover system L5964 $796.93 Above knee flex cover system L5966 $1,026.56 Hip flexible cover system L5968 $2,700.22 Multiaxial ankle w dorsiflex L5970 $166.17 Foot external keel sach foot L5971 $166.17 SACH foot, replacement L5972 $266.76 Flexible keel foot L5973 $13,008.99 Ank‐foot sys dors‐plant flex L5974 $225.06 Foot single axis ankle/foot L5975 $344.48 Combo ankle/foot prosthesis L5976 $423.89 Energy storing foot L5978 $220.89 Ft prosth multiaxial ankl/ft L5979 $1,772.48 Multi‐axial ankle/ft prosth L5980 $2,806.41 Flex foot system L5981 $2,425.77 Flex‐walk sys low ext prosth L5982 $437.58 Exoskeletal axial rotation u L5984 $433.70 Endoskeletal axial rotation L5985 $209.83 Lwr ext dynamic prosth pylon L5986 $482.19 Multi‐axial rotation unit L5987 $5,345.37 Shank ft w vert load pylon L5988 $1,484.42 Vertical shock reducing pylo L5990 $1,348.07 User adjustable heel height L6000 $1,005.70 Par hand robin‐aids thum rem L6010 $1,119.18 Hand robin‐aids little/ring L6020 $1,043.46 Part hand robin‐aids no fing L6025 $5,946.26 Part hand disart myoelectric L6050 $1,437.84 Wrst MLd sck flx hng tri pad L6055 $2,285.52 Wrst mold sock w/exp interfa L6100 $1,456.76 Elb mold sock flex hinge pad L6110 $1,545.14 Elbow mold sock suspension t L6120 $1,800.64 Elbow mold doub splt soc ste L6130 $1,959.43 Elbow stump activated lock h L6200 $2,064.92 Elbow mold outsid lock hinge L6205 $3,440.98 Elbow molded w/ expand inter L6250 $2,032.57 Elbow inter loc elbow forarm L6300 $2,819.97 Shlder disart int lock elbow L6310 $2,319.06 Shoulder passive restor comp L6320 $1,293.52 Shoulder passive restor cap L6350 $2,964.77 Thoracic intern lock elbow L6360 $2,433.90 Thoracic passive restor comp L6370 $1,832.35 Thoracic passive restor cap L6380 $989.64 Postop dsg cast chg wrst/elb L6382 $1,184.23 Postop dsg cast chg elb dis/ L6384 $1,445.09 Postop dsg cast chg shlder/t L6386 $346.55 Postop ea cast chg & realign L6388 $332.76 Postop applicat rigid dsg on L6400 $1,760.04 Below elbow prosth tiss shap L6450 $2,333.63 Elb disart prosth tiss shap L6500 $2,335.54 Above elbow prosth tiss shap L6550 $2,886.30 Shldr disar prosth tiss shap L6570 $3,502.07 Scap thorac prosth tiss shap L6580 $1,222.44 Wrist/elbow bowden cable mol L6582 $1,041.74 Wrist/elbow bowden cbl dir f L6584 $1,687.44 Elbow fair lead cable molded L6586 $1,476.16 Elbow fair lead cable dir fo L6588 $2,436.81 Shdr fair lead cable molded L6590 $2,228.98 Shdr fair lead cable direct L6600 $150.39 Polycentric hinge pair L6605 $140.40 Single pivot hinge pair L6610 $126.02 Flexible metal hinge pair L6611 $305.94 Additional switch, ext power L6615 $155.38 Disconnect locking wrist uni L6616 $65.46 Disconnect insert locking wr L6620 $243.88 Flexion/extension wrist unit L6621 $1,699.61 Flex/ext wrist w/wo friction L6623 $558.23 Spring‐ass rot wrst w/ latch L6624 $2,798.44 Flex/ext/rotation wrist unit L6625 $406.21 Rotation wrst w/ cable lock L6628 $415.10 Quick disconn hook adapter o L6629 $110.74 Lamination collar w/ couplin L6630 $163.13 Stainless steel any wrist L6632 $54.41 Latex suspension sleeve each L6635 $151.09 Lift assist for elbow L6637 $313.65 Nudge control elbow lock L6638 $1,858.21 Elec lock on manual pw elbow L6640 $214.04 Shoulder abduction joint pai L6641 $142.25 Excursion amplifier pulley t L6642 $202.53 Excursion amplifier lever ty L6645 $245.96 Shoulder flexion‐abduction j L6646 $2,343.61 Multipo locking shoulder jnt L6647 $385.82 Shoulder lock actuator L6648 $2,417.10 Ext pwrd shlder lock/unlock L6650 $256.21 Shoulder universal joint L6655 $56.86 Standard control cable extra L6660 $69.48 Heavy duty control cable L6665 $39.72 Teflon or equal cable lining L6670 $37.66 Hook to hand cable adapter L6672 $127.63 Harness chest/shlder saddle L6675 $90.90 Harness figure of 8 sing con L6676 $91.80 Harness figure of 8 dual con L6677 $220.42 UE triple control harness L6680 $175.61 Test sock wrist disart/bel e L6682 $196.82 Test sock elbw disart/above L6684 $263.84 Test socket shldr disart/tho L6686 $490.64 Suction socket L6687 $436.60 Frame typ socket bel elbow/w L6688 $422.33 Frame typ sock above elb/dis L6689 $510.01 Frame typ socket shoulder di L6690 $552.30 Frame typ sock interscap‐tho L6691 $330.30 Removable insert each L6692 $423.29 Silicone gel insert or equal L6693 $2,109.56 Lockingelbow forearm cntrbal L6694 $531.79 Elbow socket ins use w/lock L6695 $443.13 Elbow socket ins use w/o lck L6696 $977.41 Cus elbo skt in for con/atyp L6697 $977.41 Cus elbo skt in not con/atyp L6698 $376.50 Below/above elbow lock mech L6703 $267.69 Term dev, passive hand mitt L6704 $443.28 Term dev, sport/rec/work att L6706 $264.10 Term dev mech hook vol open L6707 $1,113.08 Term dev mech hook vol close L6708 $633.13 Term dev mech hand vol open L6709 $1,024.69 Term dev mech hand vol close L6711 $499.56 Ped term dev, hook, vol open L6712 $919.80 Ped term dev, hook, vol clos L6713 $1,160.90 Ped term dev, hand, vol open L6714 $983.26 Ped term dev, hand, vol clos L6721 $1,747.65 Hook/hand, hvy dty, vol open L6722 $1,506.61 Hook/hand, hvy dty, vol clos L6805 $272.46 Term dev modifier wrist unit L6810 $148.52 Term dev precision pinch dev L6881 $3,037.82 Term dev auto grasp feature L6882 $2,304.31 Microprocessor control uplmb L6883 $1,201.13 Replc sockt below e/w disa L6884 $1,689.82 Replc sockt above elbow disa L6885 $2,433.90 Replc sockt shldr dis/interc L6890 $128.74 Prefab glove for term device L6895 $468.57 Custom glove for term device L6900 $1,216.08 Hand restorat thumb/1 finger L6905 $1,193.86 Hand restoration multiple fi L6910 $1,225.58 Hand restoration no fingers L6915 $473.84 Hand restoration replacmnt g L6920 $5,834.46 Wrist disarticul switch ctrl L6925 $6,396.26 Wrist disart myoelectronic c L6930 $5,519.55 Below elbow switch control L6935 $6,531.43 Below elbow myoelectronic ct L6940 $7,195.73 Elbow disarticulation switch L6945 $8,048.28 Elbow disart myoelectronic c L6950 $7,625.94 Above elbow switch control L6955 $9,274.61 Above elbow myoelectronic ct L6960 $9,846.42 Shldr disartic switch contro L6965 $11,279.03 Shldr disartic myoelectronic L6970 $12,122.71 Interscapular‐thor switch ct L6975 $13,383.64 Interscap‐thor myoelectronic L7007 $2,745.35 Adult electric hand L7008 $4,637.90 Pediatric electric hand L7009 $2,807.44 Adult electric hook L7040 $2,201.89 Prehensile actuator L7045 $1,223.43 Pediatric electric hook L7170 $4,438.17 Electronic elbow hosmer swit L7180 $26,428.10 Electronic elbow sequential L7181 $29,773.03 Electronic elbo simultaneous L7185 $4,543.95 Electron elbow adolescent sw L7186 $6,938.97 Electron elbow child switch L7190 $5,916.04 Elbow adolescent myoelectron L7191 $7,473.85 Elbow child myoelectronic ct L7260 $1,924.60 Electron wrist rotator otto L7261 $3,543.88 Electron wrist rotator utah L7266 $749.41 Servo control steeper or equ L7272 $1,670.39 Analogue control unb or equa L7274 $5,349.82 Proportional ctl 12 volt uta L7360 $226.16 Six volt bat otto bock/eq ea L7362 $203.75 Battery chrgr six volt otto L7364 $376.62 Twelve volt battery utah/equ L7366 $507.39 Battery chrgr 12 volt utah/e L7367 $289.30 Replacemnt lithium ionbatter L7368 $375.02 Lithium ion battery charger L7400 $227.74 Add UE prost be/wd, ultlite L7401 $254.96 Add UE prost a/e ultlite mat L7402 $275.33 Add UE prost s/d ultlite mat L7403 $273.64 Add UE prost b/e acrylic L7404 $413.00 Add UE prost a/e acrylic L7405 $540.15 Add UE prost s/d acrylic L7900 $390.42 Male vacuum erection system L8000 $27.64 Mastectomy bra L8001 $93.20 Breast prosthesis bra & form L8002 $122.58 Brst prsth bra & bilat form L8015 $44.55 Ext breastprosthesis garment L8020 $189.36 Mastectomy form L8030 $245.10 Breast prosthes w/o adhesive L8031 $245.10 Breast prosthesis w adhesive L8032 $29.11 Reusable nipple prosthesis L8035 $2,722.31 Custom breast prosthesis L8040 $1,893.92 Nasal prosthesis L8040 KM $1,799.23 Nasal prosthesis L8040 KN $757.56 Nasal prosthesis L8041 $2,282.80 Midfacial prosthesis L8041 KM $2,168.66 Midfacial prosthesis L8041 KN $913.13 Midfacial prosthesis L8042 $2,564.94 Orbital prosthesis L8042 KM $2,436.69 Orbital prosthesis L8042 KN $1,025.98 Orbital prosthesis L8043 $2,872.77 Upper facial prosthesis L8043 KM $2,729.12 Upper facial prosthesis L8043 KN $1,149.10 Upper facial prosthesis L8044 $3,180.53 Hemi‐facial prosthesis L8044 KM $3,021.51 Hemi‐facial prosthesis L8044 KN $1,272.21 Hemi‐facial prosthesis L8045 $2,220.27 Auricular prosthesis L8045 KM $2,109.27 Auricular prosthesis L8045 KN $888.12 Auricular prosthesis L8046 $2,051.95 Partial facial prosthesis L8046 KM $1,949.36 Partial facial prosthesis L8046 KN $820.78 Partial facial prosthesis L8047 $1,051.63 Nasal septal prosthesis L8047 KM $999.06 Nasal septal prosthesis L8047 KN $420.65 Nasal septal prosthesis L8300 $63.85 Truss single w/ standard pad L8310 $100.81 Truss double w/ standard pad L8320 $45.19 Truss addition to std pad wa L8330 $37.37 Truss add to std pad scrotal L8400 $13.15 Sheath below knee L8410 $17.56 Sheath above knee L8415 $17.27 Sheath upper limb L8417 $55.83 Pros sheath/sock w gel cushn L8420 $15.51 Prosthetic sock multi ply BK L8430 $16.76 Prosthetic sock multi ply AK L8435 $15.92 Pros sock multi ply upper lm L8440 $31.65 Shrinker below knee L8460 $50.44 Shrinker above knee L8465 $44.65 Shrinker upper limb L8470 $5.05 Pros sock single ply BK L8480 $6.96 Pros sock single ply AK L8485 $8.74 Pros sock single ply upper l L8500 $666.04 Artificial larynx L8501 $91.43 Tracheostomy speaking valve L8507 $31.13 Trach‐esoph voice pros pt in L8509 $81.15 Trach‐esoph voice pros md in L8510 $187.76 Voice amplifier L8511 $54.05 Indwelling trach insert L8512 $1.60 Gel cap for trach voice pros L8513 $3.86 Trach pros cleaning device L8514 $70.07 Repl trach puncture dilator L8515 $46.90 Gel cap app device for trach L8600 $473.76 Implant breast silicone/eq L8603 $331.45 Collagen imp urinary 2.5 ml L8606 $164.99 Synthetic implnt urinary 1ml L8609 $4,841.37 Artificial cornea L8610 $445.33 Ocular implant L8612 $467.67 Aqueous shunt prosthesis L8613 $231.72 Ossicular implant L8614 $14,759.75 Cochlear device L8615 $335.13 Coch implant headset replace L8616 $78.06 Coch implant microphone repl L8617 $68.17 Coch implant trans coil repl L8618 $19.49 Coch implant tran cable repl L8619 $6,336.25 Coch imp ext proc/contr rplc L8621 $0.46 Repl zinc air battery L8622 $0.24 Repl alkaline battery L8623 $48.06 Lith ion batt CID,non‐earlvl L8624 $119.83 Lith ion batt CID, ear level L8627 $5,413.21 CID ext speech process repl L8628 $923.04 CID ext controller repl L8629 $133.05 CID transmit coil and cable L8630 $255.01 Metacarpophalangeal implant L8631 $1,613.12 MCP joint repl 2 pc or more L8641 $264.95 Metatarsal joint implant L8642 $247.40 Hallux implant L8658 $249.25 Interphalangeal joint spacer L8659 $1,433.88 Interphalangeal joint repl L8670 $421.34 Vascular graft, synthetic L8680 $342.75 Implt neurostim elctr each L8681 $816.56 Pt prgrm for implt neurostim L8682 $4,448.30 Implt neurostim radiofq rec L8683 $3,915.52 Radiofq trsmtr for implt neu L8684 $601.06 Radiof trsmtr implt scrl neu L8685 $9,757.26 Implt nrostm pls gen sng rec L8686 $6,225.91 Implt nrostm pls gen sng non L8687 $12,698.10 Implt nrostm pls gen dua rec L8688 $8,102.40 Implt nrostm pls gen dua non L8689 $1,281.74 External recharg sys intern L8690 $3,534.87 Aud osseo dev, int/ext comp L8691 $1,981.41 Osseointegrated snd proc rpl L8693 $1,126.72 Aud osseo dev, abutment L8695 $12.37 External recharg sys extern Q0478 $136.55 Power adapter, combo vad Q0479 $8,974.48 Power module combo vad, rep Q0480 $66,923.44 Driver pneumatic vad, rep Q0481 $10,797.31 Microprcsr cu elec vad, rep Q0482 $3,381.92 Microprcsr cu combo vad, rep Q0483 $13,932.01 Monitor elec vad, rep Q0484 $2,705.56 Monitor elec or comb vad rep Q0485 $261.21 Monitor cable elec vad, rep Q0486 $217.42 Mon cable elec/pneum vad rep Q0487 $253.65 Leads any type vad, rep only Q0489 $12,078.30 Pwr pck base combo vad, rep Q0490 $522.45 Emr pwr source elec vad, rep Q0491 $821.35 Emr pwr source combo vad rep Q0492 $66.16 Emr pwr cbl elec vad, rep Q0493 $188.42 Emr pwr cbl combo vad, rep Q0494 $159.44 Emr hd pmp elec/combo, rep Q0495 $3,103.81 Charger elec/combo vad, rep Q0496 $1,114.01 Battery elec/combo vad, rep Q0497 $347.86 Bat clps elec/comb vad, rep Q0498 $381.68 Holster elec/combo vad, rep Q0499 $124.01 Belt/vest elec/combo vad rep Q0500 $22.69 Filters elec/combo vad, rep Q0501 $379.48 Shwr cov elec/combo vad, rep Q0502 $483.13 Mobility cart pneum vad, rep Q0503 $966.26 Battery pneum vad replacemnt Q0504 $509.87 Pwr adpt pneum vad, rep veh Q0506 $634.68 Lith‐ion batt elec/pneum VAD V2020 $47.46 Vision svcs frames purchases V2100 $36.41 Lens spher single plano 4.00 V2101 $38.17 Single visn sphere 4.12‐7.00 V2102 $56.23 Singl visn sphere 7.12‐20.00 V2103 $34.33 Spherocylindr 4.00d/12‐2.00d V2104 $37.20 Spherocylindr 4.00d/2.12‐4d V2105 $41.39 Spherocylinder 4.00d/4.25‐6d V2106 $45.92 Spherocylinder 4.00d/>6.00d V2107 $42.58 Spherocylinder 4.25d/12‐2d V2108 $45.23 Spherocylinder 4.25d/2.12‐4d V2109 $50.04 Spherocylinder 4.25d/4.25‐6d V2110 $49.38 Spherocylinder 4.25d/over 6d V2111 $50.63 Spherocylindr 7.25d/.25‐2.25 V2112 $56.17 Spherocylindr 7.25d/2.25‐4d V2113 $58.53 Spherocylindr 7.25d/4.25‐6d V2114 $68.59 Spherocylinder over 12.00d V2115 $60.72 Lens lenticular bifocal V2118 $74.01 Lens aniseikonic single V2121 $59.89 Lenticular lens, single V2200 $50.17 Lens spher bifoc plano 4.00d V2201 $54.93 Lens sphere bifocal 4.12‐7.0 V2202 $66.36 Lens sphere bifocal 7.12‐20. V2203 $51.77 Lens sphcyl bifocal 4.00d/.1 V2204 $54.57 Lens sphcy bifocal 4.00d/2.1 V2205 $59.00 Lens sphcy bifocal 4.00d/4.2 V2206 $63.39 Lens sphcy bifocal 4.00d/ove V2207 $56.02 Lens sphcy bifocal 4.25‐7d/. V2208 $60.09 Lens sphcy bifocal 4.25‐7/2. V2209 $64.28 Lens sphcy bifocal 4.25‐7/4. V2210 $71.87 Lens sphcy bifocal 4.25‐7/ov V2211 $66.49 Lens sphcy bifo 7.25‐12/.25‐ V2212 $69.28 Lens sphcyl bifo 7.25‐12/2.2 V2213 $65.49 Lens sphcyl bifo 7.25‐12/4.2 V2214 $84.50 Lens sphcyl bifocal over 12. V2215 $71.93 Lens lenticular bifocal V2218 $102.08 Lens aniseikonic bifocal V2219 $44.94 Lens bifocal seg width over V2220 $36.45 Lens bifocal add over 3.25d V2221 $71.72 Lenticular lens, bifocal V2300 $59.96 Lens sphere trifocal 4.00d V2301 $70.27 Lens sphere trifocal 4.12‐7. V2302 $82.76 Lens sphere trifocal 7.12‐20 V2303 $54.93 Lens sphcy trifocal 4.0/.12‐ V2304 $64.21 Lens sphcy trifocal 4.0/2.25 V2305 $74.37 Lens sphcy trifocal 4.0/4.25 V2306 $78.95 Lens sphcyl trifocal 4.00/>6 V2307 $72.85 Lens sphcy trifocal 4.25‐7/. V2308 $75.73 Lens sphc trifocal 4.25‐7/2. V2309 $79.16 Lens sphc trifocal 4.25‐7/4. V2310 $83.98 Lens sphc trifocal 4.25‐7/>6 V2311 $75.84 Lens sphc trifo 7.25‐12/.25‐ V2312 $76.30 Lens sphc trifo 7.25‐12/2.25 V2313 $79.14 Lens sphc trifo 7.25‐12/4.25 V2314 $101.67 Lens sphcyl trifocal over 12 V2315 $90.32 Lens lenticular trifocal V2318 $141.30 Lens aniseikonic trifocal V2319 $50.11 Lens trifocal seg width > 28 V2320 $52.87 Lens trifocal add over 3.25d V2321 $89.02 Lenticular lens, trifocal V2410 $78.80 Lens variab asphericity sing V2430 $88.04 Lens variable asphericity bi V2500 $82.03 Contact lens pmma spherical V2501 $111.50 Cntct lens pmma‐toric/prism V2502 $146.75 Contact lens pmma bifocal V2503 $141.48 Cntct lens pmma color vision V2510 $110.91 Cntct gas permeable sphericl V2511 $143.79 Cntct toric prism ballast V2512 $176.93 Cntct lens gas permbl bifocl V2513 $144.19 Contact lens extended wear V2520 $102.75 Contact lens hydrophilic V2521 $162.13 Cntct lens hydrophilic toric V2522 $144.66 Cntct lens hydrophil bifocl V2523 $142.97 Cntct lens hydrophil extend V2530 $193.13 Contact lens gas impermeable V2531 $402.35 Contact lens gas permeable V2623 $679.43 Plastic eye prosth custom V2624 $61.44 Polishing artifical eye V2625 $280.15 Enlargemnt of eye prosthesis V2626 $151.02 Reduction of eye prosthesis V2627 $975.31 Scleral cover shell V2628 $230.29 Fabrication & fitting V2700 $40.75 Balance lens V2710 $56.92 Glass/plastic slab off prism V2715 $9.32 Prism lens/es V2718 $22.40 Fresnell prism press‐on lens V2730 $15.96 Special base curve V2744 $12.42 Tint photochromatic lens/es V2745 $8.82 Tint, any color/solid/grad V2750 $16.46 Anti‐reflective coating V2755 $12.57 UV lens/es V2760 $15.56 Scratch resistant coating V2762 $44.28 Polarization, any lens V2770 $14.77 Occluder lens/es V2780 $9.48 Oversize lens/es V2782 $47.83 Lens, 1.54‐1.65 p/1.60‐1.79g V2783 $53.94 Lens, >= 1.66 p/>=1.80 g V2784 $35.08 Lens polycarb or equal V2786 $0.00 Occupational multifocal lens