HCPCS|Mod|Mod2|JURIS|CATG|Ceiling|Floor|GA|Description A4216|||D|OS|0.48|0.41|0.48|Sterile water/saline| 10 ml A4217|||D|SU|3.43|2.92|3.43|Sterile water/saline| 500 ml A4217|AU||D|OS|3.43|2.92|3.43|Sterile water/saline| 500 ml A4221|||D|SU|24.76|21.05|24.76|Maint drug infus cath per wk A4222|||D|SU|51.11|43.44|51.11|Infusion supplies with pump A4233|NU||D|IN|0|0|0.58|Alkalin batt for glucose mon A4233|NU|KL|D|IN|0.76|0.65|0.76|Alkalin batt for glucose mon A4234|NU||D|IN|0|0|2.5|J-cell batt for glucose mon A4234|NU|KL|D|IN|3.43|2.92|3.43|J-cell batt for glucose mon A4235|NU||D|IN|0|0|1.06|Lithium batt for glucose mon A4235|NU|KL|D|IN|2.21|1.88|2.21|Lithium batt for glucose mon A4236|NU||D|IN|0|0|1.19|Silvr oxide batt glucose mon A4236|NU|KL|D|IN|1.59|1.35|1.59|Silvr oxide batt glucose mon A4253|NU||D|IN|0|0|10.41|Blood glucose/reagent strips A4253|NU|KL|D|IN|0|0|33.46|Blood glucose/reagent strips A4255|||D|SU|4.5|3.83|4.42|Glucose monitor platforms A4256|||D|SU|0|0|4|Calibrator solution/chips A4256|KL||D|SU|10.78|9.16|9.16|Calibrator solution/chips A4257|||D|SU|13.95|11.86|13.95|Replace lensshield cartridge A4258|||D|SU|0|0|2.52|Lancet device each A4258|KL||D|SU|17.01|14.46|17.01|Lancet device each A4259|||D|SU|0|0|1.65|Lancets per box A4259|KL||D|SU|0|0|11.36|Lancets per box A4265|||D|SU|3.72|3.16|3.72|Paraffin A4280|||D|PO|6.96|5.22|5.83|Brst prsths adhsv attchmnt A4310|||D|OS|8.44|7.17|7.59|Insert tray w/o bag/cath A4311|||D|OS|16.22|13.79|16.22|Catheter w/o bag 2-way latex A4312|||D|OS|19.72|16.76|16.76|Cath w/o bag 2-way silicone A4313|||D|OS|20.26|17.22|17.22|Catheter w/bag 3-way A4314|||D|OS|27.65|23.5|25.52|Cath w/drainage 2-way latex A4315|||D|OS|28.86|24.53|24.53|Cath w/drainage 2-way silcne A4316|||D|OS|31.05|26.39|31.05|Cath w/drainage 3-way A4320|||D|OS|5.83|4.96|5.16|Irrigation tray A4321|||D|OS|0|0|0|Cath therapeutic irrig agent A4322|||D|OS|3.33|2.83|3.24|Irrigation syringe A4326|||D|OS|11.8|10.03|11.8|Male external catheter A4327|||D|OS|48.78|41.46|48.78|Fem urinary collect dev cup A4328|||D|OS|11.42|9.71|11.19|Fem urinary collect pouch A4330|||D|OS|7.82|6.65|7.82|Stool collection pouch A4331|||D|OS|3.48|2.96|3.48|Extension drainage tubing A4332|||D|OS|0.13|0.11|0.13|Lube sterile packet A4333|||D|OS|2.41|2.05|2.41|Urinary cath anchor device A4334|||D|OS|5.38|4.57|5.38|Urinary cath leg strap A4336|||D|OS|1.58|1.34|1.58|Urethral insert A4338|||D|OS|13.41|11.4|11.4|Indwelling catheter latex A4340|||D|OS|34.72|29.51|29.65|Indwelling catheter special A4344|||D|OS|17.51|14.88|14.88|Cath indw foley 2 way silicn A4346|||D|OS|21.42|18.21|18.21|Cath indw foley 3 way A4349|||D|OS|2.21|1.88|2.21|Disposable male external cat A4351|||D|OS|1.99|1.69|1.98|Straight tip urine catheter A4352|||D|OS|7.02|5.97|6.9|Coude tip urinary catheter A4353|||D|OS|7.66|6.51|7.66|Intermittent urinary cath A4354|||D|OS|12.91|10.97|10.97|Cath insertion tray w/bag A4355|||D|OS|9.75|8.29|8.89|Bladder irrigation tubing A4356|||D|OS|49.89|42.41|49.89|Ext ureth clmp or compr dvc A4357|||D|OS|10.61|9.02|9.02|Bedside drainage bag A4358|||D|OS|7.25|6.16|7.09|Urinary leg or abdomen bag A4360|||D|OS|0.53|0.45|0.53|Disposable ext urethral dev A4361|||D|OS|20.09|17.08|17.64|Ostomy face plate A4362|||D|OS|3.79|3.22|3.22|Solid skin barrier A4363|||D|OS|2.59|2.2|2.2|Ostomy clamp| replacement A4364|||D|OS|3.21|2.73|2.73|Adhesive| liquid or equal A4366|||D|OS|1.42|1.21|1.42|Ostomy vent A4367|||D|OS|8.04|6.83|7.37|Ostomy belt A4368|||D|OS|0.28|0.24|0.28|Ostomy filter A4369|||D|OS|2.65|2.25|2.65|Skin barrier liquid per oz A4371|||D|OS|3.99|3.39|3.99|Skin barrier powder per oz A4372|||D|OS|4.59|3.9|4.59|Skin barrier solid 4x4 equiv A4373|||D|OS|6.86|5.83|6.86|Skin barrier with flange A4375|||D|OS|18.79|15.97|18.79|Drainable plastic pch w fcpl A4376|||D|OS|52.04|44.23|52.04|Drainable rubber pch w fcplt A4377|||D|OS|4.7|4|4.7|Drainable plstic pch w/o fp A4378|||D|OS|33.62|28.58|33.62|Drainable rubber pch w/o fp A4379|||D|OS|16.42|13.96|16.42|Urinary plastic pouch w fcpl A4380|||D|OS|40.82|34.7|40.82|Urinary rubber pouch w fcplt A4381|||D|OS|5.05|4.29|5.05|Urinary plastic pouch w/o fp A4382|||D|OS|26.92|22.88|26.92|Urinary hvy plstc pch w/o fp A4383|||D|OS|30.83|26.21|30.83|Urinary rubber pouch w/o fp A4384|||D|OS|10.51|8.93|10.51|Ostomy faceplt/silicone ring A4385|||D|OS|5.58|4.74|5.58|Ost skn barrier sld ext wear A4387|||D|OS|2.45|2.08|2.45|Ost clsd pouch w att st barr A4388|||D|OS|4.78|4.06|4.78|Drainable pch w ex wear barr A4389|||D|OS|6.8|5.78|6.8|Drainable pch w st wear barr A4390|||D|OS|10.5|8.93|10.5|Drainable pch ex wear convex A4391|||D|OS|7.73|6.57|7.73|Urinary pouch w ex wear barr A4392|||D|OS|8.95|7.61|8.95|Urinary pouch w st wear barr A4393|||D|OS|9.89|8.41|9.89|Urine pch w ex wear bar conv A4394|||D|OS|2.83|2.41|2.83|Ostomy pouch liq deodorant A4395|||D|OS|0.05|0.04|0.05|Ostomy pouch solid deodorant A4396|||D|OS|44.27|37.63|44.27|Peristomal hernia supprt blt A4397|||D|OS|5.23|4.45|4.83|Irrigation supply sleeve A4398|||D|OS|15.11|12.84|13.85|Ostomy irrigation bag A4399|||D|OS|13.41|11.4|11.65|Ostomy irrig cone/cath w brs A4400|||D|OS|53.44|45.42|45.42|Ostomy irrigation set A4402|||D|OS|1.75|1.49|1.49|Lubricant per ounce A4404|||D|OS|1.84|1.56|1.84|Ostomy ring each A4405|||D|OS|3.73|3.17|3.73|Nonpectin based ostomy paste A4406|||D|OS|6.27|5.33|6.27|Pectin based ostomy paste A4407|||D|OS|9.58|8.14|9.58|Ext wear ost skn barr <=4sq A4408|||D|OS|10.79|9.17|10.79|Ext wear ost skn barr >4sq A4409|||D|OS|6.8|5.78|6.8|Ost skn barr convex <=4 sq i A4410|||D|OS|9.89|8.41|9.89|Ost skn barr extnd >4 sq A4411|||D|OS|5.58|4.74|5.58|Ost skn barr extnd =4sq A4412|||D|OS|2.96|2.52|2.96|Ost pouch drain high output A4413|||D|OS|6.02|5.12|6.02|2 pc drainable ost pouch A4414|||D|OS|5.38|4.57|5.38|Ost sknbar w/o conv<=4 sq in A4415|||D|OS|6.55|5.57|6.55|Ost skn barr w/o conv >4 sqi A4416|||D|OS|3.01|2.56|3.01|Ost pch clsd w barrier/filtr A4417|||D|OS|4.07|3.46|4.07|Ost pch w bar/bltinconv/fltr A4418|||D|OS|1.99|1.69|1.99|Ost pch clsd w/o bar w filtr A4419|||D|OS|1.9|1.62|1.9|Ost pch for bar w flange/flt A4420|||D|OS|0|0|0|Ost pch clsd for bar w lk fl A4422|||D|OS|0.13|0.11|0.13|Ost pouch absorbent material A4423|||D|OS|2.04|1.73|2.04|Ost pch for bar w lk fl/fltr A4424|||D|OS|5.2|4.42|5.2|Ost pch drain w bar & filter A4425|||D|OS|3.92|3.33|3.92|Ost pch drain for barrier fl A4426|||D|OS|2.99|2.54|2.99|Ost pch drain 2 piece system A4427|||D|OS|3.04|2.58|3.04|Ost pch drain/barr lk flng/f A4428|||D|OS|7.12|6.05|7.12|Urine ost pouch w faucet/tap A4429|||D|OS|9.02|7.67|9.02|Urine ost pouch w bltinconv A4430|||D|OS|9.31|7.91|9.31|Ost urine pch w b/bltin conv A4431|||D|OS|6.8|5.78|6.8|Ost pch urine w barrier/tapv A4432|||D|OS|3.93|3.34|3.93|Os pch urine w bar/fange/tap A4433|||D|OS|3.66|3.11|3.66|Urine ost pch bar w lock fln A4434|||D|OS|4.11|3.49|4.11|Ost pch urine w lock flng/ft A4435|||D|OS|6.32|5.37|6.32|1pc ost pch drain hgh output A4450|AU||D|OS|0.09|0.08|0.09|Non-waterproof tape A4450|AV||D|OS|0.09|0.08|0.09|Non-waterproof tape A4450|AW||D|OS|0.12|0.1|0.12|Non-waterproof tape A4452|AU||D|OS|0.39|0.33|0.39|Waterproof tape A4452|AV||D|OS|0.39|0.33|0.39|Waterproof tape A4452|AW||D|OS|0.43|0.37|0.43|Waterproof tape A4455|||D|OS|1.57|1.33|1.57|Adhesive remover per ounce A4456|||D|OS|0.27|0.23|0.27|Adhesive remover| wipes A4461|||D|SD|3.6|3.06|3.6|Surgicl dress hold non-reuse A4463|||D|SD|14.56|12.38|14.56|Surgical dress holder reuse A4481|||D|OS|0.41|0.35|0.41|Tracheostoma filter A4483|||D|OS|0|0|0|Moisture exchanger A4556|||D|SU|13.28|11.29|13.28|Electrodes| pair A4557|||D|SU|23.08|19.62|23.08|Lead wires| pair A4558|||D|SU|5.96|5.07|5.96|Conductive gel or paste A4559|||D|SU|0.11|0.09|0.11|Coupling gel or paste A4561|||L|PO|26.65|19.99|22.52|Pessary rubber| any type A4562|||L|PO|66.31|49.73|55.97|Pessary| non rubber|any type A4565|||L||0|0|8.41|Slings A4595|||D|SU|31.51|26.78|31.51|Tens suppl 2 lead per month A4604|NU||D|IN|62.96|53.52|62.96|Tubing with heating element A4605|NU||D|IN|17.93|15.24|17.93|Trach suction cath close sys A4608|||D|OX|54.81|46.59|54.81|Transtracheal oxygen cath A4614|||D|IN|26.01|22.11|26.01|Hand-held pefr meter A4615|||D|SU|0.79|0.67|0.79|Cannula nasal A4616|||D|SU|0.07|0.06|0.07|Tubing (oxygen) per foot A4617|||D|SU|3.39|2.88|3.39|Mouth piece A4618|NU||D|IN|9.72|8.26|8.95|Breathing circuits A4618|RR||D|IN|1.12|0.95|0.95|Breathing circuits A4618|UE||D|IN|7.29|6.2|6.75|Breathing circuits A4619|NU||D|IN|2.03|1.73|2.03|Face tent A4620|||D|SU|0.69|0.59|0.69|Variable concentration mask A4623|||D|OS|7.16|6.09|6.85|Tracheostomy inner cannula A4624|NU||D|IN|2.88|2.45|2.88|Tracheal suction tube A4625|||D|OS|7.58|6.44|7.58|Trach care kit for new trach A4626|||D|OS|3.49|2.97|3.49|Tracheostomy cleaning brush A4628|NU||D|IN|4.09|3.48|4.09|Oropharyngeal suction cath A4629|||D|OS|5.07|4.31|5.07|Tracheostomy care kit A4630|NU||D|IN|6.83|5.81|5.81|Repl bat t.e.n.s. own by pt A4633|NU||D|IN|44.87|38.14|44.87|Uvl replacement bulb A4635|NU||D|IN|5.6|4.76|4.76|Underarm crutch pad A4635|RR||D|IN|0.76|0.65|0.65|Underarm crutch pad A4635|UE||D|IN|3.72|3.16|3.16|Underarm crutch pad A4636|NU||D|IN|3.97|3.37|3.37|Handgrip for cane etc A4636|NU|KE|D|IN|4.62|3.93|3.93|Handgrip for cane etc A4636|RR||D|IN|0.4|0.34|0.34|Handgrip for cane etc A4636|RR|KE|D|IN|0.46|0.39|0.39|Handgrip for cane etc A4636|UE||D|IN|2.9|2.47|2.47|Handgrip for cane etc A4636|UE|KE|D|IN|3.36|2.86|2.86|Handgrip for cane etc A4637|NU||D|IN|2.02|1.72|1.72|Repl tip cane/crutch/walker A4637|NU|KE|D|IN|2.33|1.98|1.98|Repl tip cane/crutch/walker A4637|RR||D|IN|0.28|0.24|0.24|Repl tip cane/crutch/walker A4637|RR|KE|D|IN|0.33|0.28|0.28|Repl tip cane/crutch/walker A4637|UE||D|IN|1.53|1.3|1.3|Repl tip cane/crutch/walker A4637|UE|KE|D|IN|1.76|1.5|1.5|Repl tip cane/crutch/walker A4638|NU||D|IN|0|0|0|Repl batt pulse gen sys A4638|RR||D|IN|0|0|0|Repl batt pulse gen sys A4638|UE||D|IN|0|0|0|Repl batt pulse gen sys A4639|RR||D|CR|31.42|26.71|31.42|Infrared ht sys replcmnt pad A4640|NU||D|IN|69.24|58.85|69.24|Alternating pressure pad A4640|RR||D|IN|7.05|5.99|7.05|Alternating pressure pad A4640|UE||D|IN|49.06|41.7|49.06|Alternating pressure pad A5051|||D|OS|2.26|1.92|2.26|Pouch clsd w barr attached A5052|||D|OS|1.63|1.39|1.63|Clsd ostomy pouch w/o barr A5053|||D|OS|1.9|1.62|1.63|Clsd ostomy pouch faceplate A5054|||D|OS|1.97|1.67|1.97|Clsd ostomy pouch w/flange A5055|||D|OS|1.58|1.34|1.58|Stoma cap A5056|||D|OS|5.1|4.34|5.1|1 pc ost pouch w filter A5057|||D|OS|10.5|8.93|10.5|1 pc ost pou w built-in conv A5061|||D|OS|3.86|3.28|3.86|Pouch drainable w barrier at A5062|||D|OS|2.43|2.07|2.43|Drnble ostomy pouch w/o barr A5063|||D|OS|2.96|2.52|2.96|Drain ostomy pouch w/flange A5071|||D|OS|6.57|5.58|6.57|Urinary pouch w/barrier A5072|||D|OS|3.86|3.28|3.86|Urinary pouch w/o barrier A5073|||D|OS|3.48|2.96|3.48|Urinary pouch on barr w/flng A5081|||D|OS|3.62|3.08|3.08|Stoma plug or seal| any type A5082|||D|OS|13|11.05|13|Continent stoma catheter A5083|||D|OS|0.7|0.6|0.7|Stoma absorptive cover A5093|||D|OS|2.14|1.82|2.14|Ostomy accessory convex inse A5102|||D|OS|24.69|20.99|24.69|Bedside drain btl w/wo tube A5105|||D|OS|44.58|37.89|44.58|Urinary suspensory A5112|||D|OS|37.85|32.17|37.85|Urinary leg bag A5113|||D|OS|5.15|4.38|5.15|Latex leg strap A5114|||D|OS|9.79|8.32|8.32|Foam/fabric leg strap A5120|AU||D|OS|0.27|0.23|0.27|Skin barrier| wipe or swab A5120|AV||D|PO|0.31|0.23|0.26|Skin barrier| wipe or swab A5121|||D|OS|8.15|6.93|6.93|Solid skin barrier 6x6 A5122|||D|OS|14.05|11.94|14.05|Solid skin barrier 8x8 A5126|||D|OS|1.44|1.22|1.44|Disk/foam pad +or- adhesive A5131|||D|OS|17.34|14.74|17.34|Appliance cleaner A5200|||D|OS|12.36|10.51|12.36|Percutaneous catheter anchor A5500|||D|TS|83.44|62.58|69.53|Diab shoe for density insert A5501|||D|TS|250.26|187.7|208.55|Diabetic custom molded shoe A5503|||D|TS|40.76|30.57|33.97|Diabetic shoe w/roller/rockr A5504|||D|TS|40.76|30.57|33.97|Diabetic shoe with wedge A5505|||D|TS|40.76|30.57|33.97|Diab shoe w/metatarsal bar A5506|||D|TS|40.76|30.57|33.97|Diabetic shoe w/off set heel A5507|||D|TS|40.76|30.57|33.97|Modification diabetic shoe A5512|||D|TS|34.03|25.52|28.36|Multi den insert direct form A5513|||D|TS|50.8|38.1|42.33|Multi den insert custom mold A6010|||J|SD|33.87|28.79|33.87|Collagen based wound filler A6011|||J|SD|2.49|2.12|2.49|Collagen gel/paste wound fil A6021|||J|SD|22.99|19.54|22.99|Collagen dressing <=16 sq in A6022|||J|SD|22.99|19.54|22.99|Collagen drsg>16<=48 sq in A6023|||J|SD|208.11|176.89|208.11|Collagen dressing >48 sq in A6024|||J|SD|6.77|5.75|6.77|Collagen dsg wound filler A6154|||J|SD|15.72|13.36|15.72|Wound pouch each A6196|||J|SD|8.04|6.83|8.04|Alginate dressing <=16 sq in A6197|||J|SD|17.97|15.27|17.97|Alginate drsg >16 <=48 sq in A6199|||J|SD|5.78|4.91|5.78|Alginate drsg wound filler A6203|||J|SD|3.67|3.12|3.67|Composite drsg <= 16 sq in A6204|||J|SD|6.81|5.79|6.81|Composite drsg >16<=48 sq in A6207|||J|SD|8.02|6.82|8.02|Contact layer >16<= 48 sq in A6209|||J|SD|8.17|6.94|8.17|Foam drsg <=16 sq in w/o bdr A6210|||J|SD|21.79|18.52|21.79|Foam drg >16<=48 sq in w/o b A6211|||J|SD|32.12|27.3|32.12|Foam drg > 48 sq in w/o brdr A6212|||J|SD|10.61|9.02|10.61|Foam drg <=16 sq in w/border A6214|||J|SD|11.25|9.56|11.25|Foam drg > 48 sq in w/border A6216|||J|SD|0.05|0.04|0.05|Non-sterile gauze<=16 sq in A6217|||J|SD|0|0|0|Non-sterile gauze>16<=48 sq A6219|||J|SD|1.04|0.88|1.04|Gauze <= 16 sq in w/border A6220|||J|SD|2.83|2.41|2.83|Gauze >16 <=48 sq in w/bordr A6222|||J|SD|2.33|1.98|2.33|Gauze <=16 in no w/sal w/o b A6223|||J|SD|2.65|2.25|2.65|Gauze >16<=48 no w/sal w/o b A6224|||J|SD|3.95|3.36|3.95|Gauze > 48 in no w/sal w/o b A6229|||J|SD|3.95|3.36|3.95|Gauze >16<=48 sq in watr/sal A6231|||J|SD|5.12|4.35|5.12|Hydrogel dsg<=16 sq in A6232|||J|SD|7.51|6.38|7.51|Hydrogel dsg>16<=48 sq in A6233|||J|SD|20.98|17.83|20.98|Hydrogel dressing >48 sq in A6234|||J|SD|7.15|6.08|7.15|Hydrocolld drg <=16 w/o bdr A6235|||J|SD|18.38|15.62|18.38|Hydrocolld drg >16<=48 w/o b A6236|||J|SD|29.8|25.33|29.8|Hydrocolld drg > 48 in w/o b A6237|||J|SD|8.66|7.36|8.66|Hydrocolld drg <=16 in w/bdr A6238|||J|SD|24.93|21.19|24.93|Hydrocolld drg >16<=48 w/bdr A6240|||J|SD|13.39|11.38|13.39|Hydrocolld drg filler paste A6241|||J|SD|2.81|2.39|2.81|Hydrocolloid drg filler dry A6242|||J|SD|6.63|5.64|6.63|Hydrogel drg <=16 in w/o bdr A6243|||J|SD|13.47|11.45|13.47|Hydrogel drg >16<=48 w/o bdr A6244|||J|SD|42.96|36.52|42.96|Hydrogel drg >48 in w/o bdr A6245|||J|SD|7.94|6.75|7.94|Hydrogel drg <= 16 in w/bdr A6246|||J|SD|10.86|9.23|10.86|Hydrogel drg >16<=48 in w/b A6247|||J|SD|26.01|22.11|26.01|Hydrogel drg > 48 sq in w/b A6248|||J|SD|17.76|15.1|17.76|Hydrogel drsg gel filler A6251|||J|SD|2.18|1.85|2.18|Absorpt drg <=16 sq in w/o b A6252|||J|SD|3.56|3.03|3.56|Absorpt drg >16 <=48 w/o bdr A6253|||J|SD|6.93|5.89|6.93|Absorpt drg > 48 sq in w/o b A6254|||J|SD|1.32|1.12|1.32|Absorpt drg <=16 sq in w/bdr A6255|||J|SD|3.32|2.82|3.32|Absorpt drg >16<=48 in w/bdr A6257|||J|SD|1.68|1.43|1.68|Transparent film <= 16 sq in A6258|||J|SD|4.72|4.01|4.72|Transparent film >16<=48 in A6259|||J|SD|11.97|10.17|11.97|Transparent film > 48 sq in A6266|||J|SD|2.11|1.79|2.11|Impreg gauze no h20/sal/yard A6402|||J|SD|0.13|0.11|0.13|Sterile gauze <= 16 sq in A6403|||J|SD|0.46|0.39|0.46|Sterile gauze>16 <= 48 sq in A6407|||J|SD|2.06|1.75|2.06|Packing strips| non-impreg A6410|||J|SD|0.42|0.36|0.42|Sterile eye pad A6411|||J|SD|0|0|0|Non-sterile eye pad A6441|||D|SD|0.74|0.63|0.74|Pad band w>=3 <5/yd A6442|||D|SD|0.18|0.15|0.18|Conform band n/s w<3/yd A6443|||D|SD|0.31|0.26|0.31|Conform band n/s w>=3<5/yd A6444|||D|SD|0.61|0.52|0.61|Conform band n/s w>=5/yd A6445|||D|SD|0.35|0.3|0.35|Conform band s w <3/yd A6446|||D|SD|0.44|0.37|0.44|Conform band s w>=3 <5/yd A6447|||D|SD|0.74|0.63|0.74|Conform band s w >=5/yd A6448|||D|SD|1.27|1.08|1.27|Lt compres band <3/yd A6449|||D|SD|1.92|1.63|1.92|Lt compres band >=3 <5/yd A6450|||D|SD|0|0|0|Lt compres band >=5/yd A6451|||D|SD|0|0|0|Mod compres band w>=3<5/yd A6452|||D|SD|6.46|5.49|6.46|High compres band w>=3<5yd A6453|||D|SD|0.68|0.58|0.68|Self-adher band w <3/yd A6454|||D|SD|0.85|0.72|0.85|Self-adher band w>=3 <5/yd A6455|||D|SD|1.53|1.3|1.53|Self-adher band >=5/yd A6456|||D|SD|1.39|1.18|1.39|Zinc paste band w >=3<5/yd A6457|||D|SD|1.25|1.06|1.25|Tubular dressing A6501|||D|SD|0|0|0|Compres burngarment bodysuit A6502|||D|SD|0|0|0|Compres burngarment chinstrp A6503|||D|SD|0|0|0|Compres burngarment facehood A6504|||D|SD|0|0|0|Cmprsburngarment glove-wrist A6505|||D|SD|0|0|0|Cmprsburngarment glove-elbow A6506|||D|SD|0|0|0|Cmprsburngrmnt glove-axilla A6507|||D|SD|0|0|0|Cmprs burngarment foot-knee A6508|||D|SD|0|0|0|Cmprs burngarment foot-thigh A6509|||D|SD|0|0|0|Compres burn garment jacket A6510|||D|SD|0|0|0|Compres burn garment leotard A6511|||D|SD|0|0|0|Compres burn garment panty A6513|||D|SD|0|0|0|Compress burn mask face/neck A6531|AW||D|SD|47.31|40.21|47.31|Compression stocking bk30-40 A6532|AW||D|SD|66.66|56.66|66.66|Compression stocking bk40-50 A6545|||D|SD|0|0|0|Grad comp non-elastic bk A6545|AW||D|SD|93.15|79.18|93.15|Grad comp non-elastic bk A6550|||D|SU|25.86|21.98|25.86|Neg pres wound ther drsg set A7000|NU||D|IN|8.99|7.64|8.92|Disposable canister for pump A7000|NU|KE|D|IN|10.43|8.87|10.34|Disposable canister for pump A7001|NU||D|IN|36.17|30.74|31.64|Nondisposable pump canister A7002|NU||D|IN|4.19|3.56|3.56|Tubing used w suction pump A7003|NU||D|IN|3|2.55|2.96|Nebulizer administration set A7004|NU||D|IN|1.98|1.68|1.68|Disposable nebulizer sml vol A7005|NU||D|IN|33.71|28.65|28.65|Nondisposable nebulizer set A7006|NU||D|IN|10.43|8.87|10.43|Filtered nebulizer admin set A7007|NU||D|IN|5.05|4.29|4.73|Lg vol nebulizer disposable A7008|NU||D|IN|12.03|10.23|10.23|Disposable nebulizer prefill A7009|NU||D|IN|45.98|39.08|44.41|Nebulizer reservoir bottle A7010|NU||D|IN|25.8|21.93|21.93|Disposable corrugated tubing A7012|NU||D|IN|4.14|3.52|4.1|Nebulizer water collec devic A7013|NU||D|IN|0.91|0.77|0.77|Disposable compressor filter A7014|NU||D|IN|4.91|4.17|4.91|Compressor nondispos filter A7015|NU||D|IN|2.06|1.75|2.06|Aerosol mask used w nebulize A7016|NU||D|IN|7.92|6.73|7.39|Nebulizer dome & mouthpiece A7017|NU||D|IN|146.57|124.58|146.57|Nebulizer not used w oxygen A7017|RR||D|IN|14.67|12.47|14.67|Nebulizer not used w oxygen A7017|UE||D|IN|109.92|93.43|109.92|Nebulizer not used w oxygen A7018|||D|SU|0.41|0.35|0.35|Water distilled w/nebulizer A7020|NU||D|IN|15.83|13.46|15.83|Interface| cough stim device A7025|RR||D|CR|47.57|40.43|47.57|Replace chest compress vest A7026|NU||D|IN|31.44|26.72|31.44|Replace chst cmprss sys hose A7027|NU||D|IN|203.97|173.37|203.97|Combination oral/nasal mask A7028|NU||D|IN|54.19|46.06|54.19|Repl oral cushion combo mask A7029|NU||D|IN|22.13|18.81|22.13|Repl nasal pillow comb mask A7030|NU||D|IN|177.8|151.13|177.8|Cpap full face mask A7031|NU||D|IN|65.76|55.9|65.76|Replacement facemask interfa A7032|NU||D|IN|38.2|32.47|38.2|Replacement nasal cushion A7033|NU||D|IN|26.78|22.76|26.78|Replacement nasal pillows A7034|NU||D|IN|110.87|94.24|110.87|Nasal application device A7035|NU||D|IN|37.45|31.83|34.02|Pos airway press headgear A7036|NU||D|IN|17.14|14.57|14.57|Pos airway press chinstrap A7037|NU||D|IN|38.65|32.85|37.59|Pos airway pressure tubing A7038|NU||D|IN|5.09|4.33|5.04|Pos airway pressure filter A7039|NU||D|IN|14.44|12.27|12.27|Filter| non disposable w pap A7040|||L|PO|52.7|39.53|44.48|One way chest drain valve A7041|||L|PO|99.03|74.28|83.58|Water seal drain container A7042|||L|PO|239.07|179.3|198.57|Implanted pleural catheter A7043|||L|PO|37.51|28.13|31.63|Vacuum drainagebottle/tubing A7044|NU||D|IN|113.96|96.87|113.96|Pap oral interface A7045|NU||D|IN|18.34|15.59|18.34|Repl exhalation port for pap A7045|RR||D|IN|1.83|1.56|1.83|Repl exhalation port for pap A7045|UE||D|IN|13.77|11.7|13.77|Repl exhalation port for pap A7046|NU||D|IN|18.38|15.62|18.38|Repl water chamber| pap dev A7047|NU||D|IN|132.22|112.39|132.22|Resp suction oral interface A7501|||D|OS|114.85|97.62|114.85|Tracheostoma valve w diaphra A7502|||D|OS|54.59|46.4|54.59|Replacement diaphragm/fplate A7503|||D|OS|12.4|10.54|12.4|Hmes filter holder or cap A7504|||D|OS|0.74|0.63|0.74|Tracheostoma hmes filter A7505|||D|OS|5.12|4.35|5.12|Hmes or trach valve housing A7506|||D|OS|0.36|0.31|0.36|Hmes/trachvalve adhesivedisk A7507|||D|OS|2.72|2.31|2.72|Integrated filter & holder A7508|||D|OS|3.13|2.66|3.13|Housing & integrated adhesiv A7509|||D|OS|1.55|1.32|1.55|Heat & moisture exchange sys A7520|||D|OS|51.92|44.13|51.92|Trach/laryn tube non-cuffed A7521|||D|OS|51.44|43.72|51.44|Trach/laryn tube cuffed A7522|||D|OS|49.39|41.98|49.39|Trach/laryn tube stainless A7524|||D|OS|84.65|71.95|84.65|Tracheostoma stent/stud/bttn A7525|||D|OS|2.26|1.92|2.26|Tracheostomy mask A7526|||D|OS|3.69|3.14|3.69|Tracheostomy tube collar A7527|||D|OS|3.92|3.33|3.92|Trach/laryn tube plug/stop A8000|NU||D|IN|167.7|142.55|167.7|Soft protect helmet prefab A8000|RR||D|IN|16.77|14.25|16.77|Soft protect helmet prefab A8000|UE||D|IN|125.8|106.93|125.8|Soft protect helmet prefab A8001|NU||D|IN|167.7|142.55|167.7|Hard protect helmet prefab A8001|RR||D|IN|16.77|14.25|16.77|Hard protect helmet prefab A8001|UE||D|IN|125.8|106.93|125.8|Hard protect helmet prefab A8002|NU||D|IN|0|0|0|Soft protect helmet custom A8002|RR||D|IN|0|0|0|Soft protect helmet custom A8002|UE||D|IN|0|0|0|Soft protect helmet custom A8003|NU||D|IN|0|0|0|Hard protect helmet custom A8003|RR||D|IN|0|0|0|Hard protect helmet custom A8003|UE||D|IN|0|0|0|Hard protect helmet custom A8004|NU||D|IN|0|0|0|Repl soft interface| helmet A8004|RR||D|IN|0|0|0|Repl soft interface| helmet A8004|UE||D|IN|0|0|0|Repl soft interface| helmet E0100|NU||D|IN|23.04|19.58|23.04|Cane adjust/fixed with tip E0100|RR||D|IN|6.49|5.52|5.52|Cane adjust/fixed with tip E0100|UE||D|IN|18.36|15.61|18.27|Cane adjust/fixed with tip E0105|NU||D|IN|53.71|45.65|53.71|Cane adjust/fixed quad/3 pro E0105|RR||D|IN|9.69|8.24|8.24|Cane adjust/fixed quad/3 pro E0105|UE||D|IN|41.4|35.19|41.4|Cane adjust/fixed quad/3 pro E0110|NU||D|IN|84.85|72.12|72.12|Crutch forearm pair E0110|RR||D|IN|17.48|14.86|14.86|Crutch forearm pair E0110|UE||D|IN|63.62|54.08|54.08|Crutch forearm pair E0111|NU||D|IN|58.24|49.5|53.79|Crutch forearm each E0111|RR||D|IN|9.21|7.83|7.83|Crutch forearm each E0111|UE||D|IN|44.95|38.21|40.34|Crutch forearm each E0112|NU||D|IN|40.46|34.39|34.39|Crutch underarm pair wood E0112|RR||D|IN|10.87|9.24|9.24|Crutch underarm pair wood E0112|UE||D|IN|30.87|26.24|26.24|Crutch underarm pair wood E0113|NU||D|IN|23.11|19.64|19.64|Crutch underarm each wood E0113|RR||D|IN|5.63|4.79|4.79|Crutch underarm each wood E0113|UE||D|IN|17.34|14.74|14.74|Crutch underarm each wood E0114|NU||D|IN|51.61|43.87|43.87|Crutch underarm pair no wood E0114|RR||D|IN|9.37|7.96|7.96|Crutch underarm pair no wood E0114|UE||D|IN|39.01|33.16|33.16|Crutch underarm pair no wood E0116|NU||D|IN|30.34|25.79|25.79|Crutch underarm each no wood E0116|RR||D|IN|5.91|5.02|5.02|Crutch underarm each no wood E0116|UE||D|IN|22.84|19.41|19.41|Crutch underarm each no wood E0117|RR||D|CR|21.06|17.9|21.06|Underarm springassist crutch E0130|NU||D|IN|66.2|56.27|66.2|Walker rigid adjust/fixed ht E0130|RR||D|IN|15.84|13.46|15.84|Walker rigid adjust/fixed ht E0130|UE||D|IN|51.59|43.85|51.59|Walker rigid adjust/fixed ht E0135|NU||D|IN|79.02|67.17|71.23|Walker folding adjust/fixed E0135|RR||D|IN|16.26|13.82|16.26|Walker folding adjust/fixed E0135|UE||D|IN|60.63|51.54|55.95|Walker folding adjust/fixed E0140|NU||D|IN|339.98|288.98|339.98|Walker w trunk support E0140|RR||D|IN|34.01|28.91|34.01|Walker w trunk support E0140|UE||D|IN|254.99|216.74|254.99|Walker w trunk support E0141|NU||D|IN|108.67|92.37|105.02|Rigid wheeled walker adj/fix E0141|RR||D|IN|21.09|17.93|17.93|Rigid wheeled walker adj/fix E0141|UE||D|IN|81.51|69.28|78.76|Rigid wheeled walker adj/fix E0143|NU||D|IN|113.32|96.32|105.02|Walker folding wheeled w/o s E0143|RR||D|IN|20.35|17.3|17.3|Walker folding wheeled w/o s E0143|UE||D|IN|84.81|72.09|78.76|Walker folding wheeled w/o s E0144|RR||D|CR|30.03|25.53|30.03|Enclosed walker w rear seat E0147|NU||D|IN|541.77|460.5|541.77|Walker variable wheel resist E0147|RR||D|IN|54.19|46.06|54.19|Walker variable wheel resist E0147|UE||D|IN|406.34|345.39|406.34|Walker variable wheel resist E0148|NU||D|IN|119.76|101.8|119.76|Heavyduty walker no wheels E0148|RR||D|IN|11.99|10.19|11.99|Heavyduty walker no wheels E0148|UE||D|IN|89.81|76.34|89.81|Heavyduty walker no wheels E0149|NU||D|IN|210.37|178.81|210.37|Heavy duty wheeled walker E0149|RR||D|IN|21.04|17.88|21.04|Heavy duty wheeled walker E0149|UE||D|IN|157.77|134.1|157.77|Heavy duty wheeled walker E0153|NU||D|IN|75.88|64.5|66.02|Forearm crutch platform atta E0153|RR||D|IN|8.57|7.28|7.28|Forearm crutch platform atta E0153|UE||D|IN|56.9|48.37|49.49|Forearm crutch platform atta E0154|NU||D|IN|66.46|56.49|66.46|Walker platform attachment E0154|RR||D|IN|8.07|6.86|6.86|Walker platform attachment E0154|UE||D|IN|50.49|42.92|49.84|Walker platform attachment E0155|NU||D|IN|29.73|25.27|28.85|Walker wheel attachment|pair E0155|RR||D|IN|3.63|3.09|3.09|Walker wheel attachment|pair E0155|UE||D|IN|22.67|19.27|21.61|Walker wheel attachment|pair E0156|NU||D|IN|24.92|21.18|24.92|Walker seat attachment E0156|RR||D|IN|3.19|2.71|3.19|Walker seat attachment E0156|UE||D|IN|18.71|15.9|18.71|Walker seat attachment E0157|NU||D|IN|77.22|65.64|68.21|Walker crutch attachment E0157|RR||D|IN|8.48|7.21|7.21|Walker crutch attachment E0157|UE||D|IN|57.91|49.22|51.15|Walker crutch attachment E0158|NU||D|IN|30.33|25.78|30.33|Walker leg extenders set of4 E0158|RR||D|IN|3.35|2.85|3.35|Walker leg extenders set of4 E0158|UE||D|IN|22.9|19.47|22.9|Walker leg extenders set of4 E0159|NU||D|IN|16.84|14.31|16.84|Brake for wheeled walker E0159|RR||D|IN|1.74|1.48|1.74|Brake for wheeled walker E0159|UE||D|IN|12.64|10.74|12.64|Brake for wheeled walker E0160|NU||D|IN|36.15|30.73|30.73|Sitz type bath or equipment E0160|RR||D|IN|4.75|4.04|4.04|Sitz type bath or equipment E0160|UE||D|IN|27.08|23.02|23.02|Sitz type bath or equipment E0161|NU||D|IN|28.68|24.38|28.68|Sitz bath/equipment w/faucet E0161|RR||D|IN|3.91|3.32|3.32|Sitz bath/equipment w/faucet E0161|UE||D|IN|21.47|18.25|21.47|Sitz bath/equipment w/faucet E0162|NU||D|IN|159.34|135.44|135.44|Sitz bath chair E0162|RR||D|IN|16.71|14.2|14.2|Sitz bath chair E0162|UE||D|IN|123.56|105.03|105.03|Sitz bath chair E0163|NU||D|IN|120.6|102.51|120.6|Commode chair with fixed arm E0163|RR||D|IN|26.7|22.7|25.43|Commode chair with fixed arm E0163|UE||D|IN|93|79.05|87.79|Commode chair with fixed arm E0165|RR||D|CR|20.32|17.27|20.32|Commode chair with detacharm E0167|NU||D|IN|13.12|11.15|11.15|Commode chair pail or pan E0167|RR||D|IN|1.37|1.16|1.16|Commode chair pail or pan E0167|UE||D|IN|9.89|8.41|9.22|Commode chair pail or pan E0168|NU||D|IN|165.04|140.28|165.04|Heavyduty/wide commode chair E0168|RR||D|IN|16.58|14.09|16.58|Heavyduty/wide commode chair E0168|UE||D|IN|123.77|105.2|123.77|Heavyduty/wide commode chair E0170|RR||D|CR|175.76|149.4|175.76|Commode chair electric E0171|RR||D|CR|31.63|26.89|31.63|Commode chair non-electric E0175|NU||D|IN|72.43|61.57|72.43|Commode chair foot rest E0175|RR||D|IN|7.24|6.15|7.24|Commode chair foot rest E0175|UE||D|IN|53.31|45.31|53.31|Commode chair foot rest E0181|RR||D|CR|28.49|24.22|28.49|Press pad alternating w/ pum E0182|RR||D|CR|28.62|24.33|24.33|Replace pump| alt press pad E0184|NU||D|IN|212.92|180.98|212.92|Dry pressure mattress E0184|RR||D|IN|26.87|22.84|24.71|Dry pressure mattress E0184|UE||D|IN|163.29|138.8|163.29|Dry pressure mattress E0185|NU||D|IN|349.77|297.3|317.44|Gel pressure mattress pad E0185|RR||D|IN|49.15|41.78|41.78|Gel pressure mattress pad E0185|UE||D|IN|268.44|228.17|238.08|Gel pressure mattress pad E0186|RR||D|CR|22.2|18.87|18.87|Air pressure mattress E0187|RR||D|CR|25.38|21.57|21.57|Water pressure mattress E0188|NU||D|IN|28.91|24.57|28.91|Synthetic sheepskin pad E0188|RR||D|IN|3.4|2.89|3.4|Synthetic sheepskin pad E0188|UE||D|IN|21.7|18.45|21.7|Synthetic sheepskin pad E0189|NU||D|IN|56.83|48.31|56.83|Lambswool sheepskin pad E0189|RR||D|IN|6.15|5.23|6.15|Lambswool sheepskin pad E0189|UE||D|IN|42.62|36.23|42.62|Lambswool sheepskin pad E0191|NU||D|IN|10.93|9.29|9.29|Protector heel or elbow E0191|RR||D|IN|1.12|0.95|0.95|Protector heel or elbow E0191|UE||D|IN|8.15|6.93|6.93|Protector heel or elbow E0193|RR||D|CR|851.53|723.8|803.54|Powered air flotation bed E0194|RR||D|CR|3558.77|3024.95|3024.95|Air fluidized bed E0196|RR||D|CR|35.53|30.2|30.2|Gel pressure mattress E0197|NU||D|IN|242.31|205.96|205.96|Air pressure pad for mattres E0197|RR||D|IN|33.43|28.42|28.42|Air pressure pad for mattres E0197|UE||D|IN|212.85|180.92|180.92|Air pressure pad for mattres E0198|RR||D|CR|24.24|20.6|20.6|Water pressure pad for mattr E0199|NU||D|IN|35.06|29.8|35.06|Dry pressure pad for mattres E0199|RR||D|IN|3.49|2.97|3.49|Dry pressure pad for mattres E0199|UE||D|IN|26.29|22.35|26.29|Dry pressure pad for mattres E0200|NU||D|IN|86.7|73.7|86.7|Heat lamp without stand E0200|RR||D|IN|11.77|10|11.77|Heat lamp without stand E0200|UE||D|IN|65.05|55.29|65.05|Heat lamp without stand E0202|RR||D|CR|68.47|58.2|58.2|Phototherapy light w/ photom E0205|NU||D|IN|212.22|180.39|212.22|Heat lamp with stand E0205|RR||D|IN|23.34|19.84|23.34|Heat lamp with stand E0205|UE||D|IN|159.16|135.29|159.16|Heat lamp with stand E0210|NU||D|IN|35.69|30.34|31.86|Electric heat pad standard E0210|RR||D|IN|3.36|2.86|3.17|Electric heat pad standard E0210|UE||D|IN|26.77|22.75|23.88|Electric heat pad standard E0215|NU||D|IN|77.47|65.85|65.85|Electric heat pad moist E0215|RR||D|IN|8.1|6.89|6.89|Electric heat pad moist E0215|UE||D|IN|58.12|49.4|49.4|Electric heat pad moist E0217|NU||D|IN|542.92|461.48|539.95|Water circ heat pad w pump E0217|RR||D|IN|60.44|51.37|53.97|Water circ heat pad w pump E0217|UE||D|IN|407.15|346.08|404.95|Water circ heat pad w pump E0225|NU||D|IN|425|361.25|425|Hydrocollator unit E0225|RR||D|IN|41.89|35.61|41.89|Hydrocollator unit E0225|UE||D|IN|318.74|270.93|318.74|Hydrocollator unit E0235|RR||D|CR|18.87|16.04|18.87|Paraffin bath unit portable E0236|RR||D|CR|48.38|41.12|43.08|Pump for water circulating p E0239|NU||D|IN|491.91|418.12|491.91|Hydrocollator unit portable E0239|RR||D|IN|49.2|41.82|49.2|Hydrocollator unit portable E0239|UE||D|IN|368.95|313.61|368.95|Hydrocollator unit portable E0249|NU||D|IN|108.93|92.59|108.93|Pad water circulating heat u E0249|RR||D|IN|11.98|10.18|11.98|Pad water circulating heat u E0249|UE||D|IN|81.69|69.44|81.69|Pad water circulating heat u E0250|RR||D|CR|92.13|78.31|80.21|Hosp bed fixed ht w/ mattres E0251|RR||D|CR|69.82|59.35|60.13|Hosp bed fixd ht w/o mattres E0255|RR||D|CR|110.73|94.12|94.91|Hospital bed var ht w/ mattr E0256|RR||D|CR|78.56|66.78|66.78|Hospital bed var ht w/o matt E0260|RR||D|CR|0|0|132.39|Hosp bed semi-electr w/ matt E0261|RR||D|CR|129.07|109.71|109.71|Hosp bed semi-electr w/o mat E0265|RR||D|CR|188.4|160.14|160.14|Hosp bed total electr w/ mat E0266|RR||D|CR|167.39|142.28|142.28|Hosp bed total elec w/o matt E0271|NU||D|IN|209.28|177.89|191.37|Mattress innerspring E0271|RR||D|IN|21.74|18.48|19.15|Mattress innerspring E0271|UE||D|IN|163.48|138.96|143.54|Mattress innerspring E0272|NU||D|IN|190.74|162.13|190.74|Mattress foam rubber E0272|RR||D|IN|19.92|16.93|19.92|Mattress foam rubber E0272|UE||D|IN|142.37|121.01|142.37|Mattress foam rubber E0275|NU||D|IN|16.75|14.24|16.75|Bed pan standard E0275|RR||D|IN|1.75|1.49|1.75|Bed pan standard E0275|UE||D|IN|12.55|10.67|12.55|Bed pan standard E0276|NU||D|IN|14.55|12.37|14.55|Bed pan fracture E0276|RR||D|IN|1.72|1.46|1.72|Bed pan fracture E0276|UE||D|IN|11.5|9.78|11.5|Bed pan fracture E0277|RR||D|CR|0|0|663.04|Powered pres-redu air mattrs E0280|NU||D|IN|36.01|30.61|36.01|Bed cradle E0280|RR||D|IN|3.88|3.3|3.88|Bed cradle E0280|UE||D|IN|27|22.95|27|Bed cradle E0290|RR||D|CR|70.44|59.87|59.87|Hosp bed fx ht w/o rails w/m E0291|RR||D|CR|51.18|43.5|43.5|Hosp bed fx ht w/o rail w/o E0292|RR||D|CR|79.2|67.32|67.32|Hosp bed var ht w/o rail w/o E0293|RR||D|CR|67.41|57.3|57.3|Hosp bed var ht w/o rail w/ E0294|RR||D|CR|123.14|104.67|104.67|Hosp bed semi-elect w/ mattr E0295|RR||D|CR|120.02|102.02|102.02|Hosp bed semi-elect w/o matt E0296|RR||D|CR|154.76|131.55|131.55|Hosp bed total elect w/ matt E0297|RR||D|CR|132.58|112.69|112.69|Hosp bed total elect w/o mat E0300|RR||D|CR|267.54|227.41|267.54|Enclosed ped crib hosp grade E0301|RR||D|CR|255.17|216.89|247.13|Hd hosp bed| 350-600 lbs E0302|RR||D|CR|674.32|573.17|674.32|Ex hd hosp bed > 600 lbs E0303|RR||D|CR|286.51|243.53|278.46|Hosp bed hvy dty xtra wide E0304|RR||D|CR|726.38|617.42|726.38|Hosp bed xtra hvy dty x wide E0305|RR||D|CR|16.77|14.25|14.25|Rails bed side half length E0310|NU||D|IN|182.98|155.53|182.98|Rails bed side full length E0310|RR||D|IN|21.45|18.23|20.48|Rails bed side full length E0310|UE||D|IN|138.47|117.7|137.27|Rails bed side full length E0316|RR||D|CR|199.13|169.26|199.13|Bed safety enclosure E0325|NU||D|IN|11.06|9.4|9.4|Urinal male jug-type E0325|RR||D|IN|1.66|1.41|1.41|Urinal male jug-type E0325|UE||D|IN|7.31|6.21|6.21|Urinal male jug-type E0326|NU||D|IN|11.48|9.76|10.08|Urinal female jug-type E0326|RR||D|IN|1.3|1.11|1.11|Urinal female jug-type E0326|UE||D|IN|8.61|7.32|7.56|Urinal female jug-type E0371|RR||D|CR|418.93|356.09|406.34|Nonpower mattress overlay E0372|RR||D|CR|508.33|432.08|493.06|Powered air mattress overlay E0373|RR||D|CR|579.15|492.28|564.8|Nonpowered pressure mattress E0424|RR||D|OX|0|0|178.24|Stationary compressed gas 02 E0431|RR||D|OX|0|0|29.97|Portable gaseous 02 E0433|RR||D|OX|0|0|51.63|Portable liquid oxygen sys E0434|RR||D|OX|0|0|29.97|Portable liquid 02 E0439|RR||D|OX|0|0|178.24|Stationary liquid 02 E0441|||D|OX|0|0|77.45|Stationary o2 contents| gas E0442|||D|OX|0|0|77.45|Stationary o2 contents| liq E0443|||D|OX|0|0|77.45|Portable 02 contents| gas E0444|||D|OX|0|0|77.45|Portable 02 contents| liquid E0450|RR||D|FS|1043.81|887.24|1043.81|Vol control vent invasiv int E0460|RR||D|FS|802.19|681.86|802.19|Neg press vent portabl/statn E0461|RR||D|FS|1043.81|887.24|1043.81|Vol control vent noninv int E0462|RR||D|CR|318.66|270.86|318.66|Rocking bed w/ or w/o side r E0463|RR||D|FS|1537.95|1307.26|1537.95|Press supp vent invasive int E0464|RR||D|FS|1537.95|1307.26|1537.95|Press supp vent noninv int E0470|RR||D|CR|241.85|205.57|241.85|Rad w/o backup non-inv intfc E0471|RR||D|CR|605.26|514.47|605.26|Rad w/backup non inv intrfc E0472|RR||D|CR|605.26|514.47|605.26|Rad w backup invasive intrfc E0480|RR||D|CR|48.06|40.85|47.24|Percussor elect/pneum home m E0482|RR||D|CR|470.26|399.72|456.13|Cough stimulating device E0483|RR||D|CR|1162.58|988.19|1162.58|Chest compression gen system E0484|NU||D|IN|40.38|34.32|40.38|Non-elec oscillatory pep dvc E0484|RR||D|IN|4.03|3.43|4.03|Non-elec oscillatory pep dvc E0484|UE||D|IN|30.3|25.76|30.3|Non-elec oscillatory pep dvc E0485|NU||D|IN|0|0|0|Oral device/appliance prefab E0485|RR||D|IN|0|0|0|Oral device/appliance prefab E0485|UE||D|IN|0|0|0|Oral device/appliance prefab E0486|NU||D|IN|0|0|0|Oral device/appliance cusfab E0486|RR||D|IN|0|0|0|Oral device/appliance cusfab E0486|UE||D|IN|0|0|0|Oral device/appliance cusfab E0500|RR||D|FS|120.03|102.03|102.03|Ippb all types E0550|RR||D|CR|54.82|46.6|54.82|Humidif extens supple w ippb E0560|NU||D|IN|161.66|137.41|137.41|Humidifier supplemental w/ i E0560|RR||D|IN|18.95|16.11|17.35|Humidifier supplemental w/ i E0560|UE||D|IN|121.24|103.05|103.05|Humidifier supplemental w/ i E0561|NU||D|IN|100.85|85.72|100.85|Humidifier nonheated w pap E0561|RR||D|IN|10.07|8.56|10.07|Humidifier nonheated w pap E0561|UE||D|IN|75.63|64.29|75.63|Humidifier nonheated w pap E0562|NU||D|IN|283.91|241.32|283.91|Humidifier heated used w pap E0562|RR||D|IN|28.37|24.11|28.37|Humidifier heated used w pap E0562|UE||D|IN|212.93|180.99|212.93|Humidifier heated used w pap E0565|RR||D|CR|66.72|56.71|66.72|Compressor air power source E0570|RR||D|CR|0|0|17.61|Nebulizer with compression E0572|RR||D|CR|41.65|35.4|40.63|Aerosol compressor adjust pr E0574|RR||D|CR|44.03|37.43|42.96|Ultrasonic generator w svneb E0575|RR||D|CR|112.39|95.53|110.21|Nebulizer ultrasonic E0580|NU||D|IN|126.34|107.39|126.34|Nebulizer for use w/ regulat E0580|RR||D|IN|12.64|10.74|12.64|Nebulizer for use w/ regulat E0580|UE||D|IN|94.74|80.53|94.74|Nebulizer for use w/ regulat E0585|RR||D|CR|38.34|32.59|32.59|Nebulizer w/ compressor & he E0600|RR||D|CR|50.07|42.56|44.53|Suction pump portab hom modl E0601|RR||D|CR|105.29|89.5|105.29|Cont airway pressure device E0602|NU||D|IN|32.28|27.44|32.28|Manual breast pump E0602|RR||D|IN|3.24|2.75|3.24|Manual breast pump E0602|UE||D|IN|24.22|20.59|24.22|Manual breast pump E0605|NU||D|IN|28.91|24.57|24.57|Vaporizer room type E0605|RR||D|IN|3.36|2.86|2.86|Vaporizer room type E0605|UE||D|IN|23.82|20.25|20.25|Vaporizer room type E0606|RR||D|CR|25.1|21.34|25.1|Drainage board postural E0607|NU||D|IN|0|0|73.06|Blood glucose monitor home E0607|RR||D|IN|0|0|7.3|Blood glucose monitor home E0607|UE||D|IN|0|0|54.79|Blood glucose monitor home E0610|NU||D|IN|260.11|221.09|230.09|Pacemaker monitr audible/vis E0610|RR||D|IN|27.43|23.32|23.32|Pacemaker monitr audible/vis E0610|UE||D|IN|195.1|165.84|172.55|Pacemaker monitr audible/vis E0615|NU||D|IN|523.6|445.06|523.6|Pacemaker monitr digital/vis E0615|RR||D|IN|63.97|54.37|63.97|Pacemaker monitr digital/vis E0615|UE||D|IN|392.72|333.81|392.72|Pacemaker monitr digital/vis E0617|RR||D|CR|332.48|282.61|332.48|Automatic ext defibrillator E0617|RR|KF|D|CR|369.16|313.79|369.16|Automatic ext defibrillator E0618|RR||D|CR|306.59|260.6|306.59|Apnea monitor E0619|RR||D|CR|0|0|0|Apnea monitor w recorder E0620|RR||D|CR|95.61|81.27|95.61|Cap bld skin piercing laser E0621|NU||D|IN|104.97|89.22|89.22|Patient lift sling or seat E0621|RR||D|IN|10.11|8.59|8.59|Patient lift sling or seat E0621|UE||D|IN|79.12|67.25|67.25|Patient lift sling or seat E0627|NU||D|IN|368.88|313.55|368.88|Seat lift incorp lift-chair E0627|RR||D|IN|36.9|31.37|36.9|Seat lift incorp lift-chair E0627|UE||D|IN|276.66|235.16|276.66|Seat lift incorp lift-chair E0628|NU||D|IN|368.88|313.55|368.88|Seat lift for pt furn-electr E0628|RR||D|IN|36.9|31.37|36.9|Seat lift for pt furn-electr E0628|UE||D|IN|276.66|235.16|276.66|Seat lift for pt furn-electr E0629|NU||D|IN|361.65|307.4|361.65|Seat lift for pt furn-non-el E0629|RR||D|IN|36.17|30.74|36.17|Seat lift for pt furn-non-el E0629|UE||D|IN|271.21|230.53|271.21|Seat lift for pt furn-non-el E0630|RR||D|CR|111.41|94.7|100.41|Patient lift hydraulic E0635|RR||D|CR|133.8|113.73|133.8|Patient lift electric E0636|RR||D|CR|1153.21|980.23|1153.21|Pt support & positioning sys E0650|NU||D|IN|787.59|669.45|669.45|Pneuma compresor non-segment E0650|RR||D|IN|97.18|82.6|87.32|Pneuma compresor non-segment E0650|UE||D|IN|590.69|502.09|502.09|Pneuma compresor non-segment E0651|NU||D|IN|1004.33|853.68|1004.33|Pneum compressor segmental E0651|RR||D|IN|102.6|87.21|102.6|Pneum compressor segmental E0651|UE||D|IN|753.26|640.27|753.26|Pneum compressor segmental E0652|NU||D|IN|5797.37|4927.76|5797.37|Pneum compres w/cal pressure E0652|RR||D|IN|572.96|487.02|572.96|Pneum compres w/cal pressure E0652|UE||D|IN|4344.15|3692.53|4344.15|Pneum compres w/cal pressure E0655|NU||D|IN|118.03|100.33|103.23|Pneumatic appliance half arm E0655|RR||D|IN|13.87|11.79|11.79|Pneumatic appliance half arm E0655|UE||D|IN|88.63|75.34|88.63|Pneumatic appliance half arm E0656|RR||D|CR|63.19|53.71|63.19|Segmental pneumatic trunk E0657|RR||D|CR|59.36|50.46|59.36|Segmental pneumatic chest E0660|NU||D|IN|174.69|148.49|174.69|Pneumatic appliance full leg E0660|RR||D|IN|18.18|15.45|17.81|Pneumatic appliance full leg E0660|UE||D|IN|131.01|111.36|131.01|Pneumatic appliance full leg E0665|NU||D|IN|149.81|127.34|146.58|Pneumatic appliance full arm E0665|RR||D|IN|15.38|13.07|14.67|Pneumatic appliance full arm E0665|UE||D|IN|112.49|95.62|112.49|Pneumatic appliance full arm E0666|NU||D|IN|151.01|128.36|151.01|Pneumatic appliance half leg E0666|RR||D|IN|15.56|13.23|15.56|Pneumatic appliance half leg E0666|UE||D|IN|113.28|96.29|113.28|Pneumatic appliance half leg E0667|NU||D|IN|354.06|300.95|354.06|Seg pneumatic appl full leg E0667|RR||D|IN|39.98|33.98|39.98|Seg pneumatic appl full leg E0667|UE||D|IN|265.55|225.72|265.55|Seg pneumatic appl full leg E0668|NU||D|IN|483.21|410.73|483.21|Seg pneumatic appl full arm E0668|RR||D|IN|47.68|40.53|47.68|Seg pneumatic appl full arm E0668|UE||D|IN|362.42|308.06|362.42|Seg pneumatic appl full arm E0669|NU||D|IN|200.46|170.39|197.96|Seg pneumatic appli half leg E0669|RR||D|IN|20.06|17.05|19.81|Seg pneumatic appli half leg E0669|UE||D|IN|150.38|127.82|148.49|Seg pneumatic appli half leg E0670|NU||D|IN|1374.64|1168.44|1374.64|Seg pneum int legs/trunk E0670|RR||D|IN|147.16|125.09|147.16|Seg pneum int legs/trunk E0670|UE||D|IN|1030.94|876.3|1030.94|Seg pneum int legs/trunk E0671|NU||D|IN|454.21|386.08|454.21|Pressure pneum appl full leg E0671|RR||D|IN|45.44|38.62|45.44|Pressure pneum appl full leg E0671|UE||D|IN|340.64|289.54|340.64|Pressure pneum appl full leg E0672|NU||D|IN|352.91|299.97|352.91|Pressure pneum appl full arm E0672|RR||D|IN|35.3|30.01|35.3|Pressure pneum appl full arm E0672|UE||D|IN|264.7|225|264.7|Pressure pneum appl full arm E0673|NU||D|IN|293.25|249.26|293.25|Pressure pneum appl half leg E0673|RR||D|IN|29.33|24.93|29.33|Pressure pneum appl half leg E0673|UE||D|IN|219.97|186.97|219.97|Pressure pneum appl half leg E0675|RR||D|CR|420.52|357.44|420.52|Pneumatic compression device E0691|NU||D|IN|982.65|835.25|982.65|Uvl pnl 2 sq ft or less E0691|RR||D|IN|98.26|83.52|98.26|Uvl pnl 2 sq ft or less E0691|UE||D|IN|736.99|626.44|736.99|Uvl pnl 2 sq ft or less E0692|NU||D|IN|1233.94|1048.85|1233.94|Uvl sys panel 4 ft E0692|RR||D|IN|123.38|104.87|123.38|Uvl sys panel 4 ft E0692|UE||D|IN|925.45|786.63|925.45|Uvl sys panel 4 ft E0693|NU||D|IN|1521.1|1292.94|1521.1|Uvl sys panel 6 ft E0693|RR||D|IN|152.12|129.3|152.12|Uvl sys panel 6 ft E0693|UE||D|IN|1140.82|969.7|1140.82|Uvl sys panel 6 ft E0694|NU||D|IN|4841.5|4115.28|4841.5|Uvl md cabinet sys 6 ft E0694|RR||D|IN|484.15|411.53|484.15|Uvl md cabinet sys 6 ft E0694|UE||D|IN|3631.14|3086.47|3631.14|Uvl md cabinet sys 6 ft E0705|NU||D|IN|60.28|51.24|60.28|Transfer device E0705|RR||D|IN|6.13|5.21|6.13|Transfer device E0705|UE||D|IN|44.15|37.53|44.15|Transfer device E0720|NU||D|TE|401.96|341.67|401.96|Tens two lead E0730|NU||D|TE|405.22|344.44|405.22|Tens four lead E0731|NU||D|IN|390.06|331.55|390.06|Conductive garment for tens/ E0740|RR||D|CR|57.19|48.61|57.19|Incontinence treatment systm E0744|RR||D|CR|100.14|85.12|100.14|Neuromuscular stim for scoli E0745|RR||D|CR|97.89|83.21|97.89|Neuromuscular stim for shock E0747|NU|KF|D|IN|4282.4|3640.04|4282.4|Elec osteogen stim not spine E0747|RR|KF|D|IN|425.55|361.72|425.55|Elec osteogen stim not spine E0747|UE|KF|D|IN|3181.74|2704.48|3181.74|Elec osteogen stim not spine E0748|NU|KF|D|IN|4254.66|3616.46|4254.66|Elec osteogen stim spinal E0748|RR|KF|D|IN|425.45|361.63|425.45|Elec osteogen stim spinal E0748|UE|KF|D|IN|3191|2712.35|3191|Elec osteogen stim spinal E0749|RR|KF|L|CR|310.97|264.32|264.32|Elec osteogen stim implanted E0760|NU|KF|D|IN|3535.55|3005.22|3535.55|Osteogen ultrasound stimltor E0760|RR|KF|D|IN|353.57|300.53|353.57|Osteogen ultrasound stimltor E0760|UE|KF|D|IN|2651.65|2253.9|2651.65|Osteogen ultrasound stimltor E0762|RR||D|CR|120.24|102.2|120.24|Trans elec jt stim dev sys E0764|RR|KF|D|CR|1210.19|1028.66|1210.19|Functional neuromuscularstim E0765|NU||D|IN|92|78.2|92|Nerve stimulator for tx n&v E0765|RR||D|IN|9.21|7.83|9.21|Nerve stimulator for tx n&v E0765|UE||D|IN|69.02|58.67|69.02|Nerve stimulator for tx n&v E0766|RR|KF|D|FS|425.55|361.72|425.55|Elec stim cancer treatment E0776|NU||D|IN|156.55|133.07|133.07|Iv pole E0776|RR||D|IN|20.39|17.33|17.33|Iv pole E0776|UE||D|IN|115.19|97.91|97.91|Iv pole E0779|RR||D|CR|18.29|15.55|17.85|Amb infusion pump mechanical E0780|NU||D|IN|11.34|9.64|11.34|Mech amb infusion pump <8hrs E0781|RR||J|CR|289.65|246.2|280.97|External ambulatory infus pu E0782|NU|KF|L|IN|4695.04|3990.78|4695.04|Non-programble infusion pump E0782|RR|KF|L|IN|469.53|399.1|469.53|Non-programble infusion pump E0782|UE|KF|L|IN|3521.28|2993.09|3521.28|Non-programble infusion pump E0783|NU|KF|L|IN|8952.75|7609.84|8952.75|Programmable infusion pump E0783|RR|KF|L|IN|895.29|761|895.29|Programmable infusion pump E0783|UE|KF|L|IN|6714.57|5707.38|6714.57|Programmable infusion pump E0784|RR||D|CR|456.63|388.14|456.63|Ext amb infusn pump insulin E0785|KF||L|IN|516.71|439.2|516.71|Replacement impl pump cathet E0786|NU|KF|L|IN|8732.86|7422.93|8732.86|Implantable pump replacement E0786|RR|KF|L|IN|873.27|742.28|873.27|Implantable pump replacement E0786|UE|KF|L|IN|6549.65|5567.2|6549.65|Implantable pump replacement E0791|RR||D|CR|345.78|293.91|293.91|Parenteral infusion pump sta E0840|NU||D|IN|80.12|68.1|77.7|Tract frame attach headboard E0840|RR||D|IN|17.85|15.17|17.85|Tract frame attach headboard E0840|UE||D|IN|60.06|51.05|58.26|Tract frame attach headboard E0849|RR||D|CR|56.36|47.91|56.36|Cervical pneum trac equip E0850|NU||D|IN|114.88|97.65|97.65|Traction stand free standing E0850|RR||D|IN|15.77|13.4|13.4|Traction stand free standing E0850|UE||D|IN|86.17|73.24|73.24|Traction stand free standing E0855|RR||D|CR|54.96|46.72|54.96|Cervical traction equipment E0856|RR||D|CR|16.83|14.31|16.83|Cervic collar w air bladder E0860|NU||D|IN|42.14|35.82|39.57|Tract equip cervical tract E0860|RR||D|IN|7.12|6.05|6.05|Tract equip cervical tract E0860|UE||D|IN|32.27|27.43|29.66|Tract equip cervical tract E0870|NU||D|IN|127.2|108.12|108.12|Tract frame attach footboard E0870|RR||D|IN|14.67|12.47|12.47|Tract frame attach footboard E0870|UE||D|IN|95.82|81.45|81.45|Tract frame attach footboard E0880|NU||D|IN|137.29|116.7|116.7|Trac stand free stand extrem E0880|RR||D|IN|21.56|18.33|18.33|Trac stand free stand extrem E0880|UE||D|IN|103.91|88.32|88.32|Trac stand free stand extrem E0890|NU||D|IN|131.66|111.91|111.91|Traction frame attach pelvic E0890|RR||D|IN|35.91|30.52|35.7|Traction frame attach pelvic E0890|UE||D|IN|106.06|90.15|90.15|Traction frame attach pelvic E0900|NU||D|IN|140.12|119.1|119.1|Trac stand free stand pelvic E0900|RR||D|IN|30.21|25.68|25.68|Trac stand free stand pelvic E0900|UE||D|IN|105.12|89.35|89.35|Trac stand free stand pelvic E0910|RR||D|CR|18.85|16.02|17.72|Trapeze bar attached to bed E0911|RR||D|CR|46.98|39.93|46.98|Hd trapeze bar attach to bed E0912|RR||D|CR|107.9|91.72|107.9|Hd trapeze bar free standing E0920|RR||D|CR|50.46|42.89|44.84|Fracture frame attached to b E0930|RR||D|CR|49.95|42.46|42.46|Fracture frame free standing E0935|RR||D|FS|24.87|21.14|21.14|Cont pas motion exercise dev E0940|RR||D|CR|32.77|27.85|27.85|Trapeze bar free standing E0941|RR||D|CR|47.46|40.34|47.46|Gravity assisted traction de E0942|NU||D|IN|21.7|18.45|18.81|Cervical head harness/halter E0942|RR||D|IN|2.57|2.18|2.18|Cervical head harness/halter E0942|UE||D|IN|16.26|13.82|14.08|Cervical head harness/halter E0944|NU||D|IN|50.16|42.64|49.01|Pelvic belt/harness/boot E0944|RR||D|IN|5.04|4.28|4.91|Pelvic belt/harness/boot E0944|UE||D|IN|37.62|31.98|36.76|Pelvic belt/harness/boot E0945|NU||D|IN|48.47|41.2|41.2|Belt/harness extremity E0945|RR||D|IN|4.86|4.13|4.13|Belt/harness extremity E0945|UE||D|IN|37.51|31.88|31.88|Belt/harness extremity E0946|RR||D|CR|64.7|55|55|Fracture frame dual w cross E0947|NU||D|IN|663.19|563.71|587.52|Fracture frame attachmnts pe E0947|RR||D|IN|68.76|58.45|59.48|Fracture frame attachmnts pe E0947|UE||D|IN|497.38|422.77|440.62|Fracture frame attachmnts pe E0948|NU||D|IN|641.46|545.24|587.52|Fracture frame attachmnts ce E0948|RR||D|IN|64.12|54.5|58.76|Fracture frame attachmnts ce E0948|UE||D|IN|452.42|384.56|440.62|Fracture frame attachmnts ce E0950|NU||D|IN|97.98|83.28|83.28|Tray E0950|NU|KE|D|IN|113.68|96.63|96.63|Tray E0950|RR||D|IN|9.82|8.35|8.35|Tray E0950|RR|KE|D|IN|11.38|9.67|9.67|Tray E0950|UE||D|IN|73.49|62.47|62.47|Tray E0950|UE|KE|D|IN|85.26|72.47|72.47|Tray E0951|NU||D|IN|17.89|15.21|17.89|Loop heel E0951|NU|KE|D|IN|20.76|17.65|20.76|Loop heel E0951|RR||D|IN|1.84|1.56|1.84|Loop heel E0951|RR|KE|D|IN|2.15|1.83|2.15|Loop heel E0951|UE||D|IN|13.41|11.4|13.41|Loop heel E0951|UE|KE|D|IN|15.55|13.22|15.55|Loop heel E0952|NU||D|IN|17.75|15.09|15.09|Toe loop/holder| each E0952|NU|KE|D|IN|20.58|17.49|17.49|Toe loop/holder| each E0952|RR||D|IN|1.84|1.56|1.56|Toe loop/holder| each E0952|RR|KE|D|IN|2.15|1.83|1.83|Toe loop/holder| each E0952|UE||D|IN|13.32|11.32|11.32|Toe loop/holder| each E0952|UE|KE|D|IN|15.46|13.14|13.14|Toe loop/holder| each E0955|NU||D|IN|190.57|161.98|190.57|Cushioned headrest E0955|NU|KE|D|IN|221.1|187.94|221.1|Cushioned headrest E0955|RR||D|IN|19.07|16.21|19.07|Cushioned headrest E0955|RR|KE|D|IN|22.12|18.8|22.12|Cushioned headrest E0955|UE||D|IN|142.92|121.48|142.92|Cushioned headrest E0955|UE|KE|D|IN|165.81|140.94|165.81|Cushioned headrest E0956|NU||D|IN|92.91|78.97|92.91|W/c lateral trunk/hip suppor E0956|NU|KE|D|IN|107.81|91.64|107.81|W/c lateral trunk/hip suppor E0956|RR||D|IN|9.29|7.9|9.29|W/c lateral trunk/hip suppor E0956|RR|KE|D|IN|10.79|9.17|10.79|W/c lateral trunk/hip suppor E0956|UE||D|IN|69.68|59.23|69.68|W/c lateral trunk/hip suppor E0956|UE|KE|D|IN|80.85|68.72|80.85|W/c lateral trunk/hip suppor E0957|NU||D|IN|130.01|110.51|130.01|W/c medial thigh support E0957|NU|KE|D|IN|150.84|128.21|150.84|W/c medial thigh support E0957|RR||D|IN|13|11.05|13|W/c medial thigh support E0957|RR|KE|D|IN|15.09|12.83|15.09|W/c medial thigh support E0957|UE||D|IN|97.51|82.88|97.51|W/c medial thigh support E0957|UE|KE|D|IN|113.12|96.15|113.12|W/c medial thigh support E0958|RR||D|CR|47.7|40.55|46.89|Whlchr att- conv 1 arm drive E0959|NU||D|IN|48.34|41.09|42.11|Amputee adapter E0959|RR||D|IN|4.87|4.14|4.2|Amputee adapter E0959|UE||D|IN|36.58|31.09|31.55|Amputee adapter E0960|NU||D|IN|85.75|72.89|85.75|W/c shoulder harness/straps E0960|NU|KE|D|IN|99.49|84.57|99.49|W/c shoulder harness/straps E0960|RR||D|IN|8.59|7.3|8.59|W/c shoulder harness/straps E0960|RR|KE|D|IN|9.96|8.47|9.96|W/c shoulder harness/straps E0960|UE||D|IN|64.33|54.68|64.33|W/c shoulder harness/straps E0960|UE|KE|D|IN|74.63|63.44|74.63|W/c shoulder harness/straps E0961|NU||D|IN|32.53|27.65|27.65|Wheelchair brake extension E0961|RR||D|IN|3.4|2.89|2.89|Wheelchair brake extension E0961|UE||D|IN|16.24|13.8|16.24|Wheelchair brake extension E0966|NU||D|IN|78.05|66.34|71.69|Wheelchair head rest extensi E0966|RR||D|IN|7.7|6.55|7.16|Wheelchair head rest extensi E0966|UE||D|IN|58.53|49.75|53.79|Wheelchair head rest extensi E0967|NU||D|IN|71.82|61.05|71.82|Manual wc hand rim w project E0967|RR||D|IN|7.19|6.11|7.19|Manual wc hand rim w project E0967|UE||D|IN|53.85|45.77|53.85|Manual wc hand rim w project E0968|RR||D|CR|19.6|16.66|18.85|Wheelchair commode seat E0969|NU||D|IN|171.29|145.6|171.29|Wheelchair narrowing device E0969|RR||D|IN|16.96|14.42|16.96|Wheelchair narrowing device E0969|UE||D|IN|128.47|109.2|128.47|Wheelchair narrowing device E0971|NU||D|IN|47.44|40.32|47.44|Wheelchair anti-tipping devi E0971|RR||D|IN|4.76|4.05|4.76|Wheelchair anti-tipping devi E0971|UE||D|IN|35.61|30.27|35.61|Wheelchair anti-tipping devi E0973|NU||D|IN|108.36|92.11|108.36|W/ch access det adj armrest E0973|NU|KE|D|IN|125.72|106.86|125.72|W/ch access det adj armrest E0973|RR||D|IN|10.32|8.77|10.32|W/ch access det adj armrest E0973|RR|KE|D|IN|11.98|10.18|11.98|W/ch access det adj armrest E0973|UE||D|IN|81.27|69.08|81.27|W/ch access det adj armrest E0973|UE|KE|D|IN|94.29|80.15|94.29|W/ch access det adj armrest E0974|NU||D|IN|85.74|72.88|85.74|W/ch access anti-rollback E0974|RR||D|IN|9.09|7.73|9.09|W/ch access anti-rollback E0974|UE||D|IN|64.79|55.07|64.79|W/ch access anti-rollback E0978|NU||D|IN|40.25|34.21|40.25|W/c acc|saf belt pelv strap E0978|NU|KE|D|IN|46.71|39.7|46.71|W/c acc|saf belt pelv strap E0978|RR||D|IN|4.03|3.43|4.03|W/c acc|saf belt pelv strap E0978|RR|KE|D|IN|4.69|3.99|4.69|W/c acc|saf belt pelv strap E0978|UE||D|IN|29.84|25.36|29.84|W/c acc|saf belt pelv strap E0978|UE|KE|D|IN|34.62|29.43|34.62|W/c acc|saf belt pelv strap E0980|NU||D|IN|36.15|30.73|30.73|Wheelchair safety vest E0980|RR||D|IN|3.62|3.08|3.08|Wheelchair safety vest E0980|UE||D|IN|26.96|22.92|22.92|Wheelchair safety vest E0981|NU||D|IN|44.44|37.77|42.98|Seat upholstery| replacement E0981|NU|KE|D|IN|51.57|43.83|49.85|Seat upholstery| replacement E0981|RR||D|IN|4.52|3.84|4.3|Seat upholstery| replacement E0981|RR|KE|D|IN|5.24|4.45|4.99|Seat upholstery| replacement E0981|UE||D|IN|33.64|28.59|33.54|Seat upholstery| replacement E0981|UE|KE|D|IN|39.05|33.19|38.93|Seat upholstery| replacement E0982|NU||D|IN|48.56|41.28|48.56|Back upholstery| replacement E0982|NU|KE|D|IN|56.36|47.91|56.36|Back upholstery| replacement E0982|RR||D|IN|4.86|4.13|4.86|Back upholstery| replacement E0982|RR|KE|D|IN|5.63|4.79|5.63|Back upholstery| replacement E0982|UE||D|IN|36.43|30.97|36.43|Back upholstery| replacement E0982|UE|KE|D|IN|42.25|35.91|42.25|Back upholstery| replacement E0983|RR||D|CR|273.32|232.32|265.64|Add pwr joystick E0984|RR||D|CR|208.92|177.58|208.92|Add pwr tiller E0985|NU||D|IN|221.83|188.56|221.83|W/c seat lift mechanism E0985|RR||D|IN|22.2|18.87|22.2|W/c seat lift mechanism E0985|UE||D|IN|166.36|141.41|166.36|W/c seat lift mechanism E0986|RR||D|CR|531.94|452.15|531.94|Man w/c push-rim pow assist E0988|RR||D|CR|327.35|278.25|327.35|Lever-activated wheel drive E0990|NU||D|IN|110.68|94.08|110.68|Wheelchair elevating leg res E0990|NU|KE|D|IN|128.42|109.16|128.42|Wheelchair elevating leg res E0990|RR||D|IN|12.46|10.59|11.07|Wheelchair elevating leg res E0990|RR|KE|D|IN|14.45|12.28|12.86|Wheelchair elevating leg res E0990|UE||D|IN|86.48|73.51|86.48|Wheelchair elevating leg res E0990|UE|KE|D|IN|100.33|85.28|100.33|Wheelchair elevating leg res E0992|NU||D|IN|104.06|88.45|88.45|Wheelchair solid seat insert E0992|RR||D|IN|10.11|8.59|8.76|Wheelchair solid seat insert E0992|UE||D|IN|78.05|66.34|66.34|Wheelchair solid seat insert E0994|NU||D|IN|19.27|16.38|16.38|Wheelchair arm rest E0994|RR||D|IN|1.95|1.66|1.66|Wheelchair arm rest E0994|UE||D|IN|14.46|12.29|12.29|Wheelchair arm rest E0995|NU||D|IN|28.65|24.35|28.65|Wheelchair calf rest E0995|NU|KE|D|IN|33.25|28.26|33.25|Wheelchair calf rest E0995|RR||D|IN|2.88|2.45|2.88|Wheelchair calf rest E0995|RR|KE|D|IN|3.34|2.84|3.34|Wheelchair calf rest E0995|UE||D|IN|21.47|18.25|21.47|Wheelchair calf rest E0995|UE|KE|D|IN|24.92|21.18|24.92|Wheelchair calf rest E1002|RR||D|CR|382.01|324.71|382.01|Pwr seat tilt E1002|RR|KE|D|CR|443.23|376.75|443.23|Pwr seat tilt E1003|RR||D|CR|413.9|351.82|413.9|Pwr seat recline E1003|RR|KE|D|CR|480.22|408.19|480.22|Pwr seat recline E1004|RR||D|CR|458.91|390.07|458.91|Pwr seat recline mech E1004|RR|KE|D|CR|532.45|452.58|532.45|Pwr seat recline mech E1005|RR||D|CR|496.74|422.23|496.74|Pwr seat recline pwr E1005|RR|KE|D|CR|576.34|489.89|576.34|Pwr seat recline pwr E1006|RR||D|CR|608.45|517.18|608.45|Pwr seat combo w/o shear E1006|RR|KE|D|CR|705.94|600.05|705.94|Pwr seat combo w/o shear E1007|RR||D|CR|823.9|700.32|823.9|Pwr seat combo w/shear E1007|RR|KE|D|CR|955.9|812.52|955.9|Pwr seat combo w/shear E1008|RR||D|CR|823.96|700.37|823.96|Pwr seat combo pwr shear E1008|RR|KE|D|CR|955.98|812.58|955.98|Pwr seat combo pwr shear E1009|NU||D|IN|0|0|0|Add mech leg elevation E1009|RR||D|IN|0|0|0|Add mech leg elevation E1009|UE||D|IN|0|0|0|Add mech leg elevation E1010|RR||D|CR|107.81|91.64|107.81|Add pwr leg elevation E1010|RR|KE|D|CR|125.08|106.32|125.08|Add pwr leg elevation E1011|NU||D|IN|0|0|0|Ped wc modify width adjustm E1011|RR||D|IN|0|0|0|Ped wc modify width adjustm E1011|UE||D|IN|0|0|0|Ped wc modify width adjustm E1014|RR||D|CR|39.94|33.95|39.94|Reclining back add ped w/c E1015|NU||D|IN|125.44|106.62|125.44|Shock absorber for man w/c E1015|RR||D|IN|12.53|10.65|12.53|Shock absorber for man w/c E1015|UE||D|IN|94.07|79.96|94.07|Shock absorber for man w/c E1016|NU||D|IN|123.77|105.2|123.77|Shock absorber for power w/c E1016|NU|KE|D|IN|143.6|122.06|143.6|Shock absorber for power w/c E1016|RR||D|IN|12.39|10.53|12.39|Shock absorber for power w/c E1016|RR|KE|D|IN|14.37|12.21|14.37|Shock absorber for power w/c E1016|UE||D|IN|92.82|78.9|92.82|Shock absorber for power w/c E1016|UE|KE|D|IN|107.7|91.55|107.7|Shock absorber for power w/c E1017|NU||D|IN|0|0|0|Hd shck absrbr for hd man wc E1017|RR||D|IN|0|0|0|Hd shck absrbr for hd man wc E1017|UE||D|IN|0|0|0|Hd shck absrbr for hd man wc E1018|NU||D|IN|0|0|0|Hd shck absrber for hd powwc E1018|RR||D|IN|0|0|0|Hd shck absrber for hd powwc E1018|UE||D|IN|0|0|0|Hd shck absrber for hd powwc E1020|NU||D|IN|229.42|195.01|229.42|Residual limb support system E1020|NU|KE|D|IN|266.18|226.25|266.18|Residual limb support system E1020|RR||D|IN|22.93|19.49|22.93|Residual limb support system E1020|RR|KE|D|IN|26.59|22.6|26.59|Residual limb support system E1020|UE||D|IN|172.05|146.24|172.05|Residual limb support system E1020|UE|KE|D|IN|199.64|169.69|199.64|Residual limb support system E1028|NU||D|IN|194.67|165.47|194.67|W/c manual swingaway E1028|NU|KE|D|IN|225.86|191.98|225.86|W/c manual swingaway E1028|RR||D|IN|19.46|16.54|19.46|W/c manual swingaway E1028|RR|KE|D|IN|22.58|19.19|22.58|W/c manual swingaway E1028|UE||D|IN|146|124.1|146|W/c manual swingaway E1028|UE|KE|D|IN|169.38|143.97|169.38|W/c manual swingaway E1029|RR||D|CR|34.82|29.6|34.82|W/c vent tray fixed E1029|RR|KE|D|CR|40.41|34.35|40.41|W/c vent tray fixed E1030|RR||D|CR|109.83|93.36|109.83|W/c vent tray gimbaled E1030|RR|KE|D|CR|127.43|108.32|127.43|W/c vent tray gimbaled E1031|RR||D|CR|55.24|46.95|46.95|Rollabout chair with casters E1035|RR||D|CR|670.57|569.98|670.57|Patient transfer system <300 E1036|RR||D|CR|940.07|799.06|940.07|Patient transfer system >300 E1037|RR||D|CR|118.63|100.84|118.63|Transport chair| ped size E1038|RR||D|CR|19.71|16.75|19.71|Transport chair pt wt<=300lb E1039|RR||D|CR|37.39|31.78|37.39|Transport chair pt wt >300lb E1050|RR||D|CR|111.36|94.66|94.66|Whelchr fxd full length arms E1060|RR||D|CR|137.85|117.17|117.17|Wheelchair detachable arms E1070|RR||D|CR|119.78|101.81|101.81|Wheelchair detachable foot r E1083|RR||D|CR|86.11|73.19|73.19|Hemi-wheelchair fixed arms E1084|RR||D|CR|107.28|91.19|107.28|Hemi-wheelchair detachable a E1087|RR||D|CR|138.36|117.61|117.61|Wheelchair lightwt fixed arm E1088|RR||D|CR|164.88|140.15|150.55|Wheelchair lightweight det a E1092|RR||D|CR|140.54|119.46|140.54|Wheelchair wide w/ leg rests E1093|RR||D|CR|120.86|102.73|102.73|Wheelchair wide w/ foot rest E1100|RR||D|CR|113.51|96.48|96.48|Whchr s-recl fxd arm leg res E1110|RR||D|CR|111.16|94.49|94.49|Wheelchair semi-recl detach E1150|RR||D|CR|89.2|75.82|81.82|Wheelchair standard w/ leg r E1160|RR||D|CR|68.35|58.1|58.1|Wheelchair fixed arms E1161|RR||D|CR|258.74|219.93|258.74|Manual adult wc w tiltinspac E1170|RR||D|CR|97.68|83.03|83.03|Whlchr ampu fxd arm leg rest E1171|RR||D|CR|87.66|74.51|77.52|Wheelchair amputee w/o leg r E1172|RR||D|CR|107.12|91.05|107.12|Wheelchair amputee detach ar E1180|RR||D|CR|110.82|94.2|94.2|Wheelchair amputee w/ foot r E1190|RR||D|CR|128.03|108.83|108.83|Wheelchair amputee w/ leg re E1195|RR||D|CR|137.38|116.77|116.77|Wheelchair amputee heavy dut E1200|RR||D|CR|95.15|80.88|80.88|Wheelchair amputee fixed arm E1221|RR||D|CR|51.96|44.17|51.96|Wheelchair spec size w foot E1222|RR||D|CR|74.13|63.01|73.49|Wheelchair spec size w/ leg E1223|RR||D|CR|80.94|68.8|80.94|Wheelchair spec size w foot E1224|RR||D|CR|88.74|75.43|88.74|Wheelchair spec size w/ leg E1225|RR||D|CR|49.43|42.02|44.41|Manual semi-reclining back E1226|NU||D|IN|596.7|507.2|596.7|Manual fully reclining back E1226|RR||D|IN|61.41|52.2|61.41|Manual fully reclining back E1226|UE||D|IN|447.48|380.36|447.48|Manual fully reclining back E1227|NU||D|IN|303.46|257.94|303.46|Wheelchair spec sz spec ht a E1227|RR||D|IN|30.35|25.8|30.35|Wheelchair spec sz spec ht a E1227|UE||D|IN|227.62|193.48|227.62|Wheelchair spec sz spec ht a E1228|RR||D|CR|30.64|26.04|26.04|Wheelchair spec sz spec ht b E1230|NU||D|IN|2473.38|2102.37|2473.38|Power operated vehicle E1230|RR||D|IN|243.26|206.77|243.26|Power operated vehicle E1230|UE||D|IN|1956.14|1662.72|1873.02|Power operated vehicle E1231|NU||D|IN|0|0|0|Rigid ped w/c tilt-in-space E1231|RR||D|IN|0|0|0|Rigid ped w/c tilt-in-space E1231|UE||D|IN|0|0|0|Rigid ped w/c tilt-in-space E1232|RR||D|CR|233.86|198.78|233.86|Folding ped wc tilt-in-space E1233|RR||D|CR|242.3|205.96|242.3|Rig ped wc tltnspc w/o seat E1234|RR||D|CR|210.96|179.32|210.96|Fld ped wc tltnspc w/o seat E1235|RR||D|CR|203.13|172.66|203.13|Rigid ped wc adjustable E1236|RR||D|CR|179.2|152.32|179.2|Folding ped wc adjustable E1237|RR||D|CR|180.77|153.65|180.77|Rgd ped wc adjstabl w/o seat E1238|RR||D|CR|179.2|152.32|179.2|Fld ped wc adjstabl w/o seat E1240|RR||D|CR|112.66|95.76|112.66|Whchr litwt det arm leg rest E1270|RR||D|CR|86.33|73.38|86.33|Wheelchair lightweight leg r E1280|RR||D|CR|143.53|122|125.02|Whchr h-duty det arm leg res E1295|RR||D|CR|132.83|112.91|132.83|Wheelchair heavy duty fixed E1296|NU||D|IN|537.65|457|537.65|Wheelchair special seat heig E1296|RR||D|IN|54.62|46.43|54.62|Wheelchair special seat heig E1296|UE||D|IN|403.24|342.75|403.24|Wheelchair special seat heig E1297|NU||D|IN|114.39|97.23|114.39|Wheelchair special seat dept E1297|RR||D|IN|12.71|10.8|12.71|Wheelchair special seat dept E1297|UE||D|IN|85.78|72.91|85.78|Wheelchair special seat dept E1298|NU||D|IN|463.29|393.8|463.29|Wheelchair spec seat depth/w E1298|RR||D|IN|47.4|40.29|47.4|Wheelchair spec seat depth/w E1298|UE||D|IN|347.46|295.34|347.46|Wheelchair spec seat depth/w E1310|NU||D|IN|2348.28|1996.04|2348.28|Whirlpool non-portable E1310|RR||D|IN|200.85|170.72|200.85|Whirlpool non-portable E1310|UE||D|IN|1761.22|1497.04|1761.22|Whirlpool non-portable E1353|||D|OX|30.98|26.33|30.98|Oxygen supplies regulator E1355|||D|OX|23.33|19.83|23.33|Oxygen supplies stand/rack E1372|NU||D|IN|178.28|151.54|151.54|Oxy suppl heater for nebuliz E1372|RR||D|IN|25.91|22.02|22.02|Oxy suppl heater for nebuliz E1372|UE||D|IN|131.97|112.17|112.17|Oxy suppl heater for nebuliz E1390|RR||D|OX|0|0|178.24|Oxygen concentrator E1391|RR||D|OX|0|0|178.24|Oxygen concentrator| dual E1392|RR||D|OX|0|0|51.63|Portable oxygen concentrator E1405|RR||D|OX|0|0|210.83|O2/water vapor enrich w/heat E1406|RR||D|OX|0|0|195.85|O2/water vapor enrich w/o he E1700|RR||D|CR|37.71|32.05|37.71|Jaw motion rehab system E1701|||D|SU|11.6|9.86|11.01|Repl cushions for jaw motion E1702|||D|SU|24.68|20.98|22.12|Repl measr scales jaw motion E1800|RR||D|CR|133.96|113.87|113.87|Adjust elbow ext/flex device E1801|RR||D|CR|141.07|119.91|136.86|Sps elbow device E1802|RR||D|CR|357.38|303.77|357.38|Adjst forearm pro/sup device E1805|RR||D|CR|138.17|117.44|117.44|Adjust wrist ext/flex device E1806|RR||D|CR|115.83|98.46|112.34|Sps wrist device E1810|RR||D|CR|136.24|115.8|115.8|Adjust knee ext/flex device E1811|RR||D|CR|146.67|124.67|142.29|Sps knee device E1812|RR||D|CR|94.03|79.93|94.03|Knee ext/flex w act res ctrl E1815|RR||D|CR|138.17|117.44|117.44|Adjust ankle ext/flex device E1816|RR||D|CR|148.99|126.64|144.5|Sps ankle device E1818|RR||D|CR|152.1|129.29|147.51|Sps forearm device E1820|NU||D|IN|89.39|75.98|89.39|Soft interface material E1820|RR||D|IN|8.94|7.6|8.94|Soft interface material E1820|UE||D|IN|67.05|56.99|67.05|Soft interface material E1821|NU||D|IN|115.09|97.83|115.09|Replacement interface spsd E1821|RR||D|IN|11.49|9.77|11.49|Replacement interface spsd E1821|UE||D|IN|86.34|73.39|86.34|Replacement interface spsd E1825|RR||D|CR|138.17|117.44|117.44|Adjust finger ext/flex devc E1830|RR||D|CR|138.17|117.44|117.44|Adjust toe ext/flex device E1831|RR||D|CR|72.26|61.42|72.26|Static str toe dev ext/flex E1840|RR||D|CR|418.51|355.73|404.67|Adj shoulder ext/flex device E1841|RR||D|CR|495.36|421.06|495.36|Static str shldr dev rom adj E2000|RR||D|CR|56.68|48.18|54.96|Gastric suction pump hme mdl E2100|NU||D|IN|703.35|597.85|597.85|Bld glucose monitor w voice E2100|RR||D|IN|70.34|59.79|59.79|Bld glucose monitor w voice E2100|UE||D|IN|527.52|448.39|448.39|Bld glucose monitor w voice E2101|NU||D|IN|206.2|175.27|206.2|Bld glucose monitor w lance E2101|RR||D|IN|20.61|17.52|20.61|Bld glucose monitor w lance E2101|UE||D|IN|154.65|131.45|154.65|Bld glucose monitor w lance E2120|RR||D|CR|310.05|263.54|310.05|Pulse gen sys tx endolymp fl E2201|NU||D|IN|408.01|346.81|408.01|Man w/ch acc seat w>=20<24 E2201|RR||D|IN|40.8|34.68|40.8|Man w/ch acc seat w>=20<24 E2201|UE||D|IN|306|260.1|306|Man w/ch acc seat w>=20<24 E2202|NU||D|IN|518.31|440.56|518.31|Seat width 24-27 in E2202|RR||D|IN|51.83|44.06|51.83|Seat width 24-27 in E2202|UE||D|IN|388.76|330.45|388.76|Seat width 24-27 in E2203|NU||D|IN|523.87|445.29|523.87|Frame depth less than 22 in E2203|RR||D|IN|52.37|44.51|52.37|Frame depth less than 22 in E2203|UE||D|IN|392.88|333.95|392.88|Frame depth less than 22 in E2204|NU||D|IN|889.5|756.08|889.5|Frame depth 22 to 25 in E2204|RR||D|IN|88.96|75.62|88.96|Frame depth 22 to 25 in E2204|UE||D|IN|667.12|567.05|667.12|Frame depth 22 to 25 in E2205|NU||D|IN|35.72|30.36|35.72|Manual wc accessory| handrim E2205|RR||D|IN|3.56|3.03|3.56|Manual wc accessory| handrim E2205|UE||D|IN|26.82|22.8|26.82|Manual wc accessory| handrim E2206|NU||D|IN|44.48|37.81|44.48|Complete wheel lock assembly E2206|RR||D|IN|4.43|3.77|4.43|Complete wheel lock assembly E2206|UE||D|IN|33.36|28.36|33.36|Complete wheel lock assembly E2207|NU||D|IN|47.4|40.29|47.4|Crutch and cane holder E2207|RR||D|IN|4.76|4.05|4.76|Crutch and cane holder E2207|UE||D|IN|35.56|30.23|35.56|Crutch and cane holder E2208|NU||D|IN|111.96|95.17|111.96|Cylinder tank carrier E2208|NU|KE|D|IN|129.9|110.42|129.9|Cylinder tank carrier E2208|RR||D|IN|11.19|9.51|11.19|Cylinder tank carrier E2208|RR|KE|D|IN|12.98|11.03|12.98|Cylinder tank carrier E2208|UE||D|IN|83.97|71.37|83.97|Cylinder tank carrier E2208|UE|KE|D|IN|97.42|82.81|97.42|Cylinder tank carrier E2209|NU||D|IN|101|85.85|101|Arm trough each E2209|NU|KE|D|IN|117.19|99.61|117.19|Arm trough each E2209|RR||D|IN|10.12|8.6|10.12|Arm trough each E2209|RR|KE|D|IN|11.75|9.99|11.75|Arm trough each E2209|UE||D|IN|75.76|64.4|75.76|Arm trough each E2209|UE|KE|D|IN|87.9|74.72|87.9|Arm trough each E2210|NU||D|IN|6.17|5.24|6.17|Wheelchair bearings E2210|NU|KE|D|IN|7.16|6.09|7.16|Wheelchair bearings E2210|RR||D|IN|0.62|0.53|0.62|Wheelchair bearings E2210|RR|KE|D|IN|0.73|0.62|0.73|Wheelchair bearings E2210|UE||D|IN|4.65|3.95|4.65|Wheelchair bearings E2210|UE|KE|D|IN|5.37|4.56|5.37|Wheelchair bearings E2211|NU||D|IN|44.74|38.03|40.02|Pneumatic propulsion tire E2211|RR||D|IN|4.38|3.72|3.98|Pneumatic propulsion tire E2211|UE||D|IN|32.05|27.24|28.15|Pneumatic propulsion tire E2212|NU||D|IN|6.42|5.46|6.42|Pneumatic prop tire tube E2212|RR||D|IN|0.68|0.58|0.68|Pneumatic prop tire tube E2212|UE||D|IN|4.84|4.11|4.84|Pneumatic prop tire tube E2213|NU||D|IN|33.26|28.27|33.26|Pneumatic prop tire insert E2213|RR||D|IN|3.34|2.84|3.34|Pneumatic prop tire insert E2213|UE||D|IN|24.93|21.19|24.93|Pneumatic prop tire insert E2214|NU||D|IN|39.37|33.46|33.46|Pneumatic caster tire each E2214|RR||D|IN|4.33|3.68|3.68|Pneumatic caster tire each E2214|UE||D|IN|29.51|25.08|25.08|Pneumatic caster tire each E2215|NU||D|IN|10.49|8.92|10.49|Pneumatic caster tire tube E2215|RR||D|IN|1.04|0.88|1.04|Pneumatic caster tire tube E2215|UE||D|IN|7.85|6.67|7.85|Pneumatic caster tire tube E2216|NU||D|IN|0|0|0|Foam filled propulsion tire E2216|RR||D|IN|0|0|0|Foam filled propulsion tire E2216|UE||D|IN|0|0|0|Foam filled propulsion tire E2217|NU||D|IN|0|0|0|Foam filled caster tire each E2217|RR||D|IN|0|0|0|Foam filled caster tire each E2217|UE||D|IN|0|0|0|Foam filled caster tire each E2218|NU||D|IN|0|0|0|Foam propulsion tire each E2218|RR||D|IN|0|0|0|Foam propulsion tire each E2218|UE||D|IN|0|0|0|Foam propulsion tire each E2219|NU||D|IN|45.76|38.9|45.76|Foam caster tire any size ea E2219|RR||D|IN|5.17|4.39|5.17|Foam caster tire any size ea E2219|UE||D|IN|34.33|29.18|34.33|Foam caster tire any size ea E2220|NU||D|IN|31.2|26.52|31.2|Solid propulsion tire each E2220|RR||D|IN|3.01|2.56|3.01|Solid propulsion tire each E2220|UE||D|IN|23.86|20.28|23.86|Solid propulsion tire each E2221|NU||D|IN|27.94|23.75|27.94|Solid caster tire each E2221|RR||D|IN|2.83|2.41|2.83|Solid caster tire each E2221|UE||D|IN|20.97|17.82|20.97|Solid caster tire each E2222|NU||D|IN|23.03|19.58|23.03|Solid caster integrated whl E2222|RR||D|IN|2.28|1.94|2.28|Solid caster integrated whl E2222|UE||D|IN|17.29|14.7|17.29|Solid caster integrated whl E2224|NU||D|IN|107.23|91.15|91.15|Propulsion whl excludes tire E2224|RR||D|IN|11.25|9.56|9.56|Propulsion whl excludes tire E2224|UE||D|IN|80.43|68.37|68.37|Propulsion whl excludes tire E2225|NU||D|IN|19.03|16.18|19.03|Caster wheel excludes tire E2225|RR||D|IN|1.9|1.62|1.9|Caster wheel excludes tire E2225|UE||D|IN|14.26|12.12|14.26|Caster wheel excludes tire E2226|NU||D|IN|41.5|35.28|41.5|Caster fork replacement only E2226|RR||D|IN|4.15|3.53|4.15|Caster fork replacement only E2226|UE||D|IN|31.12|26.45|31.12|Caster fork replacement only E2227|RR||D|CR|204.58|173.89|204.58|Gear reduction drive wheel E2228|NU||D|IN|1023.85|870.27|1023.85|Mwc acc| wheelchair brake E2228|RR||D|IN|102.37|87.01|102.37|Mwc acc| wheelchair brake E2228|UE||D|IN|767.9|652.72|767.9|Mwc acc| wheelchair brake E2231|NU||D|IN|168.05|142.84|168.05|Solid seat support base E2231|RR||D|IN|16.81|14.29|16.81|Solid seat support base E2231|UE||D|IN|126.03|107.13|126.03|Solid seat support base E2310|RR||D|CR|110.29|93.75|110.29|Electro connect btw control E2310|RR|KE|D|CR|127.98|108.78|127.98|Electro connect btw control E2311|RR||D|CR|223.31|189.81|223.31|Electro connect btw 2 sys E2311|RR|KE|D|CR|259.1|220.24|259.1|Electro connect btw 2 sys E2312|RR||D|CR|220.53|187.45|220.53|Mini-prop remote joystick E2312|RR|KC|D|CR|281.25|239.06|281.25|Mini-prop remote joystick E2313|RR||D|CR|35.04|29.78|35.04|Pwc harness| expand control E2321|RR||D|CR|149.79|127.32|149.79|Hand interface joystick E2321|RR|KC|D|CR|243.99|207.39|243.99|Hand interface joystick E2321|RR|KE|D|CR|173.79|147.72|173.79|Hand interface joystick E2322|RR||D|CR|132.92|112.98|132.92|Mult mech switches E2322|RR|KC|D|CR|258.36|219.61|258.36|Mult mech switches E2322|RR|KE|D|CR|154.22|131.09|154.22|Mult mech switches E2323|NU||D|IN|65.19|55.41|65.19|Special joystick handle E2323|NU|KE|D|IN|75.63|64.29|75.63|Special joystick handle E2323|RR||D|IN|6.51|5.53|6.51|Special joystick handle E2323|RR|KE|D|IN|7.56|6.43|7.56|Special joystick handle E2323|UE||D|IN|48.88|41.55|48.88|Special joystick handle E2323|UE|KE|D|IN|56.73|48.22|56.73|Special joystick handle E2324|NU||D|IN|41.3|35.11|41.3|Chin cup interface E2324|NU|KE|D|IN|47.91|40.72|47.91|Chin cup interface E2324|RR||D|IN|4.11|3.49|4.11|Chin cup interface E2324|RR|KE|D|IN|4.79|4.07|4.79|Chin cup interface E2324|UE||D|IN|30.98|26.33|30.98|Chin cup interface E2324|UE|KE|D|IN|35.95|30.56|35.95|Chin cup interface E2325|RR||D|CR|126.96|107.92|126.96|Sip and puff interface E2325|RR|KE|D|CR|147.31|125.21|147.31|Sip and puff interface E2326|RR||D|CR|32.73|27.82|32.73|Breath tube kit E2326|RR|KE|D|CR|37.98|32.28|37.98|Breath tube kit E2327|RR||D|CR|246.22|209.29|246.22|Head control interface mech E2327|RR|KC|D|CR|374.07|317.96|374.07|Head control interface mech E2327|RR|KE|D|CR|285.68|242.83|285.68|Head control interface mech E2328|RR||D|CR|467.04|396.98|467.04|Head/extremity control inter E2328|RR|KE|D|CR|541.88|460.6|541.88|Head/extremity control inter E2329|RR||D|CR|166.46|141.49|166.46|Head control nonproportional E2329|RR|KE|D|CR|193.13|164.16|193.13|Head control nonproportional E2330|RR||D|CR|322.53|274.15|322.53|Head control proximity switc E2330|RR|KE|D|CR|374.21|318.08|374.21|Head control proximity switc E2340|NU||D|IN|391.88|333.1|391.88|W/c wdth 20-23 in seat frame E2340|RR||D|IN|39.2|33.32|39.2|W/c wdth 20-23 in seat frame E2340|UE||D|IN|293.94|249.85|293.94|W/c wdth 20-23 in seat frame E2341|NU||D|IN|587.87|499.69|587.87|W/c wdth 24-27 in seat frame E2341|RR||D|IN|58.78|49.96|58.78|W/c wdth 24-27 in seat frame E2341|UE||D|IN|440.91|374.77|440.91|W/c wdth 24-27 in seat frame E2342|NU||D|IN|489.89|416.41|489.89|W/c dpth 20-21 in seat frame E2342|RR||D|IN|48.99|41.64|48.99|W/c dpth 20-21 in seat frame E2342|UE||D|IN|367.43|312.32|367.43|W/c dpth 20-21 in seat frame E2343|NU||D|IN|783.83|666.26|783.83|W/c dpth 22-25 in seat frame E2343|RR||D|IN|78.37|66.61|78.37|W/c dpth 22-25 in seat frame E2343|UE||D|IN|587.87|499.69|587.87|W/c dpth 22-25 in seat frame E2351|RR||D|CR|65.87|55.99|65.87|Electronic sgd interface E2351|RR|KE|D|CR|76.42|64.96|76.42|Electronic sgd interface E2359|NU||D|IN|190.43|161.87|190.43|Gr34 sealed leadacid battery E2359|RR||D|IN|19.05|16.19|19.05|Gr34 sealed leadacid battery E2359|UE||D|IN|142.81|121.39|142.81|Gr34 sealed leadacid battery E2360|NU||D|IN|122.86|104.43|104.43|22nf nonsealed leadacid E2360|RR||D|IN|12.34|10.49|10.49|22nf nonsealed leadacid E2360|UE||D|IN|92.13|78.31|78.31|22nf nonsealed leadacid E2361|NU||D|IN|131.45|111.73|131.45|22nf sealed leadacid battery E2361|NU|KE|D|IN|152.51|129.63|152.51|22nf sealed leadacid battery E2361|RR||D|IN|13.14|11.17|13.14|22nf sealed leadacid battery E2361|RR|KE|D|IN|15.26|12.97|15.26|22nf sealed leadacid battery E2361|UE||D|IN|98.61|83.82|98.61|22nf sealed leadacid battery E2361|UE|KE|D|IN|114.4|97.24|114.4|22nf sealed leadacid battery E2362|NU||D|IN|100.59|85.5|100.59|Gr24 nonsealed leadacid E2362|RR||D|IN|10.06|8.55|10.06|Gr24 nonsealed leadacid E2362|UE||D|IN|75.44|64.12|75.44|Gr24 nonsealed leadacid E2363|NU||D|IN|175.32|149.02|175.32|Gr24 sealed leadacid battery E2363|NU|KE|D|IN|203.39|172.88|203.39|Gr24 sealed leadacid battery E2363|RR||D|IN|17.53|14.9|17.53|Gr24 sealed leadacid battery E2363|RR|KE|D|IN|20.35|17.3|20.35|Gr24 sealed leadacid battery E2363|UE||D|IN|131.48|111.76|131.48|Gr24 sealed leadacid battery E2363|UE|KE|D|IN|152.55|129.67|152.55|Gr24 sealed leadacid battery E2364|NU||D|IN|122.86|104.43|104.43|U1nonsealed leadacid battery E2364|RR||D|IN|12.34|10.49|10.49|U1nonsealed leadacid battery E2364|UE||D|IN|92.13|78.31|78.31|U1nonsealed leadacid battery E2365|NU||D|IN|105.72|89.86|105.72|U1 sealed leadacid battery E2365|NU|KE|D|IN|122.65|104.25|122.65|U1 sealed leadacid battery E2365|RR||D|IN|10.56|8.98|10.56|U1 sealed leadacid battery E2365|RR|KE|D|IN|12.27|10.43|12.27|U1 sealed leadacid battery E2365|UE||D|IN|79.32|67.42|79.32|U1 sealed leadacid battery E2365|UE|KE|D|IN|92.02|78.22|92.02|U1 sealed leadacid battery E2366|NU||D|IN|248.47|211.2|211.2|Battery charger| single mode E2366|NU|KE|D|IN|288.28|245.04|245.04|Battery charger| single mode E2366|RR||D|IN|24.92|21.18|21.18|Battery charger| single mode E2366|RR|KE|D|IN|28.91|24.57|24.57|Battery charger| single mode E2366|UE||D|IN|186.36|158.41|158.41|Battery charger| single mode E2366|UE|KE|D|IN|216.22|183.79|183.79|Battery charger| single mode E2367|NU||D|IN|394.99|335.74|394.99|Battery charger| dual mode E2367|NU|KE|D|IN|458.28|389.54|458.28|Battery charger| dual mode E2367|RR||D|IN|39.5|33.58|39.5|Battery charger| dual mode E2367|RR|KE|D|IN|45.84|38.96|45.84|Battery charger| dual mode E2367|UE||D|IN|296.25|251.81|296.25|Battery charger| dual mode E2367|UE|KE|D|IN|343.71|292.15|343.71|Battery charger| dual mode E2368|NU||D|IN|486.89|413.86|486.89|Pwr wc drivewheel motor repl E2368|NU|KE|D|IN|564.89|480.16|564.89|Pwr wc drivewheel motor repl E2368|RR||D|IN|48.69|41.39|48.69|Pwr wc drivewheel motor repl E2368|RR|KE|D|IN|56.5|48.03|56.5|Pwr wc drivewheel motor repl E2368|UE||D|IN|365.18|310.4|365.18|Pwr wc drivewheel motor repl E2368|UE|KE|D|IN|423.67|360.12|423.67|Pwr wc drivewheel motor repl E2369|NU||D|IN|424.08|360.47|424.08|Pwr wc drivewheel gear repl E2369|NU|KE|D|IN|492.04|418.23|492.04|Pwr wc drivewheel gear repl E2369|RR||D|IN|42.42|36.06|42.42|Pwr wc drivewheel gear repl E2369|RR|KE|D|IN|49.21|41.83|49.21|Pwr wc drivewheel gear repl E2369|UE||D|IN|318.05|270.34|318.05|Pwr wc drivewheel gear repl E2369|UE|KE|D|IN|369.02|313.67|369.02|Pwr wc drivewheel gear repl E2370|NU||D|IN|756.7|643.2|756.7|Pwr wc dr wh motor/gear comb E2370|NU|KE|D|IN|877.94|746.25|877.94|Pwr wc dr wh motor/gear comb E2370|RR||D|IN|75.67|64.32|75.67|Pwr wc dr wh motor/gear comb E2370|RR|KE|D|IN|87.8|74.63|87.8|Pwr wc dr wh motor/gear comb E2370|UE||D|IN|567.53|482.4|567.53|Pwr wc dr wh motor/gear comb E2370|UE|KE|D|IN|658.45|559.68|658.45|Pwr wc dr wh motor/gear comb E2371|NU||D|IN|142.08|120.77|142.08|Gr27 sealed leadacid battery E2371|NU|KE|D|IN|164.84|140.11|164.84|Gr27 sealed leadacid battery E2371|RR||D|IN|14.22|12.09|14.22|Gr27 sealed leadacid battery E2371|RR|KE|D|IN|16.48|14.01|16.48|Gr27 sealed leadacid battery E2371|UE||D|IN|106.57|90.58|106.57|Gr27 sealed leadacid battery E2371|UE|KE|D|IN|123.63|105.09|123.63|Gr27 sealed leadacid battery E2372|NU||D|IN|0|0|0|Gr27 non-sealed leadacid E2372|RR||D|IN|0|0|0|Gr27 non-sealed leadacid E2372|UE||D|IN|0|0|0|Gr27 non-sealed leadacid E2373|RR||D|CR|76.86|65.33|76.86|Hand/chin ctrl spec joystick E2373|RR|KC|D|CR|118.6|100.81|118.6|Hand/chin ctrl spec joystick E2373|RR|KE|D|CR|137.6|116.96|137.6|Hand/chin ctrl spec joystick E2374|RR||D|CR|50.34|42.79|50.34|Hand/chin ctrl std joystick E2374|RR|KE|D|CR|58.39|49.63|58.39|Hand/chin ctrl std joystick E2375|NU||D|IN|807.33|686.23|807.33|Non-expandable controller E2375|NU|KE|D|IN|936.68|796.18|936.68|Non-expandable controller E2375|RR||D|IN|80.72|68.61|80.72|Non-expandable controller E2375|RR|KE|D|IN|93.67|79.62|93.67|Non-expandable controller E2375|UE||D|IN|605.48|514.66|605.48|Non-expandable controller E2375|UE|KE|D|IN|702.5|597.13|702.5|Non-expandable controller E2376|RR||D|CR|126.51|107.53|126.51|Expandable controller| repl E2376|RR|KE|D|CR|146.78|124.76|146.78|Expandable controller| repl E2377|RR||D|CR|45.77|38.9|45.77|Expandable controller| initl E2377|RR|KE|D|CR|53.11|45.14|53.11|Expandable controller| initl E2378|RR||D|CR|55.96|47.57|55.96|Pw actuator replacement E2381|NU||D|IN|71.79|61.02|71.79|Pneum drive wheel tire E2381|NU|KE|D|IN|83.3|70.81|83.3|Pneum drive wheel tire E2381|RR||D|IN|7.2|6.12|7.2|Pneum drive wheel tire E2381|RR|KE|D|IN|8.34|7.09|8.34|Pneum drive wheel tire E2381|UE||D|IN|53.85|45.77|53.85|Pneum drive wheel tire E2381|UE|KE|D|IN|62.49|53.12|62.49|Pneum drive wheel tire E2382|NU||D|IN|19.57|16.63|19.57|Tube| pneum wheel drive tire E2382|NU|KE|D|IN|22.71|19.3|22.71|Tube| pneum wheel drive tire E2382|RR||D|IN|1.95|1.66|1.95|Tube| pneum wheel drive tire E2382|RR|KE|D|IN|2.26|1.92|2.26|Tube| pneum wheel drive tire E2382|UE||D|IN|14.69|12.49|14.69|Tube| pneum wheel drive tire E2382|UE|KE|D|IN|17.02|14.47|17.02|Tube| pneum wheel drive tire E2383|NU||D|IN|143.15|121.68|143.15|Insert| pneum wheel drive E2383|NU|KE|D|IN|166.08|141.17|166.08|Insert| pneum wheel drive E2383|RR||D|IN|14.32|12.17|14.32|Insert| pneum wheel drive E2383|RR|KE|D|IN|16.6|14.11|16.6|Insert| pneum wheel drive E2383|UE||D|IN|107.36|91.26|107.36|Insert| pneum wheel drive E2383|UE|KE|D|IN|124.57|105.88|124.57|Insert| pneum wheel drive E2384|NU||D|IN|76.27|64.83|76.27|Pneumatic caster tire E2384|NU|KE|D|IN|88.5|75.23|88.5|Pneumatic caster tire E2384|RR||D|IN|7.65|6.5|7.65|Pneumatic caster tire E2384|RR|KE|D|IN|8.87|7.54|8.87|Pneumatic caster tire E2384|UE||D|IN|57.21|48.63|57.21|Pneumatic caster tire E2384|UE|KE|D|IN|66.36|56.41|66.36|Pneumatic caster tire E2385|NU||D|IN|46.66|39.66|46.66|Tube| pneumatic caster tire E2385|NU|KE|D|IN|54.15|46.03|54.15|Tube| pneumatic caster tire E2385|RR||D|IN|4.69|3.99|4.69|Tube| pneumatic caster tire E2385|RR|KE|D|IN|5.41|4.6|5.41|Tube| pneumatic caster tire E2385|UE||D|IN|34.98|29.73|34.98|Tube| pneumatic caster tire E2385|UE|KE|D|IN|40.58|34.49|40.58|Tube| pneumatic caster tire E2386|NU||D|IN|141.85|120.57|141.85|Foam filled drive wheel tire E2386|NU|KE|D|IN|164.59|139.9|164.59|Foam filled drive wheel tire E2386|RR||D|IN|14.19|12.06|14.19|Foam filled drive wheel tire E2386|RR|KE|D|IN|16.45|13.98|16.45|Foam filled drive wheel tire E2386|UE||D|IN|106.39|90.43|106.39|Foam filled drive wheel tire E2386|UE|KE|D|IN|123.42|104.91|123.42|Foam filled drive wheel tire E2387|NU||D|IN|63.61|54.07|63.61|Foam filled caster tire E2387|NU|KE|D|IN|73.8|62.73|73.8|Foam filled caster tire E2387|RR||D|IN|6.36|5.41|6.36|Foam filled caster tire E2387|RR|KE|D|IN|7.38|6.27|7.38|Foam filled caster tire E2387|UE||D|IN|47.74|40.58|47.74|Foam filled caster tire E2387|UE|KE|D|IN|55.4|47.09|55.4|Foam filled caster tire E2388|NU||D|IN|47.48|40.36|47.48|Foam drive wheel tire E2388|NU|KE|D|IN|55.11|46.84|55.11|Foam drive wheel tire E2388|RR||D|IN|4.76|4.05|4.76|Foam drive wheel tire E2388|RR|KE|D|IN|5.5|4.68|5.5|Foam drive wheel tire E2388|UE||D|IN|35.63|30.29|35.63|Foam drive wheel tire E2388|UE|KE|D|IN|41.33|35.13|41.33|Foam drive wheel tire E2389|NU||D|IN|25.79|21.92|25.79|Foam caster tire E2389|NU|KE|D|IN|29.93|25.44|29.93|Foam caster tire E2389|RR||D|IN|2.59|2.2|2.59|Foam caster tire E2389|RR|KE|D|IN|3|2.55|3|Foam caster tire E2389|UE||D|IN|19.32|16.42|19.32|Foam caster tire E2389|UE|KE|D|IN|22.44|19.07|22.44|Foam caster tire E2390|NU||D|IN|40.33|34.28|40.33|Solid drive wheel tire E2390|NU|KE|D|IN|46.8|39.78|46.8|Solid drive wheel tire E2390|RR||D|IN|4.03|3.43|4.03|Solid drive wheel tire E2390|RR|KE|D|IN|4.69|3.99|4.69|Solid drive wheel tire E2390|UE||D|IN|30.23|25.7|30.23|Solid drive wheel tire E2390|UE|KE|D|IN|35.08|29.82|35.08|Solid drive wheel tire E2391|NU||D|IN|19.31|16.41|19.31|Solid caster tire E2391|NU|KE|D|IN|22.43|19.07|22.43|Solid caster tire E2391|RR||D|IN|1.94|1.65|1.94|Solid caster tire E2391|RR|KE|D|IN|2.24|1.9|2.24|Solid caster tire E2391|UE||D|IN|14.49|12.32|14.49|Solid caster tire E2391|UE|KE|D|IN|16.82|14.3|16.82|Solid caster tire E2392|NU||D|IN|50.78|43.16|50.78|Solid caster tire| integrate E2392|NU|KE|D|IN|58.91|50.07|58.91|Solid caster tire| integrate E2392|RR||D|IN|5.1|4.34|5.1|Solid caster tire| integrate E2392|RR|KE|D|IN|5.91|5.02|5.91|Solid caster tire| integrate E2392|UE||D|IN|38.09|32.38|38.09|Solid caster tire| integrate E2392|UE|KE|D|IN|44.2|37.57|44.2|Solid caster tire| integrate E2394|NU||D|IN|72.35|61.5|72.35|Drive wheel excludes tire E2394|NU|KE|D|IN|83.93|71.34|83.93|Drive wheel excludes tire E2394|RR||D|IN|7.25|6.16|7.25|Drive wheel excludes tire E2394|RR|KE|D|IN|8.4|7.14|8.4|Drive wheel excludes tire E2394|UE||D|IN|54.27|46.13|54.27|Drive wheel excludes tire E2394|UE|KE|D|IN|62.95|53.51|62.95|Drive wheel excludes tire E2395|NU||D|IN|51.41|43.7|51.41|Caster wheel excludes tire E2395|NU|KE|D|IN|59.65|50.7|59.65|Caster wheel excludes tire E2395|RR||D|IN|5.15|4.38|5.15|Caster wheel excludes tire E2395|RR|KE|D|IN|5.97|5.07|5.97|Caster wheel excludes tire E2395|UE||D|IN|38.57|32.78|38.57|Caster wheel excludes tire E2395|UE|KE|D|IN|44.76|38.05|44.76|Caster wheel excludes tire E2396|NU||D|IN|62.68|53.28|62.68|Caster fork E2396|NU|KE|D|IN|72.73|61.82|72.73|Caster fork E2396|RR||D|IN|6.71|5.7|6.65|Caster fork E2396|RR|KE|D|IN|7.8|6.63|7.72|Caster fork E2396|UE||D|IN|47.02|39.97|47.02|Caster fork E2396|UE|KE|D|IN|54.56|46.38|54.56|Caster fork E2397|NU||D|IN|452.88|384.95|452.88|Pwc acc| lith-based battery E2397|RR||D|IN|45.29|38.5|45.29|Pwc acc| lith-based battery E2397|UE||D|IN|339.64|288.69|339.64|Pwc acc| lith-based battery E2402|RR||D|CR|1617.82|1375.15|1617.82|Neg press wound therapy pump E2500|RR||D|CR|42.77|36.35|42.77|Sgd digitized pre-rec <=8min E2502|RR||D|CR|130.77|111.15|130.77|Sgd prerec msg >8min <=20min E2504|RR||D|CR|172.52|146.64|172.52|Sgd prerec msg>20min <=40min E2506|RR||D|CR|252.92|214.98|252.92|Sgd prerec msg > 40 min E2508|RR||D|CR|391.11|332.44|391.11|Sgd spelling phys contact E2510|RR||D|CR|740.14|629.12|740.14|Sgd w multi methods msg/accs E2511|NU||D|IN|0|0|0|Sgd sftwre prgrm for pc/pda E2511|RR||D|IN|0|0|0|Sgd sftwre prgrm for pc/pda E2511|UE||D|IN|0|0|0|Sgd sftwre prgrm for pc/pda E2512|NU||D|IN|0|0|0|Sgd accessory| mounting sys E2512|RR||D|IN|0|0|0|Sgd accessory| mounting sys E2512|UE||D|IN|0|0|0|Sgd accessory| mounting sys E2601|NU||D|IN|57.64|48.99|57.64|Gen w/c cushion wdth < 22 in E2601|NU|KE|D|IN|66.89|56.86|66.89|Gen w/c cushion wdth < 22 in E2601|RR||D|IN|5.78|4.91|5.78|Gen w/c cushion wdth < 22 in E2601|RR|KE|D|IN|6.7|5.7|6.7|Gen w/c cushion wdth < 22 in E2601|UE||D|IN|43.24|36.75|43.24|Gen w/c cushion wdth < 22 in E2601|UE|KE|D|IN|50.15|42.63|50.15|Gen w/c cushion wdth < 22 in E2602|NU||D|IN|112.53|95.65|112.53|Gen w/c cushion wdth >=22 in E2602|NU|KE|D|IN|130.57|110.98|130.57|Gen w/c cushion wdth >=22 in E2602|RR||D|IN|11.26|9.57|11.26|Gen w/c cushion wdth >=22 in E2602|RR|KE|D|IN|13.06|11.1|13.06|Gen w/c cushion wdth >=22 in E2602|UE||D|IN|84.4|71.74|84.4|Gen w/c cushion wdth >=22 in E2602|UE|KE|D|IN|97.93|83.24|97.93|Gen w/c cushion wdth >=22 in E2603|NU||D|IN|142.87|121.44|142.87|Skin protect wc cus wd <22in E2603|NU|KE|D|IN|165.77|140.9|165.77|Skin protect wc cus wd <22in E2603|RR||D|IN|14.3|12.16|14.3|Skin protect wc cus wd <22in E2603|RR|KE|D|IN|16.58|14.09|16.58|Skin protect wc cus wd <22in E2603|UE||D|IN|107.16|91.09|107.16|Skin protect wc cus wd <22in E2603|UE|KE|D|IN|124.32|105.67|124.32|Skin protect wc cus wd <22in E2604|NU||D|IN|177.59|150.95|177.59|Skin protect wc cus wd>=22in E2604|NU|KE|D|IN|206.03|175.13|206.03|Skin protect wc cus wd>=22in E2604|RR||D|IN|17.75|15.09|17.75|Skin protect wc cus wd>=22in E2604|RR|KE|D|IN|20.58|17.49|20.58|Skin protect wc cus wd>=22in E2604|UE||D|IN|133.21|113.23|133.21|Skin protect wc cus wd>=22in E2604|UE|KE|D|IN|154.55|131.37|154.55|Skin protect wc cus wd>=22in E2605|NU||D|IN|253.7|215.65|253.7|Position wc cush wdth <22 in E2605|NU|KE|D|IN|294.35|250.2|294.35|Position wc cush wdth <22 in E2605|RR||D|IN|25.38|21.57|25.38|Position wc cush wdth <22 in E2605|RR|KE|D|IN|29.45|25.03|29.45|Position wc cush wdth <22 in E2605|UE||D|IN|190.31|161.76|190.31|Position wc cush wdth <22 in E2605|UE|KE|D|IN|220.81|187.69|220.81|Position wc cush wdth <22 in E2606|NU||D|IN|395.8|336.43|395.8|Position wc cush wdth>=22 in E2606|NU|KE|D|IN|459.22|390.34|459.22|Position wc cush wdth>=22 in E2606|RR||D|IN|39.59|33.65|39.59|Position wc cush wdth>=22 in E2606|RR|KE|D|IN|45.94|39.05|45.94|Position wc cush wdth>=22 in E2606|UE||D|IN|296.83|252.31|296.83|Position wc cush wdth>=22 in E2606|UE|KE|D|IN|344.41|292.75|344.41|Position wc cush wdth>=22 in E2607|NU||D|IN|273.19|232.21|273.19|Skin pro/pos wc cus wd <22in E2607|NU|KE|D|IN|316.97|269.42|316.97|Skin pro/pos wc cus wd <22in E2607|RR||D|IN|27.32|23.22|27.32|Skin pro/pos wc cus wd <22in E2607|RR|KE|D|IN|31.7|26.95|31.7|Skin pro/pos wc cus wd <22in E2607|UE||D|IN|204.9|174.17|204.9|Skin pro/pos wc cus wd <22in E2607|UE|KE|D|IN|237.72|202.06|237.72|Skin pro/pos wc cus wd <22in E2608|NU||D|IN|328.08|278.87|328.08|Skin pro/pos wc cus wd>=22in E2608|NU|KE|D|IN|380.64|323.54|380.64|Skin pro/pos wc cus wd>=22in E2608|RR||D|IN|32.8|27.88|32.8|Skin pro/pos wc cus wd>=22in E2608|RR|KE|D|IN|38.06|32.35|38.06|Skin pro/pos wc cus wd>=22in E2608|UE||D|IN|246.06|209.15|246.06|Skin pro/pos wc cus wd>=22in E2608|UE|KE|D|IN|285.49|242.67|285.49|Skin pro/pos wc cus wd>=22in E2611|NU||D|IN|294.4|250.24|294.4|Gen use back cush wdth <22in E2611|NU|KE|D|IN|341.56|290.33|341.56|Gen use back cush wdth <22in E2611|RR||D|IN|29.43|25.02|29.43|Gen use back cush wdth <22in E2611|RR|KE|D|IN|34.16|29.04|34.16|Gen use back cush wdth <22in E2611|UE||D|IN|220.83|187.71|220.83|Gen use back cush wdth <22in E2611|UE|KE|D|IN|256.2|217.77|256.2|Gen use back cush wdth <22in E2612|NU||D|IN|398.26|338.52|398.26|Gen use back cush wdth>=22in E2612|NU|KE|D|IN|462.08|392.77|462.08|Gen use back cush wdth>=22in E2612|RR||D|IN|39.82|33.85|39.82|Gen use back cush wdth>=22in E2612|RR|KE|D|IN|46.2|39.27|46.2|Gen use back cush wdth>=22in E2612|UE||D|IN|298.69|253.89|298.69|Gen use back cush wdth>=22in E2612|UE|KE|D|IN|346.53|294.55|346.53|Gen use back cush wdth>=22in E2613|NU||D|IN|370.45|314.88|370.45|Position back cush wd <22in E2613|NU|KE|D|IN|429.81|365.34|429.81|Position back cush wd <22in E2613|RR||D|IN|37.05|31.49|37.05|Position back cush wd <22in E2613|RR|KE|D|IN|43|36.55|43|Position back cush wd <22in E2613|UE||D|IN|277.84|236.16|277.84|Position back cush wd <22in E2613|UE|KE|D|IN|322.35|274|322.35|Position back cush wd <22in E2614|NU||D|IN|512.68|435.78|512.68|Position back cush wd>=22in E2614|NU|KE|D|IN|594.81|505.59|594.81|Position back cush wd>=22in E2614|RR||D|IN|51.27|43.58|51.27|Position back cush wd>=22in E2614|RR|KE|D|IN|59.49|50.57|59.49|Position back cush wd>=22in E2614|UE||D|IN|384.52|326.84|384.52|Position back cush wd>=22in E2614|UE|KE|D|IN|446.14|379.22|446.14|Position back cush wd>=22in E2615|NU||D|IN|426.32|362.37|426.32|Pos back post/lat wdth <22in E2615|NU|KE|D|IN|494.65|420.45|494.65|Pos back post/lat wdth <22in E2615|RR||D|IN|42.64|36.24|42.64|Pos back post/lat wdth <22in E2615|RR|KE|D|IN|49.47|42.05|49.47|Pos back post/lat wdth <22in E2615|UE||D|IN|319.73|271.77|319.73|Pos back post/lat wdth <22in E2615|UE|KE|D|IN|370.95|315.31|370.95|Pos back post/lat wdth <22in E2616|NU||D|IN|573.61|487.57|573.61|Pos back post/lat wdth>=22in E2616|NU|KE|D|IN|665.51|565.68|665.51|Pos back post/lat wdth>=22in E2616|RR||D|IN|57.36|48.76|57.36|Pos back post/lat wdth>=22in E2616|RR|KE|D|IN|66.55|56.57|66.55|Pos back post/lat wdth>=22in E2616|UE||D|IN|430.22|365.69|430.22|Pos back post/lat wdth>=22in E2616|UE|KE|D|IN|499.14|424.27|499.14|Pos back post/lat wdth>=22in E2619|NU||D|IN|48.36|41.11|48.36|Replace cover w/c seat cush E2619|NU|KE|D|IN|56.13|47.71|56.13|Replace cover w/c seat cush E2619|RR||D|IN|4.84|4.11|4.84|Replace cover w/c seat cush E2619|RR|KE|D|IN|5.61|4.77|5.61|Replace cover w/c seat cush E2619|UE||D|IN|36.31|30.86|36.31|Replace cover w/c seat cush E2619|UE|KE|D|IN|42.12|35.8|42.12|Replace cover w/c seat cush E2620|NU||D|IN|516.22|438.79|516.22|Wc planar back cush wd <22in E2620|NU|KE|D|IN|598.94|509.1|598.94|Wc planar back cush wd <22in E2620|RR||D|IN|51.63|43.89|51.63|Wc planar back cush wd <22in E2620|RR|KE|D|IN|59.89|50.91|59.89|Wc planar back cush wd <22in E2620|UE||D|IN|387.17|329.09|387.17|Wc planar back cush wd <22in E2620|UE|KE|D|IN|449.22|381.84|449.22|Wc planar back cush wd <22in E2621|NU||D|IN|541.73|460.47|541.73|Wc planar back cush wd>=22in E2621|NU|KE|D|IN|628.53|534.25|628.53|Wc planar back cush wd>=22in E2621|RR||D|IN|54.18|46.05|54.18|Wc planar back cush wd>=22in E2621|RR|KE|D|IN|62.84|53.41|62.84|Wc planar back cush wd>=22in E2621|UE||D|IN|406.3|345.36|406.3|Wc planar back cush wd>=22in E2621|UE|KE|D|IN|471.4|400.69|471.4|Wc planar back cush wd>=22in E2622|NU||D|IN|312.41|265.55|312.41|Adj skin pro w/c cus wd<22in E2622|NU|KE|D|IN|362.47|308.1|362.47|Adj skin pro w/c cus wd<22in E2622|RR||D|IN|31.25|26.56|31.25|Adj skin pro w/c cus wd<22in E2622|RR|KE|D|IN|36.25|30.81|36.25|Adj skin pro w/c cus wd<22in E2622|UE||D|IN|234.31|199.16|234.31|Adj skin pro w/c cus wd<22in E2622|UE|KE|D|IN|271.86|231.08|271.86|Adj skin pro w/c cus wd<22in E2623|NU||D|IN|397.54|337.91|397.54|Adj skin pro wc cus wd>=22in E2623|NU|KE|D|IN|461.24|392.05|461.24|Adj skin pro wc cus wd>=22in E2623|RR||D|IN|39.76|33.8|39.76|Adj skin pro wc cus wd>=22in E2623|RR|KE|D|IN|46.14|39.22|46.14|Adj skin pro wc cus wd>=22in E2623|UE||D|IN|298.14|253.42|298.14|Adj skin pro wc cus wd>=22in E2623|UE|KE|D|IN|345.93|294.04|345.93|Adj skin pro wc cus wd>=22in E2624|NU||D|IN|314.99|267.74|314.99|Adj skin pro/pos cus<22in E2624|NU|KE|D|IN|365.45|310.63|365.45|Adj skin pro/pos cus<22in E2624|RR||D|IN|31.51|26.78|31.51|Adj skin pro/pos cus<22in E2624|RR|KE|D|IN|36.54|31.06|36.54|Adj skin pro/pos cus<22in E2624|UE||D|IN|236.26|200.82|236.26|Adj skin pro/pos cus<22in E2624|UE|KE|D|IN|274.1|232.99|274.1|Adj skin pro/pos cus<22in E2625|NU||D|IN|398.75|338.94|398.75|Adj skin pro/pos wc cus>=22 E2625|NU|KE|D|IN|462.64|393.24|462.64|Adj skin pro/pos wc cus>=22 E2625|RR||D|IN|39.86|33.88|39.86|Adj skin pro/pos wc cus>=22 E2625|RR|KE|D|IN|46.27|39.33|46.27|Adj skin pro/pos wc cus>=22 E2625|UE||D|IN|299.05|254.19|299.05|Adj skin pro/pos wc cus>=22 E2625|UE|KE|D|IN|346.98|294.93|346.98|Adj skin pro/pos wc cus>=22 E2626|NU||D|IN|679.23|577.35|679.23|Seo mobile arm sup att to wc E2626|RR||D|IN|67.9|57.72|67.9|Seo mobile arm sup att to wc E2626|UE||D|IN|509.37|432.96|509.37|Seo mobile arm sup att to wc E2627|NU||D|IN|1083.83|921.26|1083.83|Arm supp att to wc rancho ty E2627|RR||D|IN|108.41|92.15|108.41|Arm supp att to wc rancho ty E2627|UE||D|IN|812.87|690.94|812.87|Arm supp att to wc rancho ty E2628|NU||D|IN|816.49|694.02|816.49|Mobile arm supports reclinin E2628|RR||D|IN|81.65|69.4|81.65|Mobile arm supports reclinin E2628|UE||D|IN|612.36|520.51|612.36|Mobile arm supports reclinin E2629|NU||D|IN|1033.25|878.26|1033.25|Friction dampening arm supp E2629|RR||D|IN|103.31|87.81|103.31|Friction dampening arm supp E2629|UE||D|IN|774.94|658.7|774.94|Friction dampening arm supp E2630|NU||D|IN|722.55|614.17|722.55|Monosuspension arm/hand supp E2630|RR||D|IN|72.26|61.42|72.26|Monosuspension arm/hand supp E2630|UE||D|IN|541.91|460.62|541.91|Monosuspension arm/hand supp E2631|NU||D|IN|289.03|245.68|289.03|Elevat proximal arm support E2631|RR||D|IN|28.91|24.57|28.91|Elevat proximal arm support E2631|UE||D|IN|216.77|184.25|216.77|Elevat proximal arm support E2632|NU||D|IN|183.78|156.21|183.78|Offset/lat rocker arm w/ela E2632|RR||D|IN|18.37|15.61|18.37|Offset/lat rocker arm w/ela E2632|UE||D|IN|137.83|117.16|137.83|Offset/lat rocker arm w/ela E2633|NU||D|IN|155.88|132.5|155.88|Mobile arm support supinator E2633|RR||D|IN|15.6|13.26|15.6|Mobile arm support supinator E2633|UE||D|IN|116.92|99.38|116.92|Mobile arm support supinator K0001|RR||D|CR|0|0|51.42|Standard wheelchair K0002|RR||D|CR|89.48|76.06|76.06|Stnd hemi (low seat) whlchr K0003|RR||D|CR|97.98|83.28|96.74|Lightweight wheelchair K0004|RR||D|CR|146.14|124.22|124.22|High strength ltwt whlchr K0005|NU||D|IN|2021.71|1718.45|2021.71|Ultralightweight wheelchair K0005|RR||D|IN|202.15|171.83|202.15|Ultralightweight wheelchair K0005|UE||D|IN|1516.25|1288.81|1516.25|Ultralightweight wheelchair K0006|RR||D|CR|137.15|116.58|137.15|Heavy duty wheelchair K0007|RR||D|CR|195.19|165.91|191.94|Extra heavy duty wheelchair K0009|RR||D|CR|81.31|69.11|81.31|Other manual wheelchair/base K0010|RR||D|CR|465.83|395.96|395.96|Stnd wt frame power whlchr K0011|RR||D|CR|0|0|560.18|Stnd wt pwr whlchr w control K0011|RR|KF|D|CR|0|0|621.95|Stnd wt pwr whlchr w control K0012|RR||D|CR|355.32|302.02|344.64|Ltwt portbl power whlchr K0015|NU||D|IN|171.27|145.58|171.27|Detach non-adjus hght armrst K0015|NU|KE|D|IN|198.7|168.9|198.7|Detach non-adjus hght armrst K0015|RR||D|IN|17.12|14.55|17.12|Detach non-adjus hght armrst K0015|RR|KE|D|IN|19.89|16.91|19.89|Detach non-adjus hght armrst K0015|UE||D|IN|128.44|109.17|128.44|Detach non-adjus hght armrst K0015|UE|KE|D|IN|149.02|126.67|149.02|Detach non-adjus hght armrst K0017|NU||D|IN|48.17|40.94|48.17|Detach adjust armrest base K0017|NU|KE|D|IN|55.9|47.52|55.9|Detach adjust armrest base K0017|RR||D|IN|4.82|4.1|4.82|Detach adjust armrest base K0017|RR|KE|D|IN|5.59|4.75|5.59|Detach adjust armrest base K0017|UE||D|IN|36.13|30.71|36.13|Detach adjust armrest base K0017|UE|KE|D|IN|41.93|35.64|41.93|Detach adjust armrest base K0018|NU||D|IN|26.91|22.87|26.91|Detach adjust armrst upper K0018|NU|KE|D|IN|31.23|26.55|31.23|Detach adjust armrst upper K0018|RR||D|IN|2.68|2.28|2.68|Detach adjust armrst upper K0018|RR|KE|D|IN|3.1|2.64|3.1|Detach adjust armrst upper K0018|UE||D|IN|20.19|17.16|20.19|Detach adjust armrst upper K0018|UE|KE|D|IN|23.43|19.92|23.43|Detach adjust armrst upper K0019|NU||D|IN|16.24|13.8|16.02|Arm pad each K0019|NU|KE|D|IN|18.85|16.02|18.58|Arm pad each K0019|RR||D|IN|1.63|1.39|1.61|Arm pad each K0019|RR|KE|D|IN|1.88|1.6|1.86|Arm pad each K0019|UE||D|IN|12.19|10.36|12.02|Arm pad each K0019|UE|KE|D|IN|14.15|12.03|13.95|Arm pad each K0020|NU||D|IN|43.79|37.22|43.79|Fixed adjust armrest pair K0020|NU|KE|D|IN|50.8|43.18|50.8|Fixed adjust armrest pair K0020|RR||D|IN|4.38|3.72|4.38|Fixed adjust armrest pair K0020|RR|KE|D|IN|5.09|4.33|5.09|Fixed adjust armrest pair K0020|UE||D|IN|32.84|27.91|32.84|Fixed adjust armrest pair K0020|UE|KE|D|IN|38.09|32.38|38.09|Fixed adjust armrest pair K0037|NU||D|IN|45.39|38.58|45.39|High mount flip-up footrest K0037|NU|KE|D|IN|52.66|44.76|52.66|High mount flip-up footrest K0037|RR||D|IN|4.05|3.44|4.05|High mount flip-up footrest K0037|RR|KE|D|IN|4.72|4.01|4.72|High mount flip-up footrest K0037|UE||D|IN|34.06|28.95|34.06|High mount flip-up footrest K0037|UE|KE|D|IN|39.51|33.58|39.51|High mount flip-up footrest K0038|NU||D|IN|22.88|19.45|22.88|Leg strap each K0038|NU|KE|D|IN|26.52|22.54|26.52|Leg strap each K0038|RR||D|IN|2.29|1.95|2.29|Leg strap each K0038|RR|KE|D|IN|2.66|2.26|2.66|Leg strap each K0038|UE||D|IN|17.14|14.57|17.14|Leg strap each K0038|UE|KE|D|IN|19.91|16.92|19.91|Leg strap each K0039|NU||D|IN|50.78|43.16|50.78|Leg strap h style each K0039|NU|KE|D|IN|58.91|50.07|58.91|Leg strap h style each K0039|RR||D|IN|5.1|4.34|5.1|Leg strap h style each K0039|RR|KE|D|IN|5.91|5.02|5.91|Leg strap h style each K0039|UE||D|IN|38.09|32.38|38.09|Leg strap h style each K0039|UE|KE|D|IN|44.2|37.57|44.2|Leg strap h style each K0040|NU||D|IN|70.38|59.82|70.38|Adjustable angle footplate K0040|NU|KE|D|IN|81.65|69.4|81.65|Adjustable angle footplate K0040|RR||D|IN|7.02|5.97|7.02|Adjustable angle footplate K0040|RR|KE|D|IN|8.14|6.92|8.14|Adjustable angle footplate K0040|UE||D|IN|52.76|44.85|52.76|Adjustable angle footplate K0040|UE|KE|D|IN|61.23|52.05|61.23|Adjustable angle footplate K0041|NU||D|IN|49.87|42.39|49.87|Large size footplate each K0041|NU|KE|D|IN|57.86|49.18|57.86|Large size footplate each K0041|RR||D|IN|5.02|4.27|5.02|Large size footplate each K0041|RR|KE|D|IN|5.81|4.94|5.81|Large size footplate each K0041|UE||D|IN|37.4|31.79|37.4|Large size footplate each K0041|UE|KE|D|IN|43.4|36.89|43.4|Large size footplate each K0042|NU||D|IN|34.34|29.19|34.34|Standard size footplate each K0042|NU|KE|D|IN|39.83|33.86|39.83|Standard size footplate each K0042|RR||D|IN|3.43|2.92|3.43|Standard size footplate each K0042|RR|KE|D|IN|3.97|3.37|3.97|Standard size footplate each K0042|UE||D|IN|25.74|21.88|25.74|Standard size footplate each K0042|UE|KE|D|IN|29.88|25.4|29.88|Standard size footplate each K0043|NU||D|IN|18.39|15.63|18.39|Ftrst lower extension tube K0043|NU|KE|D|IN|21.36|18.16|21.36|Ftrst lower extension tube K0043|RR||D|IN|1.83|1.56|1.83|Ftrst lower extension tube K0043|RR|KE|D|IN|2.14|1.82|2.14|Ftrst lower extension tube K0043|UE||D|IN|13.83|11.76|13.83|Ftrst lower extension tube K0043|UE|KE|D|IN|16.03|13.63|16.03|Ftrst lower extension tube K0044|NU||D|IN|15.68|13.33|15.68|Ftrst upper hanger bracket K0044|NU|KE|D|IN|18.19|15.46|18.19|Ftrst upper hanger bracket K0044|RR||D|IN|1.58|1.34|1.58|Ftrst upper hanger bracket K0044|RR|KE|D|IN|1.82|1.55|1.82|Ftrst upper hanger bracket K0044|UE||D|IN|11.76|10|11.76|Ftrst upper hanger bracket K0044|UE|KE|D|IN|13.65|11.6|13.65|Ftrst upper hanger bracket K0045|NU||D|IN|53.37|45.36|53.37|Footrest complete assembly K0045|NU|KE|D|IN|61.92|52.63|61.92|Footrest complete assembly K0045|RR||D|IN|5.5|4.68|5.5|Footrest complete assembly K0045|RR|KE|D|IN|6.38|5.42|6.38|Footrest complete assembly K0045|UE||D|IN|40.03|34.03|40.03|Footrest complete assembly K0045|UE|KE|D|IN|46.44|39.47|46.44|Footrest complete assembly K0046|NU||D|IN|18.39|15.63|18.39|Elevat legrst low extension K0046|NU|KE|D|IN|21.36|18.16|21.36|Elevat legrst low extension K0046|RR||D|IN|1.83|1.56|1.83|Elevat legrst low extension K0046|RR|KE|D|IN|2.14|1.82|2.14|Elevat legrst low extension K0046|UE||D|IN|13.83|11.76|13.83|Elevat legrst low extension K0046|UE|KE|D|IN|16.03|13.63|16.03|Elevat legrst low extension K0047|NU||D|IN|72.08|61.27|72.08|Elevat legrst up hangr brack K0047|NU|KE|D|IN|83.64|71.09|83.64|Elevat legrst up hangr brack K0047|RR||D|IN|7.23|6.15|7.23|Elevat legrst up hangr brack K0047|RR|KE|D|IN|8.38|7.12|8.38|Elevat legrst up hangr brack K0047|UE||D|IN|54.04|45.93|54.04|Elevat legrst up hangr brack K0047|UE|KE|D|IN|62.7|53.3|62.7|Elevat legrst up hangr brack K0050|NU||D|IN|30.63|26.04|30.63|Ratchet assembly K0050|NU|KE|D|IN|35.55|30.22|35.55|Ratchet assembly K0050|RR||D|IN|3.05|2.59|3.05|Ratchet assembly K0050|RR|KE|D|IN|3.55|3.02|3.55|Ratchet assembly K0050|UE||D|IN|22.99|19.54|22.99|Ratchet assembly K0050|UE|KE|D|IN|26.66|22.66|26.66|Ratchet assembly K0051|NU||D|IN|49.58|42.14|49.58|Cam relese assem ftrst/lgrst K0051|NU|KE|D|IN|57.52|48.89|57.52|Cam relese assem ftrst/lgrst K0051|RR||D|IN|4.99|4.24|4.99|Cam relese assem ftrst/lgrst K0051|RR|KE|D|IN|5.78|4.91|5.78|Cam relese assem ftrst/lgrst K0051|UE||D|IN|37.17|31.59|37.17|Cam relese assem ftrst/lgrst K0051|UE|KE|D|IN|43.13|36.66|43.13|Cam relese assem ftrst/lgrst K0052|NU||D|IN|87.13|74.06|87.13|Swingaway detach footrest K0052|NU|KE|D|IN|101.08|85.92|101.08|Swingaway detach footrest K0052|RR||D|IN|8.71|7.4|8.71|Swingaway detach footrest K0052|RR|KE|D|IN|10.1|8.59|10.1|Swingaway detach footrest K0052|UE||D|IN|65.33|55.53|65.33|Swingaway detach footrest K0052|UE|KE|D|IN|75.82|64.45|75.82|Swingaway detach footrest K0053|NU||D|IN|96.15|81.73|96.15|Elevate footrest articulate K0053|NU|KE|D|IN|111.55|94.82|111.55|Elevate footrest articulate K0053|RR||D|IN|9.61|8.17|9.61|Elevate footrest articulate K0053|RR|KE|D|IN|11.15|9.48|11.15|Elevate footrest articulate K0053|UE||D|IN|72.11|61.29|72.11|Elevate footrest articulate K0053|UE|KE|D|IN|83.68|71.13|83.68|Elevate footrest articulate K0056|NU||D|IN|104|88.4|104|Seat ht <17 or >=21 ltwt wc K0056|RR||D|IN|10.4|8.84|10.4|Seat ht <17 or >=21 ltwt wc K0056|UE||D|IN|78.02|66.32|78.02|Seat ht <17 or >=21 ltwt wc K0065|NU||D|IN|48.61|41.32|48.61|Spoke protectors K0065|RR||D|IN|4.87|4.14|4.87|Spoke protectors K0065|UE||D|IN|36.46|30.99|36.46|Spoke protectors K0069|NU||D|IN|109.28|92.89|109.28|Rear whl complete solid tire K0069|RR||D|IN|11.38|9.67|11.38|Rear whl complete solid tire K0069|UE||D|IN|81.95|69.66|81.95|Rear whl complete solid tire K0070|NU||D|IN|200.29|170.25|200.29|Rear whl compl pneum tire K0070|RR||D|IN|20.05|17.04|20.05|Rear whl compl pneum tire K0070|UE||D|IN|150.23|127.7|150.23|Rear whl compl pneum tire K0071|NU||D|IN|119.47|101.55|119.47|Front castr compl pneum tire K0071|RR||D|IN|11.96|10.17|11.96|Front castr compl pneum tire K0071|UE||D|IN|89.58|76.14|89.58|Front castr compl pneum tire K0072|NU||D|IN|71.92|61.13|71.92|Frnt cstr cmpl sem-pneum tir K0072|RR||D|IN|7.19|6.11|7.19|Frnt cstr cmpl sem-pneum tir K0072|UE||D|IN|53.93|45.84|53.93|Frnt cstr cmpl sem-pneum tir K0073|NU||D|IN|38.06|32.35|38.06|Caster pin lock each K0073|RR||D|IN|3.81|3.24|3.81|Caster pin lock each K0073|UE||D|IN|28.54|24.26|28.54|Caster pin lock each K0077|NU||D|IN|64.36|54.71|64.36|Front caster assem complete K0077|RR||D|IN|6.42|5.46|6.42|Front caster assem complete K0077|UE||D|IN|48.26|41.02|48.26|Front caster assem complete K0098|NU||D|IN|25.65|21.8|25.65|Drive belt power wheelchair K0098|NU|KE|D|IN|29.74|25.28|29.74|Drive belt power wheelchair K0098|RR||D|IN|2.57|2.18|2.57|Drive belt power wheelchair K0098|RR|KE|D|IN|2.98|2.53|2.98|Drive belt power wheelchair K0098|UE||D|IN|19.21|16.33|19.21|Drive belt power wheelchair K0098|UE|KE|D|IN|22.3|18.96|22.3|Drive belt power wheelchair K0105|NU||D|IN|108.73|92.42|108.73|Iv hanger K0105|RR||D|IN|10.87|9.24|10.87|Iv hanger K0105|UE||D|IN|81.55|69.32|81.55|Iv hanger K0195|RR||D|CR|19.87|16.89|19.72|Elevating whlchair leg rests K0195|RR|KE|D|CR|23.04|19.58|22.9|Elevating whlchair leg rests K0455|RR||D|FS|289.65|246.2|280.97|Pump uninterrupted infusion K0552|||D|SU|2.9|2.47|2.9|Supply/ext inf pump syr type K0601|NU||D|IN|1.21|1.03|1.21|Repl batt silver oxide 1.5 v K0602|NU||D|IN|6.95|5.91|6.95|Repl batt silver oxide 3 v K0603|NU||D|IN|0.62|0.53|0.62|Repl batt alkaline 1.5 v K0604|NU||D|IN|6.65|5.65|6.65|Repl batt lithium 3.6 v K0605|NU||D|IN|15.97|13.57|15.97|Repl batt lithium 4.5 v K0606|RR|KF|D|CR|2753.85|2340.77|2753.85|Aed garment w elec analysis K0607|RR||D|CR|21.25|18.06|21.25|Repl batt for aed K0607|RR|KF|D|CR|23.59|20.05|23.59|Repl batt for aed K0608|NU||D|IN|132.54|112.66|132.54|Repl garment for aed K0608|NU|KF|D|IN|147.18|125.1|147.18|Repl garment for aed K0608|RR||D|IN|13.28|11.29|13.28|Repl garment for aed K0608|RR|KF|D|IN|14.74|12.53|14.74|Repl garment for aed K0608|UE||D|IN|99.41|84.5|99.41|Repl garment for aed K0608|UE|KF|D|IN|110.37|93.81|110.37|Repl garment for aed K0609|||D|SU|881.49|749.27|881.49|Repl electrode for aed K0609|KF||D|SU|978.68|831.88|978.68|Repl electrode for aed K0672|||D|PO|95.46|71.6|80.4|Removable soft interface le K0730|RR||D|CR|188.53|160.25|188.53|Ctrl dose inh drug deliv sys K0733|NU||D|IN|28.47|24.2|28.47|12-24hr sealed lead acid K0733|NU|KE|D|IN|33.04|28.08|33.04|12-24hr sealed lead acid K0733|RR||D|IN|2.87|2.44|2.87|12-24hr sealed lead acid K0733|RR|KE|D|IN|3.33|2.83|3.33|12-24hr sealed lead acid K0733|UE||D|IN|21.37|18.16|21.37|12-24hr sealed lead acid K0733|UE|KE|D|IN|24.79|21.07|24.79|12-24hr sealed lead acid K0738|RR||D|OX|0|0|51.63|Portable gas oxygen system K0800|NU||D|IN|1218.47|1035.7|1218.47|Pov group 1 std up to 300lbs K0800|RR||D|IN|121.86|103.58|121.86|Pov group 1 std up to 300lbs K0800|UE||D|IN|913.86|776.78|913.86|Pov group 1 std up to 300lbs K0801|NU||D|IN|1964.44|1669.77|1964.44|Pov group 1 hd 301-450 lbs K0801|RR||D|IN|196.41|166.95|196.41|Pov group 1 hd 301-450 lbs K0801|UE||D|IN|1473.33|1252.33|1473.33|Pov group 1 hd 301-450 lbs K0802|NU||D|IN|2223.12|1889.65|2223.12|Pov group 1 vhd 451-600 lbs K0802|RR||D|IN|222.31|188.96|222.31|Pov group 1 vhd 451-600 lbs K0802|UE||D|IN|1667.34|1417.24|1667.34|Pov group 1 vhd 451-600 lbs K0806|NU||D|IN|1474.02|1252.92|1474.02|Pov group 2 std up to 300lbs K0806|RR||D|IN|147.4|125.29|147.4|Pov group 2 std up to 300lbs K0806|UE||D|IN|1105.53|939.7|1105.53|Pov group 2 std up to 300lbs K0807|NU||D|IN|2236.68|1901.18|2236.68|Pov group 2 hd 301-450 lbs K0807|RR||D|IN|223.67|190.12|223.67|Pov group 2 hd 301-450 lbs K0807|UE||D|IN|1677.52|1425.89|1677.52|Pov group 2 hd 301-450 lbs K0808|NU||D|IN|3460.6|2941.51|3460.6|Pov group 2 vhd 451-600 lbs K0808|RR||D|IN|346.06|294.15|346.06|Pov group 2 vhd 451-600 lbs K0808|UE||D|IN|2595.44|2206.12|2595.44|Pov group 2 vhd 451-600 lbs K0813|RR||D|CR|341.06|289.9|341.06|Pwc gp 1 std port seat/back K0814|RR||D|CR|436.59|371.1|436.59|Pwc gp 1 std port cap chair K0815|RR||D|CR|497.11|422.54|497.11|Pwc gp 1 std seat/back K0816|RR||D|CR|476.09|404.68|476.09|Pwc gp 1 std cap chair K0820|RR||D|CR|364.3|309.66|364.3|Pwc gp 2 std port seat/back K0821|RR||D|CR|467.64|397.49|467.64|Pwc gp 2 std port cap chair K0822|RR||D|CR|565.17|480.39|565.17|Pwc gp 2 std seat/back K0823|RR||D|CR|568.89|483.56|568.89|Pwc gp 2 std cap chair K0824|RR||D|CR|684.65|581.95|684.65|Pwc gp 2 hd seat/back K0825|RR||D|CR|626.8|532.78|626.8|Pwc gp 2 hd cap chair K0826|RR||D|CR|886.38|753.42|886.38|Pwc gp 2 vhd seat/back K0827|RR||D|CR|753.67|640.62|753.67|Pwc gp vhd cap chair K0828|RR||D|CR|976.68|830.18|976.68|Pwc gp 2 xtra hd seat/back K0829|RR||D|CR|896.89|762.36|896.89|Pwc gp 2 xtra hd cap chair K0835|RR||D|CR|573.64|487.59|573.64|Pwc gp2 std sing pow opt s/b K0836|RR||D|CR|594.89|505.66|594.89|Pwc gp2 std sing pow opt cap K0837|RR||D|CR|684.65|581.95|684.65|Pwc gp 2 hd sing pow opt s/b K0838|RR||D|CR|612.48|520.61|612.48|Pwc gp 2 hd sing pow opt cap K0839|RR||D|CR|886.38|753.42|886.38|Pwc gp2 vhd sing pow opt s/b K0840|RR||D|CR|1342.84|1141.41|1342.84|Pwc gp2 xhd sing pow opt s/b K0841|RR||D|CR|610.58|518.99|610.58|Pwc gp2 std mult pow opt s/b K0842|RR||D|CR|610.58|518.99|610.58|Pwc gp2 std mult pow opt cap K0843|RR||D|CR|735.12|624.85|735.12|Pwc gp2 hd mult pow opt s/b K0848|RR||D|CR|747.1|635.04|747.1|Pwc gp 3 std seat/back K0849|RR||D|CR|718.31|610.56|718.31|Pwc gp 3 std cap chair K0850|RR||D|CR|866.62|736.63|866.62|Pwc gp 3 hd seat/back K0851|RR||D|CR|833.25|708.26|833.25|Pwc gp 3 hd cap chair K0852|RR||D|CR|1001.32|851.12|1001.32|Pwc gp 3 vhd seat/back K0853|RR||D|CR|1028.61|874.32|1028.61|Pwc gp 3 vhd cap chair K0854|RR||D|CR|1362.68|1158.28|1362.68|Pwc gp 3 xhd seat/back K0855|RR||D|CR|1287.26|1094.17|1287.26|Pwc gp 3 xhd cap chair K0856|RR||D|CR|801.94|681.65|801.94|Pwc gp3 std sing pow opt s/b K0857|RR||D|CR|818.01|695.31|818.01|Pwc gp3 std sing pow opt cap K0858|RR||D|CR|994.98|845.73|994.98|Pwc gp3 hd sing pow opt s/b K0859|RR||D|CR|948.9|806.57|948.9|Pwc gp3 hd sing pow opt cap K0860|RR||D|CR|1421.44|1208.22|1421.44|Pwc gp3 vhd sing pow opt s/b K0861|RR||D|CR|803.22|682.74|803.22|Pwc gp3 std mult pow opt s/b K0861|RR|KF|D|CR|1034.66|879.46|1034.66|Pwc gp3 std mult pow opt s/b K0862|RR||D|CR|994.98|845.73|994.98|Pwc gp3 hd mult pow opt s/b K0863|RR||D|CR|1421.44|1208.22|1421.44|Pwc gp3 vhd mult pow opt s/b K0864|RR||D|CR|1691.53|1437.8|1691.53|Pwc gp3 xhd mult pow opt s/b L0112|||D|PO|1572.09|1179.06|1327.01|Cranial cervical orthosis L0113|||D|PO|321.07|240.8|270.39|Cranial cervical torticollis L0120|||D|PO|31.2|23.4|26.52|Cerv flex n/adj foam pre ots L0130|||D|PO|191.81|143.86|191.81|Flex thermoplastic collar mo L0140|||D|PO|75.26|56.45|66.19|Cervical semi-rigid adjustab L0150|||D|PO|127.04|95.28|110.37|Cerv semi-rig adj molded chn L0160|||D|PO|184.13|138.1|157.15|Cerv sr wire occ/man pre ots L0170|||D|PO|758.2|568.65|665|Cervical collar molded to pt L0172|||D|PO|149.26|111.95|134.84|Cerv col sr foam 2pc pre ots L0174|||D|PO|322.96|242.22|242.22|Cerv sr 2pc thor ext pre ots L0180|||D|PO|435.62|326.71|329.42|Cer post col occ/man sup adj L0190|||D|PO|582.37|436.78|495.89|Cerv collar supp adj cerv ba L0200|||D|PO|607.12|455.34|455.34|Cerv col supp adj bar & thor L0220|||D|PO|143.99|107.99|107.99|Thor rib belt custom fabrica L0450|||D|PO|204.33|153.25|178.28|Tlso flex trunk/thor pre ots L0452|||D|PO|0|0|0|Tlso flex custom fab thoraci L0454|||D|PO|389.56|292.17|328.83|Tlso trnk sj-t9 pre cst L0455|||D|PO|389.56|292.17|328.83|Tlso flex trnk sj-t9 pre ots L0456|||D|PO|1117.14|837.85|942.99|Tlso flex trnk sj-ss pre cst L0457|||D|PO|1117.14|837.85|942.99|Tlso flex trnk sj-ss pre ots L0458|||D|PO|1001.73|751.3|845.57|Tlso 2mod symphis-xipho pre L0460|||D|PO|1127.52|845.64|951.76|Tlso 2 shl symphys-stern cst L0462|||D|PO|1402.45|1051.84|1183.82|Tlso 3mod sacro-scap pre L0464|||D|PO|1669.59|1252.19|1409.32|Tlso 4mod sacro-scap pre L0466|||D|PO|439.25|329.43|362.39|Tlso r fram soft ant pre cst L0467|||D|PO|439.25|329.43|362.39|Tlso r fram soft pre ots L0468|||D|PO|538.9|404.17|454.34|Tlso rig fram pelvic pre cst L0469|||D|PO|538.9|404.17|454.34|Tlso rig fram pelvic pre ots L0470|||D|PO|749.55|562.16|646.87|Tlso rigid frame pre subclav L0472|||D|PO|475.37|356.53|406.04|Tlso rigid frame hyperex pre L0480|||D|PO|1674.08|1255.56|1255.56|Tlso rigid plastic custom fa L0482|||D|PO|1823.12|1367.34|1439.33|Tlso rigid lined custom fab L0484|||D|PO|2089.32|1566.99|1678.23|Tlso rigid plastic cust fab L0486|||D|PO|2216.65|1662.49|1662.49|Tlso rigidlined cust fab two L0488|||D|PO|1127.52|845.64|951.76|Tlso rigid lined pre one pie L0490|||D|PO|317.74|238.3|268.2|Tlso rigid plastic pre one L0491|||D|PO|862.64|646.98|728.14|Tlso 2 piece rigid shell L0492|||D|PO|560.14|420.1|471.91|Tlso 3 piece rigid shell L0621|||D|PO|108.42|81.31|84.54|Sio flex pelvic/sacr pre ots L0622|||D|PO|303.72|227.79|229.24|Sio flex pelvisacral custom L0623|||D|PO|0|0|0|Sio rig pnl pelv/sac pre ots L0624|||D|PO|0|0|0|Sio panel custom L0625|||D|PO|61.89|46.42|52.25|Lo flex l1-below l5 pre ots L0626|||D|PO|87.57|65.68|73.91|Lo sag rig pnl stays pre cst L0627|||D|PO|461.82|346.36|389.74|Lo sag ri an/pos pnl pre cst L0628|||D|PO|94.24|70.68|79.52|Lso flex no ri stays pre ots L0629|||D|PO|0|0|0|Lso flex w/rigid stays cust L0630|||D|PO|181.95|136.46|153.53|Lso r post pnl sj-t9 pre cst L0631|||D|PO|1153.37|865.02|973.32|Lso sag r an/pos pnl pre cst L0632|||D|PO|0|0|0|Lso sag rigid frame cust L0633|||D|PO|322.17|241.63|271.88|Lso sc r pos/lat pnl pre cst L0634|||D|PO|0|0|0|Lso flexion control custom L0635|||D|PO|1125.34|844.01|1008.2|Lso sagit rigid panel prefab L0636|||D|PO|1665.92|1249.44|1487.66|Lso sagittal rigid panel cus L0637|||D|PO|1318.37|988.78|1290.74|Lso sc r ant/pos pnl pre cst L0638|||D|PO|1481.43|1111.08|1250.49|Lso sag-coronal panel custom L0639|||D|PO|1318.37|988.78|1290.74|Lso s/c shell/panel prefab L0640|||D|PO|1175.34|881.5|992.12|Lso s/c shell/panel custom L0641|||D|PO|87.57|65.68|73.91|Lo rig pos pnl l1-l5 pre ots L0642|||D|PO|461.82|346.36|389.74|Lo sag ri an/pos pnl pre ots L0643|||D|PO|181.95|136.46|153.53|Lso sag ctr rigi pos pre ots L0648|||D|PO|1153.37|865.02|973.32|Lso sag r an/pos pnl pre ots L0649|||D|PO|322.17|241.63|271.88|Lso sc r pos/lat pnl pre ots L0650|||D|PO|1318.37|988.78|1290.74|Lso sc r ant/pos pnl pre ots L0651|||D|PO|1318.37|988.78|1290.74|Lso sag-co shell pnl pre ots L0700|||D|PO|2376.85|1782.64|2041.33|Ctlso a-p-l control molded L0710|||D|PO|2455.39|1841.54|2228.25|Ctlso a-p-l control w/ inter L0810|||D|PO|3032.54|2274.4|2367.18|Halo cervical into jckt vest L0820|||D|PO|2539.54|1904.65|1914.95|Halo cervical into body jack L0830|||D|PO|3686.64|2764.98|2764.98|Halo cerv into milwaukee typ L0859|||D|PO|1432.24|1074.18|1074.18|Mri compatible system L0861|||D|PO|242.09|181.57|204.35|Halo repl liner/interface L0970|||D|PO|134.37|100.78|100.78|Tlso corset front L0972|||D|PO|120.99|90.75|103.01|Lso corset front L0974|||D|PO|210.48|157.86|210.48|Tlso full corset L0976|||D|PO|187.99|140.99|187.99|Lso full corset L0978|||D|PO|226.31|169.73|169.73|Axillary crutch extension L0980|||D|PO|20.53|15.4|15.4|Peroneal straps pair pre ots L0982|||D|PO|19.14|14.36|16.78|Stocking sup grips 4 pre ots L0984|||D|PO|70.38|52.78|53.54|Protect body sock ea pre ots L1000|||D|PO|2386.88|1790.16|1790.16|Ctlso milwauke initial model L1001|||D|PO|0|0|0|Ctlso infant immobilizer L1005|||D|PO|3595.04|2696.28|3034.62|Tension based scoliosis orth L1010|||D|PO|78.9|59.18|72.09|Ctlso axilla sling L1020|||D|PO|101.62|76.21|98.5|Kyphosis pad L1025|||D|PO|146.6|109.95|111.95|Kyphosis pad floating L1030|||D|PO|74.79|56.09|74.79|Lumbar bolster pad L1040|||D|PO|91.72|68.79|90.02|Lumbar or lumbar rib pad L1050|||D|PO|97.89|73.41|77.94|Sternal pad L1060|||D|PO|112.44|84.33|87.92|Thoracic pad L1070|||D|PO|105.79|79.34|89.88|Trapezius sling L1080|||D|PO|65.07|48.8|62.29|Outrigger L1085|||D|PO|180.96|135.72|173.02|Outrigger bil w/ vert extens L1090|||D|PO|107.76|80.82|80.82|Lumbar sling L1100|||D|PO|186.96|140.22|142.67|Ring flange plastic/leather L1110|||D|PO|300.26|225.2|241.66|Ring flange plas/leather mol L1120|||D|PO|46.69|35.02|38.5|Covers for upright each L1200|||D|PO|1842.06|1381.55|1532.37|Furnsh initial orthosis only L1210|||D|PO|307.62|230.72|230.72|Lateral thoracic extension L1220|||D|PO|260.46|195.34|195.34|Anterior thoracic extension L1230|||D|PO|668.31|501.23|501.23|Milwaukee type superstructur L1240|||D|PO|91.29|68.47|86.26|Lumbar derotation pad L1250|||D|PO|84.94|63.7|84.94|Anterior asis pad L1260|||D|PO|88.94|66.7|87.28|Anterior thoracic derotation L1270|||D|PO|91.09|68.32|87.18|Abdominal pad L1280|||D|PO|101.42|76.06|77.71|Rib gusset (elastic) each L1290|||D|PO|92.41|69.3|88.11|Lateral trochanteric pad L1300|||D|PO|1963.87|1472.9|1472.9|Body jacket mold to patient L1310|||D|PO|2020.82|1515.62|1515.62|Post-operative body jacket L1600|||D|PO|151.5|113.62|113.62|Ho flex frejka w/cov pre cst L1610|||D|PO|51.61|38.71|38.71|Ho frejka cov only pre cst L1620|||D|PO|157.52|118.14|127.47|Ho flex pavlik harns pre cst L1630|||D|PO|199.22|149.41|152.12|Abduct control hip semi-flex L1640|||D|PO|542.49|406.86|406.86|Pelv band/spread bar thigh c L1650|||D|PO|272.2|204.15|215.77|Ho abduction hip adjustable L1652|||D|PO|400.4|300.3|337.99|Ho bi thighcuffs w sprdr bar L1660|||D|PO|201.2|150.9|150.9|Ho abduction static plastic L1680|||D|PO|1432.46|1074.34|1240.61|Pelvic & hip control thigh c L1685|||D|PO|1398.44|1048.83|1309.05|Post-op hip abduct custom fa L1686|||D|PO|1072.44|804.33|878.21|Ho post-op hip abduction L1690|||D|PO|2172.03|1629.02|1833.44|Combination bilateral ho L1700|||D|PO|1795.37|1346.53|1525.3|Leg perthes orth toronto typ L1710|||D|PO|2101.68|1576.26|1792.9|Legg perthes orth newington L1720|||D|PO|1549.2|1161.9|1324.42|Legg perthes orthosis trilat L1730|||D|PO|1330.61|997.96|999.24|Legg perthes orth scottish r L1755|||D|PO|1861.36|1396.02|1454.41|Legg perthes patten bottom t L1810|||D|PO|115.78|86.84|114.79|Ko elastic with joints L1812|||D|PO|115.78|86.84|114.79|Ko elastic w/joints pre ots L1820|||D|PO|152.44|114.33|114.33|Ko elas w/ condyle pads & jo L1830|||D|PO|102.85|77.14|95.64|Ko immob canvas long pre ots L1831|||D|PO|330.58|247.94|279.03|Knee orth pos locking joint L1832|||D|PO|714.77|536.08|714.77|Ko adj jnt pos r sup pre cst L1833|||D|PO|714.77|536.08|714.77|Ko adj jnt pos r sup pre ots L1834|||D|PO|912.63|684.47|840.91|Ko w/0 joint rigid molded to L1836|||D|PO|149.87|112.4|126.49|Ko rigid w/o joints pre ots L1840|||D|PO|1081|810.75|883.94|Ko derot ant cruciate custom L1843|||D|PO|1007.83|755.87|850.7|Ko single upright pre cst L1844|||D|PO|1869.39|1402.04|1474.08|Ko w/adj jt rot cntrl molded L1845|||D|PO|960.94|720.7|888.07|Ko double upright pre cst L1846|||D|PO|1313.37|985.03|1126.8|Ko w adj flex/ext rotat mold L1847|||D|PO|646.04|484.53|545.34|Ko dbl upright w/air pre cst L1848|||D|PO|646.04|484.53|545.34|Ko dbl upright w/air pre ots L1850|||D|PO|338.4|253.8|253.8|Ko swedish type pre ots L1860|||D|PO|1261.55|946.17|984.41|Ko supracondylar socket mold L1900|||D|PO|317.16|237.87|266.68|Afo sprng wir drsflx calf bd L1902|||D|PO|93.85|70.39|72.43|Afo ankle gauntlet pre ots L1904|||D|PO|552.85|414.64|414.64|Afo molded ankle gauntlet L1906|||D|PO|141.38|106.04|121.16|Afo multilig ank sup pre ots L1907|||D|PO|632.02|474.02|533.5|Afo supramalleolar custom L1910|||D|PO|314.4|235.8|235.8|Afo sing bar clasp attach sh L1920|||D|PO|411.01|308.26|308.26|Afo sing upright w/ adjust s L1930|||D|PO|278.12|208.59|208.59|Afo plastic L1932|||D|PO|1002.31|751.73|846.06|Afo rig ant tib prefab tcf/= L1940|||D|PO|581.42|436.06|471.38|Afo molded to patient plasti L1945|||D|PO|1088.3|816.23|865.66|Afo molded plas rig ant tib L1950|||D|PO|875.69|656.77|656.77|Afo spiral molded to pt plas L1951|||D|PO|943.32|707.49|796.26|Afo spiral prefabricated L1960|||D|PO|651.66|488.74|488.74|Afo pos solid ank plastic mo L1970|||D|PO|836.56|627.42|722.88|Afo plastic molded w/ankle j L1971|||D|PO|526.48|394.86|444.4|Afo w/ankle joint| prefab L1980|||D|PO|431.48|323.61|323.61|Afo sing solid stirrup calf L1990|||D|PO|524.05|393.04|415.79|Afo doub solid stirrup calf L2000|||D|PO|1192.46|894.35|894.35|Kafo sing fre stirr thi/calf L2005|||D|PO|4603.81|3452.86|3885.15|Kafo sng/dbl mechanical act L2010|||D|PO|1087.05|815.28|815.28|Kafo sng solid stirrup w/o j L2020|||D|PO|1372.77|1029.58|1029.58|Kafo dbl solid stirrup band/ L2030|||D|PO|1191.01|893.25|893.25|Kafo dbl solid stirrup w/o j L2034|||D|PO|2301.65|1726.23|1946.79|Kafo pla sin up w/wo k/a cus L2035|||D|PO|195.8|146.85|164.25|Kafo plastic pediatric size L2036|||D|PO|2181.24|1635.93|1635.93|Kafo plas doub free knee mol L2037|||D|PO|1958.19|1468.64|1507.61|Kafo plas sing free knee mol L2038|||D|PO|1680.89|1260.67|1260.67|Kafo w/o joint multi-axis an L2040|||D|PO|208.73|156.55|161.03|Hkafo torsion bil rot straps L2050|||D|PO|560.05|420.04|428.85|Hkafo torsion cable hip pelv L2060|||D|PO|682.58|511.94|550.39|Hkafo torsion ball bearing j L2070|||D|PO|158.11|118.58|158.11|Hkafo torsion unilat rot str L2080|||D|PO|422.87|317.15|337.18|Hkafo unilat torsion cable L2090|||D|PO|515.52|386.64|415.62|Hkafo unilat torsion ball br L2106|||D|PO|799.36|599.52|599.52|Afo tib fx cast plaster mold L2108|||D|PO|1256.15|942.11|942.11|Afo tib fx cast molded to pt L2112|||D|PO|548.51|411.38|447.33|Afo tibial fracture soft L2114|||D|PO|682.39|511.79|511.79|Afo tib fx semi-rigid L2116|||D|PO|836.96|627.72|674.31|Afo tibial fracture rigid L2126|||D|PO|1407.81|1055.86|1199.76|Kafo fem fx cast thermoplas L2128|||D|PO|2015.95|1511.97|1511.97|Kafo fem fx cast molded to p L2132|||D|PO|948.39|711.29|711.29|Kafo femoral fx cast soft L2134|||D|PO|1137.08|852.81|852.81|Kafo fem fx cast semi-rigid L2136|||D|PO|1390.35|1042.76|1042.76|Kafo femoral fx cast rigid L2180|||D|PO|137.68|103.26|103.26|Plas shoe insert w ank joint L2182|||D|PO|107.76|80.82|80.82|Drop lock knee L2184|||D|PO|145.64|109.23|145.64|Limited motion knee joint L2186|||D|PO|177|132.75|161.39|Adj motion knee jnt lerman t L2188|||D|PO|352.1|264.07|352.1|Quadrilateral brim L2190|||D|PO|102.67|77|91.46|Waist belt L2192|||D|PO|419.19|314.39|314.39|Pelvic band & belt thigh fla L2200|||D|PO|55.89|41.92|41.92|Limited ankle motion ea jnt L2210|||D|PO|79.03|59.27|68.03|Dorsiflexion assist each joi L2220|||D|PO|96.28|72.21|78.11|Dorsi & plantar flex ass/res L2230|||D|PO|90.21|67.66|67.66|Split flat caliper stirr & p L2232|||D|PO|109.92|82.44|91.6|Rocker bottom| contact afo L2240|||D|PO|98.32|73.74|73.74|Round caliper and plate atta L2250|||D|PO|417.75|313.32|313.32|Foot plate molded stirrup at L2260|||D|PO|235.68|176.76|176.76|Reinforced solid stirrup L2265|||D|PO|138.45|103.84|103.84|Long tongue stirrup L2270|||D|PO|63.14|47.35|47.35|Varus/valgus strap padded/li L2275|||D|PO|147.45|110.59|115.22|Plastic mod low ext pad/line L2280|||D|PO|532.36|399.27|428.04|Molded inner boot L2300|||D|PO|316.54|237.4|241.62|Abduction bar jointed adjust L2310|||D|PO|144.63|108.47|108.47|Abduction bar-straight L2320|||D|PO|241.9|181.42|181.42|Non-molded lacer L2330|||D|PO|461.64|346.23|346.23|Lacer molded to patient mode L2335|||D|PO|267.08|200.31|203.68|Anterior swing band L2340|||D|PO|525.45|394.08|480.63|Pre-tibial shell molded to p L2350|||D|PO|1047.58|785.69|785.69|Prosthetic type socket molde L2360|||D|PO|60.83|45.62|45.62|Extended steel shank L2370|||D|PO|301.8|226.35|226.35|Patten bottom L2375|||D|PO|132.84|99.63|99.63|Torsion ank & half solid sti L2380|||D|PO|144.73|108.55|108.55|Torsion straight knee joint L2385|||D|PO|157.47|118.1|118.1|Straight knee joint heavy du L2387|||D|PO|194.57|145.93|160.29|Add le poly knee custom kafo L2390|||D|PO|128.7|96.52|96.52|Offset knee joint each L2395|||D|PO|183.94|137.96|147.37|Offset knee joint heavy duty L2397|||D|PO|132.13|99.1|103.34|Suspension sleeve lower ext L2405|||D|PO|97.92|73.44|82.67|Knee joint drop lock ea jnt L2415|||D|PO|136.44|102.33|115.18|Knee joint cam lock each joi L2425|||D|PO|161.01|120.76|135.9|Knee disc/dial lock/adj flex L2430|||D|PO|161.01|120.76|135.9|Knee jnt ratchet lock ea jnt L2492|||D|PO|119.88|89.91|89.91|Knee lift loop drop lock rin L2500|||D|PO|370.89|278.17|278.17|Thi/glut/ischia wgt bearing L2510|||D|PO|853.98|640.48|744.77|Th/wght bear quad-lat brim m L2520|||D|PO|541.6|406.2|406.2|Th/wght bear quad-lat brim c L2525|||D|PO|1433.13|1074.85|1393.6|Th/wght bear nar m-l brim mo L2526|||D|PO|805.27|603.95|751.16|Th/wght bear nar m-l brim cu L2530|||D|PO|276.23|207.18|207.18|Thigh/wght bear lacer non-mo L2540|||D|PO|497.05|372.79|372.79|Thigh/wght bear lacer molded L2550|||D|PO|337.66|253.24|253.24|Thigh/wght bear high roll cu L2570|||D|PO|559.98|419.99|559.98|Hip clevis type 2 posit jnt L2580|||D|PO|545.64|409.23|530.83|Pelvic control pelvic sling L2600|||D|PO|241.46|181.09|181.09|Hip clevis/thrust bearing fr L2610|||D|PO|285.51|214.14|214.14|Hip clevis/thrust bearing lo L2620|||D|PO|314.35|235.76|235.76|Pelvic control hip heavy dut L2622|||D|PO|360.53|270.4|270.4|Hip joint adjustable flexion L2624|||D|PO|389.31|291.98|367.6|Hip adj flex ext abduct cont L2627|||D|PO|2015.44|1511.58|1514.48|Plastic mold recipro hip & c L2628|||D|PO|1969.7|1477.28|1779.03|Metal frame recipro hip & ca L2630|||D|PO|291.12|218.34|218.34|Pelvic control band & belt u L2640|||D|PO|395.09|296.32|296.32|Pelvic control band & belt b L2650|||D|PO|141.08|105.81|105.81|Pelv & thor control gluteal L2660|||D|PO|219.13|164.34|164.34|Thoracic control thoracic ba L2670|||D|PO|200.55|150.41|150.41|Thorac cont paraspinal uprig L2680|||D|PO|183.98|137.98|137.98|Thorac cont lat support upri L2750|||D|PO|98.27|73.7|73.7|Plating chrome/nickel pr bar L2755|||D|PO|146.76|110.07|123.91|Carbon graphite lamination L2760|||D|PO|71.43|53.57|53.57|Extension per extension per L2768|||D|PO|146.35|109.76|123.55|Ortho sidebar disconnect L2780|||D|PO|79.57|59.68|63.38|Non-corrosive finish L2785|||D|PO|37.26|27.95|37.26|Drop lock retainer each L2795|||D|PO|99.9|74.92|74.92|Knee control full kneecap L2800|||D|PO|125.4|94.05|94.05|Knee cap medial or lateral p L2810|||D|PO|91.82|68.87|68.87|Knee control condylar pad L2820|||D|PO|102.1|76.57|76.57|Soft interface below knee se L2830|||D|PO|110.45|82.84|86.11|Soft interface above knee se L2840|||D|PO|51.37|38.52|48.06|Tibial length sock fx or equ L2850|||D|PO|72.79|54.59|54.59|Femoral lgth sock fx or equa L3000|||D|PO|352.83|264.62|297.84|Ft insert ucb berkeley shell L3001|||D|PO|148.56|111.42|125.39|Foot insert remov molded spe L3002|||D|PO|181.4|136.05|153.13|Foot insert plastazote or eq L3003|||D|PO|195.72|146.79|165.19|Foot insert silicone gel eac L3010|||D|PO|195.72|146.79|165.19|Foot longitudinal arch suppo L3020|||D|PO|222.85|167.13|188.11|Foot longitud/metatarsal sup L3030|||D|PO|85.72|64.29|72.36|Foot arch support remov prem L3031|||D|PO|137.9|103.42|116.11|Foot lamin/prepreg composite L3040|||D|PO|52.86|39.65|44.62|Ft arch suprt premold longit L3050|||D|PO|52.86|39.65|44.62|Foot arch supp premold metat L3060|||D|PO|82.84|62.13|69.93|Foot arch supp longitud/meta L3070|||D|PO|35.7|26.77|30.15|Arch suprt att to sho longit L3080|||D|PO|35.7|26.77|30.15|Arch supp att to shoe metata L3090|||D|PO|45.72|34.29|38.6|Arch supp att to shoe long/m L3100|||D|PO|48.56|36.42|40.98|Hallus-valgus nt dyn pre ots L3140|||D|PO|100|75|84.41|Abduction rotation bar shoe L3150|||D|PO|91.43|68.57|77.18|Abduct rotation bar w/o shoe L3170|||D|PO|57.16|42.87|48.25|Foot plas heel stabi pre ots L3224|||D|PO|69.13|51.85|51.85|Woman's shoe oxford brace L3225|||D|PO|79.53|59.65|59.65|Man's shoe oxford brace L3300|||D|PO|58.56|43.92|49.43|Sho lift taper to metatarsal L3310|||D|PO|91.43|68.57|77.18|Shoe lift elev heel/sole neo L3330|||D|PO|635.68|476.76|536.57|Lifts elevation metal extens L3332|||D|PO|82.84|62.13|69.93|Shoe lifts tapered to one-ha L3334|||D|PO|42.86|32.15|36.17|Shoe lifts elevation heel /i L3340|||D|PO|95.73|71.8|80.82|Shoe wedge sach L3350|||D|PO|25.71|19.28|21.68|Shoe heel wedge L3360|||D|PO|39.99|30|33.76|Shoe sole wedge outside sole L3370|||D|PO|55.7|41.78|47.03|Shoe sole wedge between sole L3380|||D|PO|55.7|41.78|47.03|Shoe clubfoot wedge L3390|||D|PO|55.7|41.78|47.03|Shoe outflare wedge L3400|||D|PO|45.72|34.29|38.6|Shoe metatarsal bar wedge ro L3410|||D|PO|104.29|78.22|88.05|Shoe metatarsal bar between L3420|||D|PO|61.43|46.07|51.83|Full sole/heel wedge btween L3430|||D|PO|180|135|151.93|Sho heel count plast reinfor L3440|||D|PO|85.72|64.29|72.36|Heel leather reinforced L3450|||D|PO|118.56|88.92|100.06|Shoe heel sach cushion type L3455|||D|PO|45.72|34.29|38.6|Shoe heel new leather standa L3460|||D|PO|38.56|28.92|32.54|Shoe heel new rubber standar L3465|||D|PO|65.72|49.29|55.47|Shoe heel thomas with wedge L3470|||D|PO|69.99|52.49|59.06|Shoe heel thomas extend to b L3480|||D|PO|69.99|52.49|59.06|Shoe heel pad & depress for L3500|||D|PO|32.85|24.64|27.75|Ortho shoe add leather insol L3510|||D|PO|32.85|24.64|27.75|Orthopedic shoe add rub insl L3520|||D|PO|35.7|26.77|30.15|O shoe add felt w leath insl L3530|||D|PO|35.7|26.77|30.15|Ortho shoe add half sole L3540|||D|PO|57.16|42.87|48.25|Ortho shoe add full sole L3550|||D|PO|10|7.5|8.45|O shoe add standard toe tap L3560|||D|PO|25.71|19.28|21.68|O shoe add horseshoe toe tap L3570|||D|PO|95.73|71.8|80.82|O shoe add instep extension L3580|||D|PO|72.85|54.64|61.49|O shoe add instep velcro clo L3590|||D|PO|60|45|50.65|O shoe convert to sof counte L3595|||D|PO|47.12|35.34|39.78|Ortho shoe add march bar L3600|||D|PO|85.72|64.29|72.36|Trans shoe calip plate exist L3610|||D|PO|112.85|84.64|95.26|Trans shoe caliper plate new L3620|||D|PO|85.72|64.29|72.36|Trans shoe solid stirrup exi L3630|||D|PO|112.85|84.64|95.26|Trans shoe solid stirrup new L3640|||D|PO|48.56|36.42|40.98|Shoe dennis browne splint bo L3650|||D|PO|68.23|51.17|51.65|So 8 abd restraint pre ots L3660|||D|PO|118.24|88.68|88.68|So 8 ab rstr can/web pre ots L3670|||D|PO|130.09|97.57|123.61|So acro/clav can web pre ots L3671|||D|PO|921.1|690.82|777.49|So cap design w/o jnts cf L3674|||D|PO|1208.33|906.24|1019.95|So airplane w/wo joint cf L3675|||D|PO|179.39|134.54|151.43|So vest canvas/web pre ots L3702|||D|PO|295.18|221.38|249.16|Eo w/o joints cf L3710|||D|PO|142.21|106.66|125.1|Eo elas w/metal jnts pre ots L3720|||D|PO|752.48|564.36|624.15|Forearm/arm cuffs free motio L3730|||D|PO|1037.07|777.8|821.62|Forearm/arm cuffs ext/flex a L3740|||D|PO|1229.54|922.15|923.37|Cuffs adj lock w/ active con L3760|||D|PO|511.21|383.41|431.51|Eo withjoint| prefabricated L3762|||D|PO|109.92|82.44|92.79|Eo rigid w/o joints pre ots L3763|||D|PO|752.55|564.42|685.07|Ewho rigid w/o jnts cf L3764|||D|PO|849.96|637.47|683.22|Ewho w/joint(s) cf L3765|||D|PO|1310.75|983.06|1106.41|Ewhfo rigid w/o jnts cf L3766|||D|PO|1388|1041|1171.63|Ewhfo w/joint(s) cf L3806|||D|PO|464.34|348.26|391.95|Whfo w/joint(s) custom fab L3807|||D|PO|255.61|191.71|215.77|Whfo w/o joints pre cst L3808|||D|PO|380.97|285.72|288.21|Whfo| rigid w/o joints L3809|||D|PO|255.61|191.71|215.77|Whfo w/o joints pre ots L3900|||D|PO|1488.63|1116.47|1347.96|Hinge extension/flex wrist/f L3901|||D|PO|1848.8|1386.6|1511.42|Hinge ext/flex wrist finger L3904|||D|PO|3369.03|2526.77|3076.83|Whfo electric custom fitted L3905|||D|PO|1013.75|760.31|855.7|Who w/nontorsion jnt(s) cf L3906|||D|PO|454.59|340.94|364|Who w/o joints cf L3908|||D|PO|68.93|51.7|51.7|Who cock-up nonmolde pre ots L3912|||D|PO|109.1|81.83|82.93|Hfo flexion glove pre ots L3913|||D|PO|276.86|207.65|233.71|Hfo w/o joints cf L3915|||D|PO|543.39|407.54|458.68|Who nontorsion jnts pre cst L3916|||D|PO|543.39|407.54|458.68|Who nontorsion jnts pre ots L3917|||D|PO|107.98|80.99|91.15|Metacarp fx orthosis pre cst L3918|||D|PO|107.98|80.99|91.15|Metacarp fx orthosis pre ots L3919|||D|PO|276.86|207.65|233.71|Ho w/o joints cf L3921|||D|PO|328.34|246.25|277.14|Hfo w/joint(s) cf L3923|||D|PO|100.08|75.06|75.06|Hfo without joints pre cst L3924|||D|PO|100.08|75.06|75.06|Hfo without joints pre ots L3925|||D|PO|56.79|42.59|45.59|Fo pip dip jnt/sprng pre ots L3927|||D|PO|35.76|26.82|30.2|Fo pip dip no jt spr pre ots L3929|||D|PO|89.93|67.45|72.64|Hfo nontorsion jnts pre cst L3930|||D|PO|89.93|67.45|72.64|Hfo nontorsion jnts pre ots L3931|||D|PO|209.78|157.33|175.72|Whfo nontorsion joint prefab L3933|||D|PO|218.11|163.58|184.12|Fo w/o joints cf L3935|||D|PO|225.84|169.38|190.65|Fo nontorsion joint cf L3956|||D|PO|0|0|0|Add joint upper ext orthosis L3960|||D|PO|845.5|634.13|711.25|Sewho airplan desig abdu pos L3961|||D|PO|1717.47|1288.11|1449.73|Sewho cap design w/o jnts cf L3962|||D|PO|825.44|619.08|740.57|Sewho erbs palsey design abd L3967|||D|PO|2027.76|1520.82|1711.64|Sewho airplane w/o jnts cf L3971|||D|PO|1924.8|1443.6|1624.72|Sewho cap design w/jnt(s) cf L3973|||D|PO|2027.76|1520.82|1711.64|Sewho airplane w/jnt(s) cf L3975|||D|PO|1717.47|1288.11|1449.73|Sewhfo cap design w/o jnt cf L3976|||D|PO|1717.47|1288.11|1449.73|Sewhfo airplane w/o jnts cf L3977|||D|PO|1924.8|1443.6|1624.72|Sewhfo cap desgn w/jnt(s) cf L3978|||D|PO|2027.76|1520.82|1711.64|Sewhfo airplane w/jnt(s) cf L3980|||D|PO|355.65|266.74|266.74|Upp ext fx orthosis humeral L3982|||D|PO|429.48|322.11|329.56|Upper ext fx orthosis rad/ul L3984|||D|PO|395.97|296.98|351.77|Upper ext fx orthosis wrist L3995|||D|PO|37.62|28.22|29.52|Sock fracture or equal each L4000|||D|PO|1499.03|1124.27|1150.28|Repl girdle milwaukee orth L4002|||D|PO|0|0|0|Replace strap| any orthosis L4010|||D|PO|789.01|591.76|647.31|Replace trilateral socket br L4020|||D|PO|1012.63|759.48|808.54|Replace quadlat socket brim L4030|||D|PO|593.58|445.18|445.18|Replace socket brim cust fit L4040|||D|PO|479.9|359.93|359.93|Replace molded thigh lacer L4045|||D|PO|385.66|289.24|289.24|Replace non-molded thigh lac L4050|||D|PO|485.37|364.03|364.03|Replace molded calf lacer L4055|||D|PO|314.29|235.72|235.72|Replace non-molded calf lace L4060|||D|PO|373.63|280.22|280.22|Replace high roll cuff L4070|||D|PO|330.86|248.15|267.35|Replace prox & dist upright L4080|||D|PO|118.91|89.19|94.25|Repl met band kafo-afo prox L4090|||D|PO|106.17|79.63|83.43|Repl met band kafo-afo calf/ L4100|||D|PO|122.62|91.97|94.09|Repl leath cuff kafo prox th L4110|||D|PO|99.7|74.77|74.77|Repl leath cuff kafo-afo cal L4130|||D|PO|583.29|437.47|514.64|Replace pretibial shell L4350|||D|PO|105.1|78.82|92.72|Ankle control ortho pre ots L4360|||D|PO|325.53|244.15|259.4|Pneumat walking boot pre cst L4361|||D|PO|325.53|244.15|259.4|Pneuma/vac walk boot pre ots L4370|||D|PO|221.95|166.46|166.46|Pneum full leg splnt pre ots L4386|||D|PO|178.09|133.57|150.33|Non-pneum walk boot pre cst L4387|||D|PO|178.09|133.57|150.33|Non-pneum walk boot pre ots L4392|||D|PO|26.39|19.79|22.33|Replace afo soft interface L4394|||D|PO|19.26|14.44|16.3|Replace foot drop spint L4396|||D|PO|188.16|141.12|159.14|Static or dynami afo pre cst L4397|||D|PO|188.16|141.12|159.14|Static or dynami afo pre ots L4398|||D|PO|86.62|64.97|73.24|Foot drop splint pre ots L4631|||D|PO|1732.29|1299.22|1414.9|Afo| walk boot type| cus fab L5000|||D|PO|632.85|474.64|497.14|Sho insert w arch toe filler L5010|||D|PO|1524.88|1143.66|1200.72|Mold socket ank hgt w/ toe f L5020|||D|PO|2482.2|1861.65|2039.1|Tibial tubercle hgt w/ toe f L5050|||D|PO|2874.5|2155.87|2255.62|Ank symes mold sckt sach ft L5060|||D|PO|3459.5|2594.62|2594.62|Symes met fr leath socket ar L5100|||D|PO|2911.07|2183.3|2260.6|Molded socket shin sach foot L5105|||D|PO|4351.22|3263.42|3263.42|Plast socket jts/thgh lacer L5150|||D|PO|4398.49|3298.86|3298.86|Mold sckt ext knee shin sach L5160|||D|PO|4784.15|3588.11|3588.11|Mold socket bent knee shin s L5200|||D|PO|4137.7|3103.27|3436.12|Kne sing axis fric shin sach L5210|||D|PO|3039.36|2279.52|2279.52|No knee/ankle joints w/ ft b L5220|||D|PO|3454.79|2591.09|2591.09|No knee joint with artic ali L5230|||D|PO|4764.83|3573.62|3573.62|Fem focal defic constant fri L5250|||D|PO|6498.81|4874.1|4874.1|Hip canad sing axi cons fric L5270|||D|PO|6441.87|4831.4|4852.47|Tilt table locking hip sing L5280|||D|PO|6377.46|4783.09|4815.32|Hemipelvect canad sing axis L5301|||D|PO|2875.84|2156.88|2584|Bk mold socket sach ft endo L5312|||D|PO|4131.46|3098.59|3698.83|Knee disart| sach ft| endo L5321|||D|PO|4116.69|3087.52|3745.59|Ak open end sach L5331|||D|PO|5825.27|4368.95|4772.63|Hip disart canadian sach ft L5341|||D|PO|6330.23|4747.67|4968.33|Hemipelvectomy canadian sach L5400|||D|PO|1507.47|1130.6|1279.3|Postop dress & 1 cast chg bk L5410|||D|PO|523.32|392.49|392.49|Postop dsg bk ea add cast ch L5420|||D|PO|1903.87|1427.9|1567.74|Postop dsg & 1 cast chg ak/d L5430|||D|PO|630.29|472.72|472.72|Postop dsg ak ea add cast ch L5450|||D|PO|510.29|382.72|384.57|Postop app non-wgt bear dsg L5460|||D|PO|682.98|512.23|512.37|Postop app non-wgt bear dsg L5500|||D|PO|1608.66|1206.5|1206.5|Init bk ptb plaster direct L5505|||D|PO|2178.54|1633.91|1668.61|Init ak ischal plstr direct L5510|||D|PO|1823.52|1367.64|1367.64|Prep bk ptb plaster molded L5520|||D|PO|1801.2|1350.9|1350.9|Perp bk ptb thermopls direct L5530|||D|PO|2163.42|1622.56|1622.56|Prep bk ptb thermopls molded L5535|||D|PO|2124.05|1593.03|1593.03|Prep bk ptb open end socket L5540|||D|PO|2267.03|1700.27|1700.27|Prep bk ptb laminated socket L5560|||D|PO|2434.39|1825.79|1825.79|Prep ak ischial plast molded L5570|||D|PO|2530.91|1898.18|1898.18|Prep ak ischial direct form L5580|||D|PO|2954.65|2215.99|2215.99|Prep ak ischial thermo mold L5585|||D|PO|3204.67|2403.5|2727.13|Prep ak ischial open end L5590|||D|PO|3010.99|2258.24|2258.24|Prep ak ischial laminated L5595|||D|PO|5043.3|3782.48|3989.5|Hip disartic sach thermopls L5600|||D|PO|5569.32|4176.99|4288.52|Hip disart sach laminat mold L5610|||D|PO|2593.22|1944.91|1944.91|Above knee hydracadence L5611|||D|PO|2018.04|1513.53|1513.53|Ak 4 bar link w/fric swing L5613|||D|PO|3069.56|2302.17|2366.35|Ak 4 bar ling w/hydraul swig L5614|||D|PO|1899.09|1424.32|1603.04|4-bar link above knee w/swng L5616|||D|PO|1701.13|1275.85|1278.76|Ak univ multiplex sys frict L5617|||D|PO|633.72|475.29|531.52|Ak/bk self-aligning unit ea L5618|||D|PO|352.25|264.19|281.18|Test socket symes L5620|||D|PO|348.22|261.17|261.17|Test socket below knee L5622|||D|PO|454.07|340.56|340.56|Test socket knee disarticula L5624|||D|PO|455.36|341.52|341.52|Test socket above knee L5626|||D|PO|597.19|447.89|447.89|Test socket hip disarticulat L5628|||D|PO|604.74|453.55|478.91|Test socket hemipelvectomy L5629|||D|PO|398.05|298.54|298.54|Below knee acrylic socket L5630|||D|PO|562.13|421.59|421.59|Syme typ expandabl wall sckt L5631|||D|PO|550.33|412.75|412.75|Ak/knee disartic acrylic soc L5632|||D|PO|278.11|208.58|230.36|Symes type ptb brim design s L5634|||D|PO|381.01|285.75|285.75|Symes type poster opening so L5636|||D|PO|319.14|239.36|239.36|Symes type medial opening so L5637|||D|PO|361.84|271.38|271.38|Below knee total contact L5638|||D|PO|609.56|457.17|472.74|Below knee leather socket L5639|||D|PO|1404.31|1053.23|1053.23|Below knee wood socket L5640|||D|PO|800.91|600.68|600.68|Knee disarticulat leather so L5642|||D|PO|776.02|582.02|582.02|Above knee leather socket L5643|||D|PO|1949.48|1462.11|1462.11|Hip flex inner socket ext fr L5644|||D|PO|739.8|554.85|554.85|Above knee wood socket L5645|||D|PO|999.38|749.54|749.54|Bk flex inner socket ext fra L5646|||D|PO|686.27|514.7|514.7|Below knee cushion socket L5647|||D|PO|996.33|747.25|747.25|Below knee suction socket L5648|||D|PO|824.63|618.47|618.47|Above knee cushion socket L5649|||D|PO|2384.73|1788.55|2241.08|Isch containmt/narrow m-l so L5650|||D|PO|611.46|458.6|458.6|Tot contact ak/knee disart s L5651|||D|PO|1504.19|1128.14|1128.14|Ak flex inner socket ext fra L5652|||D|PO|546.08|409.56|409.56|Suction susp ak/knee disart L5653|||D|PO|728.96|546.72|546.72|Knee disart expand wall sock L5654|||D|PO|415.39|311.54|311.54|Socket insert symes L5655|||D|PO|332.22|249.17|264.01|Socket insert below knee L5656|||D|PO|464.62|348.47|354.17|Socket insert knee articulat L5658|||D|PO|455.42|341.56|341.56|Socket insert above knee L5661|||D|PO|762.22|571.67|571.67|Multi-durometer symes L5665|||D|PO|641.32|480.99|480.99|Multi-durometer below knee L5666|||D|PO|87.68|65.76|65.76|Below knee cuff suspension L5668|||D|PO|126.48|94.86|106.06|Bk molded distal cushion L5670|||D|PO|339.87|254.9|254.9|Bk molded supracondylar susp L5671|||D|PO|623.02|467.26|540.17|Bk/ak locking mechanism L5672|||D|PO|373.49|280.12|280.12|Bk removable medial brim sus L5673|||D|PO|836.96|627.72|667.96|Socket insert w lock mech L5676|||D|PO|453.88|340.41|340.41|Bk knee joints single axis p L5677|||D|PO|617.57|463.18|463.18|Bk knee joints polycentric p L5678|||D|PO|49.73|37.3|37.3|Bk joint covers pair L5679|||D|PO|697.45|523.08|556.61|Socket insert w/o lock mech L5680|||D|PO|381.24|285.93|311.36|Bk thigh lacer non-molded L5681|||D|PO|1480.73|1110.55|1249.6|Intl custm cong/latyp insert L5682|||D|PO|783.32|587.49|587.49|Bk thigh lacer glut/ischia m L5683|||D|PO|1480.73|1110.55|1249.6|Initial custom socket insert L5684|||D|PO|60.28|45.21|45.21|Bk fork strap L5685|||D|PO|144.15|108.11|121.67|Below knee sus/seal sleeve L5686|||D|PO|63.99|47.99|47.99|Bk back check L5688|||D|PO|76.51|57.38|57.38|Bk waist belt webbing L5690|||D|PO|122.56|91.92|91.92|Bk waist belt padded and lin L5692|||D|PO|166.44|124.83|124.83|Ak pelvic control belt light L5694|||D|PO|227.23|170.42|170.42|Ak pelvic control belt pad/l L5695|||D|PO|204.27|153.2|157.33|Ak sleeve susp neoprene/equa L5696|||D|PO|231.74|173.81|173.81|Ak/knee disartic pelvic join L5697|||D|PO|100.55|75.41|75.41|Ak/knee disartic pelvic band L5698|||D|PO|130.65|97.99|123.32|Ak/knee disartic silesian ba L5699|||D|PO|233.54|175.15|222.15|Shoulder harness L5700|||D|PO|3430.11|2572.58|2691.55|Replace socket below knee L5701|||D|PO|4258.76|3194.07|3232.34|Replace socket above knee L5702|||D|PO|5441.79|4081.34|4089.39|Replace socket hip L5703|||D|PO|2620.12|1965.09|2116.3|Symes ankle w/o (sach) foot L5704|||D|PO|659.52|494.64|503.53|Custom shape cover bk L5705|||D|PO|1163.5|872.63|899.71|Custom shape cover ak L5706|||D|PO|1141.49|856.11|881.95|Custom shape cvr knee disart L5707|||D|PO|1549.43|1162.08|1162.72|Custom shape cvr hip disart L5710|||D|PO|450.49|337.86|351.32|Kne-shin exo sng axi mnl loc L5711|||D|PO|654.02|490.51|491|Knee-shin exo mnl lock ultra L5712|||D|PO|539.71|404.78|411.41|Knee-shin exo frict swg & st L5714|||D|PO|523.9|392.92|422.59|Knee-shin exo variable frict L5716|||D|PO|912.89|684.67|684.67|Knee-shin exo mech stance ph L5718|||D|PO|1141.02|855.76|855.76|Knee-shin exo frct swg & sta L5722|||D|PO|1130.87|848.16|904.08|Knee-shin pneum swg frct exo L5724|||D|PO|1890.58|1417.94|1417.94|Knee-shin exo fluid swing ph L5726|||D|PO|2178.85|1634.14|1634.14|Knee-shin ext jnts fld swg e L5728|||D|PO|2980.39|2235.29|2235.29|Knee-shin fluid swg & stance L5780|||D|PO|1434.03|1075.52|1075.52|Knee-shin pneum/hydra pneum L5781|||D|PO|4502.98|3377.24|3801|Lower limb pros vacuum pump L5782|||D|PO|4747.16|3560.37|4007.13|Hd low limb pros vacuum pump L5785|||D|PO|650.75|488.07|604.57|Exoskeletal bk ultralt mater L5790|||D|PO|900.6|675.45|675.45|Exoskeletal ak ultra-light m L5795|||D|PO|1344.83|1008.62|1344.83|Exoskel hip ultra-light mate L5810|||D|PO|609.81|457.36|457.36|Endoskel knee-shin mnl lock L5811|||D|PO|913.49|685.11|685.11|Endo knee-shin mnl lck ultra L5812|||D|PO|708.05|531.04|531.04|Endo knee-shin frct swg & st L5814|||D|PO|4179.65|3134.74|3528.07|Endo knee-shin hydral swg ph L5816|||D|PO|1065.21|798.9|803.71|Endo knee-shin polyc mch sta L5818|||D|PO|1202.83|902.12|902.12|Endo knee-shin frct swg & st L5822|||D|PO|2132.93|1599.7|1599.7|Endo knee-shin pneum swg frc L5824|||D|PO|1920.83|1440.62|1440.62|Endo knee-shin fluid swing p L5826|||D|PO|3536.61|2652.46|2966.65|Miniature knee joint L5828|||D|PO|3537.06|2652.79|2652.79|Endo knee-shin fluid swg/sta L5830|||D|PO|2376.72|1782.54|1782.54|Endo knee-shin pneum/swg pha L5840|||D|PO|4245.32|3183.99|3295.92|Multi-axial knee/shin system L5845|||D|PO|2017.16|1512.87|1702.72|Knee-shin sys stance flexion L5848|||D|PO|1210.18|907.64|1021.51|Knee-shin sys hydraul stance L5850|||D|PO|160.23|120.17|120.17|Endo ak/hip knee extens assi L5855|||D|PO|386.82|290.11|322.91|Mech hip extension assist L5856|||D|PO|27055.69|20291.76|22804.91|Elec knee-shin swing/stance L5857|||D|PO|9625.61|7219.2|8092.01|Elec knee-shin swing only L5858|||D|PO|20916.09|15687.07|17655.44|Stance phase only L5859|||D|PO|16387.71|12290.79|13783.46|Knee-shin pro flex/ext cont L5910|||D|PO|453.63|340.22|340.22|Endo below knee alignable sy L5920|||D|PO|664.58|498.44|498.44|Endo ak/hip alignable system L5925|||D|PO|420.86|315.64|420.86|Above knee manual lock L5930|||D|PO|3812.33|2859.25|3197.5|High activity knee frame L5940|||D|PO|628.28|471.21|471.21|Endo bk ultra-light material L5950|||D|PO|974.48|730.86|736.77|Endo ak ultra-light material L5960|||D|PO|1207.49|905.62|905.62|Endo hip ultra-light materia L5961|||D|PO|5360.17|4020.13|4318.34|Endo poly hip| pneu/hyd/rot L5962|||D|PO|736.22|552.17|595.99|Below knee flex cover system L5964|||D|PO|1173.02|879.77|879.77|Above knee flex cover system L5966|||D|PO|1494.71|1121.04|1121.04|Hip flexible cover system L5968|||D|PO|4089.67|3067.25|3452.14|Multiaxial ankle w dorsiflex L5970|||D|PO|254.38|190.78|190.78|Foot external keel sach foot L5971|||D|PO|254.38|190.78|190.78|Sach foot| replacement L5972|||D|PO|441.43|331.07|356.36|Flexible keel foot L5973|||D|PO|19639.48|14729.61|16343.98|Ank-foot sys dors-plant flex L5974|||D|PO|291.87|218.91|218.91|Foot single axis ankle/foot L5975|||D|PO|521.74|391.3|440.42|Combo ankle/foot prosthesis L5976|||D|PO|701.44|526.08|526.08|Energy storing foot L5978|||D|PO|365.52|274.14|274.14|Ft prosth multiaxial ankl/ft L5979|||D|PO|2857.97|2143.47|2143.47|Multi-axial ankle/ft prosth L5980|||D|PO|4644.01|3483.01|3483.01|Flex foot system L5981|||D|PO|3607.5|2705.62|2813.79|Flex-walk sys low ext prosth L5982|||D|PO|724.1|543.08|543.08|Exoskeletal axial rotation u L5984|||D|PO|713.53|535.15|535.15|Endoskeletal axial rotation L5985|||D|PO|319.83|239.88|268.26|Lwr ext dynamic prosth pylon L5986|||D|PO|793.71|595.28|595.28|Multi-axial rotation unit L5987|||D|PO|8095.95|6071.97|6833.86|Shank ft w vert load pylon L5988|||D|PO|2248.24|1686.18|1897.75|Vertical shock reducing pylo L5990|||D|PO|2041.74|1531.3|1723.45|User adjustable heel height L6000|||D|PO|1664.22|1248.17|1248.17|Part hand thumb rem L6010|||D|PO|1852|1389|1389|Part hand little/ring L6020|||D|PO|1726.7|1295.03|1295.03|Part hand no fingers L6025|||D|PO|9006.01|6754.5|7602.04|Part hand disart myoelectric L6050|||D|PO|2379.32|1784.49|1784.49|Wrst mld sck flx hng tri pad L6055|||D|PO|3316.17|2487.13|2487.13|Wrst mold sock w/exp interfa L6100|||D|PO|2410.63|1807.97|1807.97|Elb mold sock flex hinge pad L6110|||D|PO|2556.87|1917.65|1917.65|Elbow mold sock suspension t L6120|||D|PO|2979.67|2234.76|2234.76|Elbow mold doub splt soc ste L6130|||D|PO|3242.44|2431.83|2431.83|Elbow stump activated lock h L6200|||D|PO|3417|2562.75|2562.75|Elbow mold outsid lock hinge L6205|||D|PO|4561.16|3420.87|3420.87|Elbow molded w/ expand inter L6250|||D|PO|3363.47|2522.6|2685.17|Elbow inter loc elbow forarm L6300|||D|PO|4666.45|3499.84|3499.84|Shlder disart int lock elbow L6310|||D|PO|3800.92|2850.69|3021.95|Shoulder passive restor comp L6320|||D|PO|2140.49|1605.37|1650.82|Shoulder passive restor cap L6350|||D|PO|4906.06|3679.55|3679.55|Thoracic intern lock elbow L6360|||D|PO|3989.52|2992.14|3309.17|Thoracic passive restor comp L6370|||D|PO|2543.99|1907.99|1980.11|Thoracic passive restor cap L6380|||D|PO|1440.75|1080.56|1147.43|Postop dsg cast chg wrst/elb L6382|||D|PO|1854.58|1390.93|1726.25|Postop dsg cast chg elb dis/ L6384|||D|PO|2388.08|1791.06|2388.08|Postop dsg cast chg shlder/t L6386|||D|PO|503|377.25|377.25|Postop ea cast chg & realign L6388|||D|PO|550.64|412.98|412.98|Postop applicat rigid dsg on L6400|||D|PO|2906.36|2179.77|2179.77|Below elbow prosth tiss shap L6450|||D|PO|3861.65|2896.23|2912.11|Elb disart prosth tiss shap L6500|||D|PO|3864.81|2898.61|3046.68|Above elbow prosth tiss shap L6550|||D|PO|4776.2|3582.15|3662.16|Shldr disar prosth tiss shap L6570|||D|PO|5482.16|4111.62|4111.62|Scap thorac prosth tiss shap L6580|||D|PO|1957.9|1468.42|1569.72|Wrist/elbow bowden cable mol L6582|||D|PO|1723.86|1292.9|1421.75|Wrist/elbow bowden cbl dir f L6584|||D|PO|2563.68|1922.76|2229.67|Elbow fair lead cable molded L6586|||D|PO|2359.05|1769.29|2086.62|Elbow fair lead cable dir fo L6588|||D|PO|3540.29|2655.22|2741.77|Shdr fair lead cable molded L6590|||D|PO|3295.28|2471.46|2604.25|Shdr fair lead cable direct L6600|||D|PO|234.95|176.21|176.21|Polycentric hinge pair L6605|||D|PO|231.99|173.99|173.99|Single pivot hinge pair L6610|||D|PO|208.53|156.4|167.08|Flexible metal hinge pair L6611|||D|PO|463.35|347.52|391.1|Additional switch| ext power L6615|||D|PO|217.59|163.19|180.03|Disconnect locking wrist uni L6616|||D|PO|81.24|60.93|66.71|Disconnect insert locking wr L6620|||D|PO|379.78|284.83|288.03|Flexion/extension wrist unit L6621|||D|PO|2574.17|1930.63|2172.84|Flex/ext wrist w/wo friction L6623|||D|PO|803.45|602.59|803.45|Spring-ass rot wrst w/ latch L6624|||D|PO|4238.43|3178.82|3577.66|Flex/ext/rotation wrist unit L6625|||D|PO|666.16|499.62|570.87|Rotation wrst w/ cable lock L6628|||D|PO|600.02|450.01|450.01|Quick disconn hook adapter o L6629|||D|PO|183.25|137.44|137.44|Lamination collar w/ couplin L6630|||D|PO|269.94|202.46|202.46|Stainless steel any wrist L6632|||D|PO|81.38|61.03|70.32|Latex suspension sleeve each L6635|||D|PO|220.61|165.46|165.46|Lift assist for elbow L6637|||D|PO|459.91|344.93|352.91|Nudge control elbow lock L6638|||D|PO|2814.37|2110.78|2375.63|Elec lock on manual pw elbow L6640|||D|PO|350.85|263.14|313.52|Shoulder abduction joint pai L6641|||D|PO|200.93|150.7|150.7|Excursion amplifier pulley t L6642|||D|PO|272.36|204.27|204.27|Excursion amplifier lever ty L6645|||D|PO|399.84|299.88|377.04|Shoulder flexion-abduction j L6646|||D|PO|3549.56|2662.17|2996.21|Multipo locking shoulder jnt L6647|||D|PO|584.36|438.27|493.26|Shoulder lock actuator L6648|||D|PO|3660.86|2745.64|3090.15|Ext pwrd shlder lock/unlock L6650|||D|PO|423.96|317.97|391.47|Shoulder universal joint L6655|||D|PO|94.09|70.57|76.94|Standard control cable extra L6660|||D|PO|114.97|86.23|86.23|Heavy duty control cable L6665|||D|PO|57.69|43.26|43.26|Teflon or equal cable lining L6670|||D|PO|60.07|45.05|47.83|Hook to hand cable adapter L6672|||D|PO|211.2|158.4|189.83|Harness chest/shlder saddle L6675|||D|PO|150.42|112.81|112.81|Harness figure of 8 sing con L6676|||D|PO|151.9|113.93|130.4|Harness figure of 8 dual con L6677|||D|PO|333.86|250.39|281.84|Ue triple control harness L6680|||D|PO|290.6|217.95|217.95|Test sock wrist disart/bel e L6682|||D|PO|321.29|240.97|240.97|Test sock elbw disart/above L6684|||D|PO|436.59|327.45|327.45|Test socket shldr disart/tho L6686|||D|PO|739.45|554.59|739.45|Suction socket L6687|||D|PO|722.47|541.86|541.86|Frame typ socket bel elbow/w L6688|||D|PO|663.52|497.64|538.59|Frame typ sock above elb/dis L6689|||D|PO|843.96|632.97|645.29|Frame typ socket shoulder di L6690|||D|PO|861.26|645.94|703.18|Frame typ sock interscap-tho L6691|||D|PO|432.36|324.27|325.47|Removable insert each L6692|||D|PO|700.45|525.34|525.34|Silicone gel insert or equal L6693|||D|PO|3195.05|2396.29|2696.95|Lockingelbow forearm cntrbal L6694|||D|PO|836.96|627.72|667.96|Elbow socket ins use w/lock L6695|||D|PO|697.45|523.08|556.61|Elbow socket ins use w/o lck L6696|||D|PO|1480.73|1110.55|1249.6|Cus elbo skt in for con/atyp L6697|||D|PO|1480.73|1110.55|1249.6|Cus elbo skt in not con/atyp L6698|||D|PO|623.02|467.26|540.17|Below/above elbow lock mech L6703|||D|PO|407.19|305.39|341.51|Term dev| passive hand mitt L6704|||D|PO|733.53|550.15|550.15|Term dev| sport/rec/work att L6706|||D|PO|437.03|327.78|327.78|Term dev mech hook vol open L6707|||D|PO|1610.83|1208.12|1208.12|Term dev mech hook vol close L6708|||D|PO|1047.7|785.77|789.79|Term dev mech hand vol open L6709|||D|PO|1517.48|1138.11|1138.11|Term dev mech hand vol close L6711|||D|PO|756.63|567.47|638.67|Ped term dev| hook| vol open L6712|||D|PO|1393.12|1044.84|1175.94|Ped term dev| hook| vol clos L6713|||D|PO|1758.25|1318.68|1484.13|Ped term dev| hand| vol open L6714|||D|PO|1489.22|1116.92|1257.07|Ped term dev| hand| vol clos L6715|||D|PO|3553.99|2665.49|2999.21|Term device| multi art digit L6721|||D|PO|2646.95|1985.21|2234.32|Hook/hand| hvy dty| vol open L6722|||D|PO|2281.86|1711.39|1926.13|Hook/hand| hvy dty| vol clos L6805|||D|PO|426.15|319.61|319.61|Term dev modifier wrist unit L6810|||D|PO|233.64|175.23|181.16|Term dev precision pinch dev L6880|||D|PO|26895.72|20171.79|22697.23|Elec hand ind art digits L6881|||D|PO|4600.97|3450.73|3883.7|Term dev auto grasp feature L6882|||D|PO|3490.07|2617.55|2946|Microprocessor control uplmb L6883|||D|PO|1987.61|1490.71|1490.71|Replc sockt below e/w disa L6884|||D|PO|2796.28|2097.21|2212.52|Replc sockt above elbow disa L6885|||D|PO|3989.52|2992.14|3309.17|Replc sockt shldr dis/interc L6890|||D|PO|213.04|159.78|159.78|Prefab glove for term device L6895|||D|PO|699.4|524.55|587.79|Custom glove for term device L6900|||D|PO|1891.9|1418.92|1677.4|Hand restorat thumb/1 finger L6905|||D|PO|1838.98|1379.23|1667.86|Hand restoration multiple fi L6910|||D|PO|1791.54|1343.65|1426.19|Hand restoration no fingers L6915|||D|PO|784.11|588.08|719.06|Hand restoration replacmnt g L6920|||D|PO|8359.03|6269.27|6269.27|Wrist disarticul switch ctrl L6925|||D|PO|9650.38|7237.79|8439.53|Wrist disart myoelectronic c L6930|||D|PO|8410.86|6308.15|6308.15|Below elbow switch control L6935|||D|PO|9831.04|7373.28|8570.5|Below elbow myoelectronic ct L6940|||D|PO|10989.34|8242.01|8242.01|Elbow disarticulation switch L6945|||D|PO|12784.82|9588.62|10070.75|Elbow disart myoelectronic c L6950|||D|PO|12490.93|9368.2|9368.2|Above elbow switch control L6955|||D|PO|14959.6|11219.7|11219.7|Above elbow myoelectronic ct L6960|||D|PO|15087.88|11315.91|12709.12|Shldr disartic switch contro L6965|||D|PO|17751.61|13313.7|13554.74|Shldr disartic myoelectronic L6970|||D|PO|18268.03|13701.02|14124.26|Interscapular-thor switch ct L6975|||D|PO|20015.97|15011.98|15447.39|Interscap-thor myoelectronic L7007|||D|PO|4310.03|3232.53|3232.53|Adult electric hand L7008|||D|PO|6783.53|5087.65|5087.65|Pediatric electric hand L7009|||D|PO|4397.6|3298.2|3298.2|Adult electric hook L7040|||D|PO|3531.1|2648.32|2648.32|Prehensile actuator L7045|||D|PO|2024.5|1518.37|1518.37|Pediatric electric hook L7170|||D|PO|7344.21|5508.16|6991.17|Electronic elbow hosmer swit L7180|||D|PO|40916.46|30687.34|30687.34|Electronic elbow sequential L7181|||D|PO|45093.28|33819.96|38063.53|Electronic elbo simultaneous L7185|||D|PO|7436.99|5577.75|6903.87|Electron elbow adolescent sw L7186|||D|PO|11079.3|8309.47|8309.47|Electron elbow child switch L7190|||D|PO|9462.17|7096.63|7251.42|Elbow adolescent myoelectron L7191|||D|PO|11577.22|8682.91|8682.91|Elbow child myoelectronic ct L7260|||D|PO|2465|1848.75|1848.75|Electron wrist rotator otto L7261|||D|PO|4487.26|3365.44|3365.44|Electron wrist rotator utah L7360|||D|PO|284.82|213.61|224.15|Six volt bat otto bock/eq ea L7362|||D|PO|313.81|235.36|235.36|Battery chrgr six volt otto L7364|||D|PO|499.1|374.33|374.33|Twelve volt battery utah/equ L7366|||D|PO|672.31|504.23|504.23|Battery chrgr 12 volt utah/e L7367|||D|PO|438.15|328.61|369.83|Replacemnt lithium ionbatter L7368|||D|PO|568|426|479.45|Lithium ion battery charger L7400|||D|PO|344.93|258.7|291.16|Add ue prost be/wd| ultlite L7401|||D|PO|386.14|289.61|325.95|Add ue prost a/e ultlite mat L7402|||D|PO|417|312.75|351.97|Add ue prost s/d ultlite mat L7403|||D|PO|414.45|310.84|349.85|Add ue prost b/e acrylic L7404|||D|PO|625.52|469.14|527.98|Add ue prost a/e acrylic L7405|||D|PO|818.08|613.56|690.54|Add ue prost s/d acrylic L7900|||D|PO|603.55|452.67|514.14|Male vacuum erection system L7902|||D|PO|21.24|15.93|17.87|Tension ring| vac erect dev L8000|||D|PO|45.73|34.3|41.32|Mastectomy bra L8001|||D|PO|141.16|105.87|119.15|Breast prosthesis bra & form L8002|||D|PO|185.68|139.26|156.74|Brst prsth bra & bilat form L8015|||D|PO|67.62|50.71|56.94|Ext breastprosthesis garment L8020|||D|PO|251.27|188.45|214.16|Mastectomy form L8030|||D|PO|395.15|296.36|309.78|Breast prosthes w/o adhesive L8031|||D|PO|395.15|296.36|309.78|Breast prosthesis w adhesive L8032|||D|PO|44.19|33.14|37.21|Reusable nipple prosthesis L8035|||D|PO|4123.11|3092.33|3480.34|Custom breast prosthesis L8040|||D|PO|2787.39|2090.54|2296.25|Nasal prosthesis L8040|KM||D|PO|2648.02|1986.01|2181.44|Nasal prosthesis L8040|KN||D|PO|1114.95|836.21|918.51|Nasal prosthesis L8041|||D|PO|3359.74|2519.8|2767.69|Midfacial prosthesis L8041|KM||D|PO|3191.74|2393.81|2629.29|Midfacial prosthesis L8041|KN||D|PO|1343.9|1007.92|1107.08|Midfacial prosthesis L8042|||D|PO|3774.98|2831.24|3109.75|Orbital prosthesis L8042|KM||D|PO|3586.23|2689.67|2954.26|Orbital prosthesis L8042|KN||D|PO|1510|1132.5|1243.89|Orbital prosthesis L8043|||D|PO|4228|3171|3482.93|Upper facial prosthesis L8043|KM||D|PO|4016.58|3012.44|3308.76|Upper facial prosthesis L8043|KN||D|PO|1691.19|1268.39|1393.16|Upper facial prosthesis L8044|||D|PO|4680.97|3510.73|3856.09|Hemi-facial prosthesis L8044|KM||D|PO|4446.93|3335.2|3663.3|Hemi-facial prosthesis L8044|KN||D|PO|1872.4|1404.3|1542.45|Hemi-facial prosthesis L8045|||D|PO|3080.09|2310.07|2414.79|Auricular prosthesis L8045|KM||D|PO|2926.08|2194.56|2294.04|Auricular prosthesis L8045|KN||D|PO|1232.03|924.03|965.91|Auricular prosthesis L8046|||D|PO|3019.98|2264.99|2487.8|Partial facial prosthesis L8046|KM||D|PO|2868.99|2151.74|2363.41|Partial facial prosthesis L8046|KN||D|PO|1207.99|905.99|995.1|Partial facial prosthesis L8047|||D|PO|1547.74|1160.8|1274.99|Nasal septal prosthesis L8047|KM||D|PO|1470.36|1102.77|1211.24|Nasal septal prosthesis L8047|KN||D|PO|619.1|464.33|510|Nasal septal prosthesis L8300|||D|PO|105.65|79.24|91.49|Truss single w/ standard pad L8310|||D|PO|166.81|125.11|140.67|Truss double w/ standard pad L8320|||D|PO|66.95|50.22|61.45|Truss addition to std pad wa L8330|||D|PO|61.84|46.38|60.91|Truss add to std pad scrotal L8400|||D|PO|19.72|14.79|17.8|Sheath below knee L8410|||D|PO|25.95|19.46|20.26|Sheath above knee L8415|||D|PO|26.85|20.14|20.14|Sheath upper limb L8417|||D|PO|84.6|63.45|71.43|Pros sheath/sock w gel cushn L8420|||D|PO|24.36|18.27|23.55|Prosthetic sock multi ply bk L8430|||D|PO|27.73|20.8|25.89|Prosthetic sock multi ply ak L8435|||D|PO|26.34|19.75|23.23|Pros sock multi ply upper lm L8440|||D|PO|52.38|39.29|49.25|Shrinker below knee L8460|||D|PO|83.48|62.61|68.54|Shrinker above knee L8465|||D|PO|61.1|45.82|61.1|Shrinker upper limb L8470|||D|PO|8.36|6.27|6.27|Pros sock single ply bk L8480|||D|PO|11.53|8.65|8.65|Pros sock single ply ak L8485|||D|PO|13.93|10.45|10.45|Pros sock single ply upper l L8500|||D|PO|826.62|619.96|619.96|Artificial larynx L8501|||D|PO|151.3|113.48|137.69|Tracheostomy speaking valve L8507|||D|PO|47.14|35.35|39.79|Trach-esoph voice pros pt in L8509|||L|PO|122.91|92.18|103.76|Trach-esoph voice pros md in L8510|||D|PO|284.39|213.29|240.07|Voice amplifier L8511|||J|PO|81.85|61.39|69.09|Indwelling trach insert L8512|||J|PO|2.46|1.84|2.09|Gel cap for trach voice pros L8513|||J|PO|5.86|4.39|4.95|Trach pros cleaning device L8514|||J|PO|106.13|79.6|89.59|Repl trach puncture dilator L8515|||J|PO|71.04|53.28|59.95|Gel cap app device for trach L8600|||L|PO|782.14|586.6|586.6|Implant breast silicone/eq L8603|||L|PO|493.91|370.43|411.97|Collagen imp urinary 2.5 ml L8605|||L|PO|806.25|604.69|680.4|Inj bulking agent anal canal L8606|||L|PO|247.67|185.75|216.26|Synthetic implnt urinary 1ml L8609|||L|PO|7334.41|5500.81|6189.5|Artificial cornea L8610|||L|PO|733.12|549.84|601.71|Ocular implant L8612|||L|PO|761.58|571.19|634.63|Aqueous shunt prosthesis L8613|||L|PO|322.07|241.55|284.13|Ossicular implant L8614|||L|PO|21768.18|16326.14|17984.48|Cochlear device L8615|||L|PO|507.71|380.78|428.45|Coch implant headset replace L8616|||L|PO|118.25|88.69|99.79|Coch implant microphone repl L8617|||L|PO|103.28|77.46|87.18|Coch implant trans coil repl L8618|||L|PO|29.52|22.14|24.9|Coch implant tran cable repl L8619|||L|PO|9343.75|7007.81|7714.67|Coch imp ext proc/contr rplc L8621|||L|PO|0.69|0.52|0.58|Repl zinc air battery L8622|||L|PO|0.37|0.27|0.31|Repl alkaline battery L8623|||L|PO|72.82|54.61|61.45|Lith ion batt cid|non-earlvl L8624|||L|PO|181.52|136.14|153.16|Lith ion batt cid| ear level L8627|||L|PO|7935.3|5951.48|6539.48|Cid ext speech process repl L8628|||L|PO|1408.45|1056.34|1175.2|Cid ext controller repl L8629|||L|PO|201.56|151.17|170.1|Cid transmit coil and cable L8630|||L|PO|421.98|316.48|316.48|Metacarpophalangeal implant L8631|||L|PO|2476.63|1857.47|2123.97|Mcp joint repl 2 pc or more L8641|||L|PO|438.44|328.83|343.5|Metatarsal joint implant L8642|||L|PO|355.62|266.72|281.96|Hallux implant L8658|||L|PO|382.28|286.71|294.68|Interphalangeal joint spacer L8659|||L|PO|2172.25|1629.19|1833.13|Interphalangeal joint repl L8670|||L|PO|627.5|470.63|522.92|Vascular graft| synthetic L8679|||L|PO|9499.22|7124.41|7926.63|Imp neurosti pls gn any type L8681|||L|PO|1351.22|1013.42|1072.97|Pt prgrm for implt neurostim L8682|||L|PO|6787.01|5090.26|5663.42|Implt neurostim radiofq rec L8683|||L|PO|5974.12|4480.59|4985.08|Radiofq trsmtr for implt neu L8684|||L|PO|852.9|639.67|654.64|Radiof trsmtr implt scrl neu L8689|||L|PO|1941.77|1456.32|1638.63|External recharg sys intern L8690|||L|PO|5355.13|4016.35|4519.17|Aud osseo dev| int/ext comp L8691|||L|PO|3001.72|2251.29|2533.15|Osseointegrated snd proc rpl L8693|||L|PO|1706.93|1280.2|1440.47|Aud osseo dev| abutment L8695|||L|PO|18.75|14.06|15.82|External recharg sys extern Q0478|||L|PO|206.86|155.14|174.57|Power adapter| combo vad Q0479|||L|PO|13595.85|10196.89|11473.5|Power module combo vad| rep Q0480|||L|PO|101385.4|76039.07|85558.83|Driver pneumatic vad| rep Q0481|||L|PO|16357.36|12268.02|13803.93|Microprcsr cu elec vad| rep Q0482|||L|PO|5123.44|3842.58|4323.65|Microprcsr cu combo vad| rep Q0483|||L|PO|21106.24|15829.68|17811.48|Monitor elec vad| rep Q0484|||L|PO|4098.76|3074.07|3458.94|Monitor elec or comb vad rep Q0485|||L|PO|395.74|296.8|333.96|Monitor cable elec vad| rep Q0486|||L|PO|329.36|247.02|277.94|Mon cable elec/pneum vad rep Q0487|||L|PO|384.26|288.19|324.29|Leads any type vad| rep only Q0489|||L|PO|18297.97|13723.48|15441.58|Pwr pck base combo vad| rep Q0490|||L|PO|791.49|593.61|667.93|Emr pwr source elec vad| rep Q0491|||L|PO|1244.29|933.22|1050.03|Emr pwr source combo vad rep Q0492|||L|PO|100.25|75.19|84.62|Emr pwr cbl elec vad| rep Q0493|||L|PO|285.43|214.07|240.85|Emr pwr cbl combo vad| rep Q0494|||L|PO|241.53|181.15|203.82|Emr hd pmp elec/combo| rep Q0495|||L|PO|4702.12|3526.59|3968.13|Charger elec/combo vad| rep Q0496|||L|PO|1687.66|1265.75|1424.23|Battery elec/combo vad| rep Q0497|||L|PO|526.98|395.24|444.71|Bat clps elec/comb vad| rep Q0498|||L|PO|578.22|433.67|487.95|Holster elec/combo vad| rep Q0499|||L|PO|187.86|140.9|158.54|Belt/vest elec/combo vad rep Q0500|||L|PO|34.37|25.78|29.01|Filters elec/combo vad| rep Q0501|||L|PO|574.88|431.16|485.14|Shwr cov elec/combo vad| rep Q0502|||L|PO|731.9|548.93|617.65|Mobility cart pneum vad| rep Q0503|||L|PO|1463.83|1097.87|1235.32|Battery pneum vad replacemnt Q0504|||L|PO|772.43|579.32|651.83|Pwr adpt pneum vad| rep veh Q0506|||L|PO|961.48|721.11|811.39|Lith-ion batt elec/pneum vad Q4001|||L||0|0|47.85|Cast sup body cast plaster Q4002|||L||0|0|180.82|Cast sup body cast fiberglas Q4003|||L||0|0|34.36|Cast sup shoulder cast plstr Q4004|||L||0|0|118.96|Cast sup shoulder cast fbrgl Q4005|||L||0|0|12.67|Cast sup long arm adult plst Q4006|||L||0|0|28.55|Cast sup long arm adult fbrg Q4007|||L||0|0|6.34|Cast sup long arm ped plster Q4008|||L||0|0|14.27|Cast sup long arm ped fbrgls Q4009|||L||0|0|8.46|Cast sup sht arm adult plstr Q4010|||L||0|0|19.04|Cast sup sht arm adult fbrgl Q4011|||L||0|0|4.22|Cast sup sht arm ped plaster Q4012|||L||0|0|9.53|Cast sup sht arm ped fbrglas Q4013|||L||0|0|15.4|Cast sup gauntlet plaster Q4014|||L||0|0|25.97|Cast sup gauntlet fiberglass Q4015|||L||0|0|7.71|Cast sup gauntlet ped plster Q4016|||L||0|0|12.98|Cast sup gauntlet ped fbrgls Q4017|||L||0|0|8.91|Cast sup lng arm splint plst Q4018|||L||0|0|14.19|Cast sup lng arm splint fbrg Q4019|||L||0|0|4.46|Cast sup lng arm splnt ped p Q4020|||L||0|0|7.11|Cast sup lng arm splnt ped f Q4021|||L||0|0|6.59|Cast sup sht arm splint plst Q4022|||L||0|0|11.89|Cast sup sht arm splint fbrg Q4023|||L||0|0|3.31|Cast sup sht arm splnt ped p Q4024|||L||0|0|5.95|Cast sup sht arm splnt ped f Q4025|||L||0|0|36.94|Cast sup hip spica plaster Q4026|||L||0|0|115.34|Cast sup hip spica fiberglas Q4027|||L||0|0|18.48|Cast sup hip spica ped plstr Q4028|||L||0|0|57.69|Cast sup hip spica ped fbrgl Q4029|||L||0|0|28.25|Cast sup long leg plaster Q4030|||L||0|0|74.36|Cast sup long leg fiberglass Q4031|||L||0|0|14.12|Cast sup lng leg ped plaster Q4032|||L||0|0|37.18|Cast sup lng leg ped fbrgls Q4033|||L||0|0|26.35|Cast sup lng leg cylinder pl Q4034|||L||0|0|65.54|Cast sup lng leg cylinder fb Q4035|||L||0|0|13.17|Cast sup lngleg cylndr ped p Q4036|||L||0|0|32.78|Cast sup lngleg cylndr ped f Q4037|||L||0|0|16.07|Cast sup shrt leg plaster Q4038|||L||0|0|40.27|Cast sup shrt leg fiberglass Q4039|||L||0|0|8.05|Cast sup shrt leg ped plster Q4040|||L||0|0|20.13|Cast sup shrt leg ped fbrgls Q4041|||L||0|0|19.55|Cast sup lng leg splnt plstr Q4042|||L||0|0|33.37|Cast sup lng leg splnt fbrgl Q4043|||L||0|0|9.78|Cast sup lng leg splnt ped p Q4044|||L||0|0|16.69|Cast sup lng leg splnt ped f Q4045|||L||0|0|11.35|Cast sup sht leg splnt plstr Q4046|||L||0|0|18.25|Cast sup sht leg splnt fbrgl Q4047|||L||0|0|5.66|Cast sup sht leg splnt ped p Q4048|||L||0|0|9.13|Cast sup sht leg splnt ped f Q4049|||L||0|0|2.07|Finger splint| static V2020|||D|PO|78.53|58.9|75.71|Vision svcs frames purchases V2100|||D|PO|49.06|36.8|36.8|Lens spher single plano 4.00 V2101|||D|PO|51.7|38.77|38.77|Single visn sphere 4.12-7.00 V2102|||D|PO|72.72|54.54|54.99|Singl visn sphere 7.12-20.00 V2103|||D|PO|42.6|31.95|31.95|Spherocylindr 4.00d/12-2.00d V2104|||D|PO|47.18|35.38|35.38|Spherocylindr 4.00d/2.12-4d V2105|||D|PO|51.37|38.52|43.32|Spherocylinder 4.00d/4.25-6d V2106|||D|PO|57|42.75|43.97|Spherocylinder 4.00d/>6.00d V2107|||D|PO|54.21|40.66|46.21|Spherocylinder 4.25d/12-2d V2108|||D|PO|56.13|42.1|44.82|Spherocylinder 4.25d/2.12-4d V2109|||D|PO|62.1|46.57|51.52|Spherocylinder 4.25d/4.25-6d V2110|||D|PO|61.28|45.96|60.13|Spherocylinder 4.25d/over 6d V2111|||D|PO|63.88|47.91|53|Spherocylindr 7.25d/.25-2.25 V2112|||D|PO|69.73|52.3|52.3|Spherocylindr 7.25d/2.25-4d V2113|||D|PO|78.59|58.94|72.26|Spherocylindr 7.25d/4.25-6d V2114|||D|PO|85.13|63.85|63.91|Spherocylinder over 12.00d V2115|||D|PO|92.65|69.49|69.49|Lens lenticular bifocal V2118|||D|PO|91.85|68.89|68.89|Lens aniseikonic single V2121|||D|PO|94.83|71.12|71.12|Lenticular lens| single V2200|||D|PO|64.22|48.16|48.16|Lens spher bifoc plano 4.00d V2201|||D|PO|69.99|52.49|52.49|Lens sphere bifocal 4.12-7.0 V2202|||D|PO|82.36|61.77|61.77|Lens sphere bifocal 7.12-20. V2203|||D|PO|64.78|48.59|48.59|Lens sphcyl bifocal 4.00d/.1 V2204|||D|PO|67.72|50.79|52.68|Lens sphcy bifocal 4.00d/2.1 V2205|||D|PO|73.22|54.92|57.79|Lens sphcy bifocal 4.00d/4.2 V2206|||D|PO|78.67|59|70.37|Lens sphcy bifocal 4.00d/ove V2207|||D|PO|71.57|53.67|58.74|Lens sphcy bifocal 4.25-7d/. V2208|||D|PO|75.11|56.33|59.46|Lens sphcy bifocal 4.25-7/2. V2209|||D|PO|80.87|60.66|65.41|Lens sphcy bifocal 4.25-7/4. V2210|||D|PO|89.2|66.9|84.15|Lens sphcy bifocal 4.25-7/ov V2211|||D|PO|92.5|69.37|71.75|Lens sphcy bifo 7.25-12/.25- V2212|||D|PO|95.52|71.64|78.09|Lens sphcyl bifo 7.25-12/2.2 V2213|||D|PO|96.49|72.37|80.07|Lens sphcyl bifo 7.25-12/4.2 V2214|||D|PO|104.88|78.66|85.83|Lens sphcyl bifocal over 12. V2215|||D|PO|106.47|79.85|92.88|Lens lenticular bifocal V2218|||D|PO|126.69|95.02|95.02|Lens aniseikonic bifocal V2219|||D|PO|55.77|41.83|41.83|Lens bifocal seg width over V2220|||D|PO|45.23|33.93|33.93|Lens bifocal add over 3.25d V2221|||D|PO|110.63|82.98|90.63|Lenticular lens| bifocal V2300|||D|PO|81.74|61.3|62.54|Lens sphere trifocal 4.00d V2301|||D|PO|96.36|72.27|72.53|Lens sphere trifocal 4.12-7. V2302|||D|PO|102.71|77.04|79.46|Lens sphere trifocal 7.12-20 V2303|||D|PO|80.44|60.33|65.83|Lens sphcy trifocal 4.0/.12- V2304|||D|PO|84.16|63.12|68.89|Lens sphcy trifocal 4.0/2.25 V2305|||D|PO|97.52|73.14|84.47|Lens sphcy trifocal 4.0/4.25 V2306|||D|PO|100.41|75.31|78.77|Lens sphcyl trifocal 4.00/>6 V2307|||D|PO|95.07|71.3|78.11|Lens sphcy trifocal 4.25-7/. V2308|||D|PO|99.63|74.72|83.35|Lens sphc trifocal 4.25-7/2. V2309|||D|PO|108.54|81.41|97.51|Lens sphc trifocal 4.25-7/4. V2310|||D|PO|107.25|80.44|107.25|Lens sphc trifocal 4.25-7/>6 V2311|||D|PO|111.6|83.7|102.14|Lens sphc trifo 7.25-12/.25- V2312|||D|PO|112.24|84.18|90.04|Lens sphc trifo 7.25-12/2.25 V2313|||D|PO|125.35|94.01|122.9|Lens sphc trifo 7.25-12/4.25 V2314|||D|PO|134.62|100.96|134.62|Lens sphcyl trifocal over 12 V2315|||D|PO|149.45|112.09|149.45|Lens lenticular trifocal V2318|||D|PO|183.73|137.8|137.8|Lens aniseikonic trifocal V2319|||D|PO|62.2|46.65|46.65|Lens trifocal seg width > 28 V2320|||D|PO|65.62|49.21|49.21|Lens trifocal add over 3.25d V2321|||D|PO|147.31|110.49|147.31|Lenticular lens| trifocal V2410|||D|PO|112.31|84.23|84.23|Lens variab asphericity sing V2430|||D|PO|135.35|101.51|109.66|Lens variable asphericity bi V2500|||D|PO|101.8|76.35|76.35|Contact lens pmma spherical V2501|||D|PO|155.07|116.3|116.3|Cntct lens pmma-toric/prism V2502|||D|PO|191.04|143.28|143.28|Contact lens pmma bifocal V2503|||D|PO|175.95|131.96|137.09|Cntct lens pmma color vision V2510|||D|PO|138.97|104.23|104.23|Cntct gas permeable sphericl V2511|||D|PO|199.68|149.76|149.76|Cntct toric prism ballast V2512|||D|PO|235.95|176.97|176.97|Cntct lens gas permbl bifocl V2513|||D|PO|198.09|148.57|148.57|Contact lens extended wear V2520|||D|PO|130.63|97.97|97.97|Contact lens hydrophilic V2521|||D|PO|227.42|170.57|170.57|Cntct lens hydrophilic toric V2522|||D|PO|221.32|165.99|165.99|Cntct lens hydrophil bifocl V2523|||D|PO|188.6|141.45|141.45|Cntct lens hydrophil extend V2530|||D|PO|279.35|209.52|209.52|Contact lens gas impermeable V2531|||D|PO|613.27|459.95|514.36|Contact lens gas permeable V2623|||D|PO|1124.32|843.24|843.24|Plastic eye prosth custom V2624|||D|PO|76.25|57.19|57.19|Polishing artifical eye V2625|||D|PO|463.59|347.69|370.42|Enlargemnt of eye prosthesis V2626|||D|PO|249.89|187.42|235.01|Reduction of eye prosthesis V2627|||D|PO|1613.92|1210.44|1345.46|Scleral cover shell V2628|||D|PO|381.08|285.81|307.63|Fabrication & fitting V2630|||L||0|0|111.81|Anter chamber intraocul lens V2631|||L||0|0|111.81|Iris support intraoclr lens V2632|||L||0|0|111.81|Post chmbr intraocular lens V2700|||D|PO|54.87|41.15|41.15|Balance lens V2710|||D|PO|80.31|60.23|60.23|Glass/plastic slab off prism V2715|||D|PO|14.56|10.92|10.92|Prism lens/es V2718|||D|PO|35.76|26.82|26.82|Fresnell prism press-on lens V2730|||D|PO|26.41|19.81|19.81|Special base curve V2744|||D|PO|20.55|15.41|20.55|Tint photochromatic lens/es V2745|||D|PO|12.87|9.65|11.66|Tint| any color/solid/grad V2750|||D|PO|23.91|17.93|23.91|Anti-reflective coating V2755|||D|PO|20.81|15.6|17.28|Uv lens/es V2760|||D|PO|20.06|15.04|15.04|Scratch resistant coating V2762|||D|PO|67.08|50.31|56.64|Polarization| any lens V2770|||D|PO|24.44|18.33|19.43|Occluder lens/es V2780|||D|PO|15.7|11.77|15.7|Oversize lens/es V2782|||D|PO|72.45|54.33|61.15|Lens| 1.54-1.65 p/1.60-1.79g V2783|||D|PO|81.69|61.27|68.96|Lens| >= 1.66 p/>=1.80 g V2784|||D|PO|53.12|39.84|44.84|Lens polycarb or equal V2786|||D|PO|0|0|0|Occupational multifocal lens