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OWNA4635$UNDERARM PAD CRUTCH REPLACEMENT EACHA4636(REPLACE HANDGRIP CANE CRUTCH WALKER EACHA4637#REPLACE TIP CANE CRUTCH WALKER EACHA4640+REPLACE PAD MED NEC ALT PRESSURE PAD PT OWNA5051)POUCH CLOSED W/BARRIER ATTACHED (1 PIECE)A5052*POUCH CLOSED WO/BARRIER ATTACHED (1 PIECE)A5053POUCH CLOSED USE FACEPLATEA5054+POUCH CLOSED USE BARRIER W/FLANGE (2 PIECE)A5055 STOMA CAPA5061,POUCH DRAINABLE W/BARRIER ATTACHED (1 PIECE)A5062-POUCH DRAINABLE WO/BARRIER ATTACHED (1 PIECE)A5063.POUCH DRAINABLE USE BARRIER W/FLANGE (2 PIECE)A5071*POUCH URINARY W/BARRIER ATTACHED (1 PIECE)A5072)POUCH URINARY WO BARRIER ATTACH (1 PIECE)A5073,POUCH URINARY USE BARRIER W/FLANGE (2 PIECE)A5081%CONTINENT DEVICE PLUG CONTINENT STOMAA5082%CONTINENT DEVICE CATH CONTINENT STOMAA5093OSTOMY ACCESSORY CONVEX INSERTA5102-BEDSIDE DRAIN BTL RIGID/EXPAND W/WO TUBING EAA5105&URINARY SUSPENSORY W/LEG BAG W/WO TUBEA5112URINARY LEG BAG LATEXA5113#LEG STRAP LATEX REPLCE ONLY PER SETA5114)LEG STRAP FOAM/FABRIC REPLAC ONLY PER SETA5119SKIN BARRIER WIPES BOX PER 50A5121&SKIN BARRIER SOLID 6X6/EQUIVALENT EACHA5122&SKIN BARRIER SOLID 8X8/EQUIVALENT EACHA5123#SKIN BARRIER W/FLANGE ANY SIZE EACHA5126ADHES/NON-ADHES DISK/FOAM PADA5131/APPLIANCE CLEAN (INCONTINENCE/OSTOMY) PER 16 OZE0100(CANE ALL MATERIAL ADJUSTABLE/FIXED W/TIPE01050CANE QUAD/3 PRONG ALL MATERIALS ADJ/FIXED W/TIPSE01100CRUTCHS FOREAREM ALL MAT ADJ/FIXED W/TIP HANDGRPE01110CRUTCH FOREARM VAR MAT ADJ/FIX W/TIP HANDGRIP EAE0112/CRUTCHS UNDERARM WOOD ADJ/FIX PAIR PAD/TIP GRIPE0113,CRUTCH UNDERARM WOOD ADJ/FIX PAD/TIP/GRIP EAE01140CRUTCHES UND'ARM NOT WOOD ADJ/FIX W/PAD/TIP/GRIPE0116.CRUTCH UND'ARM NOT WOOD ADJ/FIX W/PAD/TIP/GRIPE0130)WALKER RIGID (PICKUP) ADJUST/FIXED HEIGHTE0135+WALKER FOLDING (PICKUP) ADJUST/FIXED HEIGHTE0141RIGID WALKER WHEELED WO SEATE0142RIGID WALKER WHEELED W/SEATE0143FOLDING WALKER WHEELED WO SEATE0145*WALKER WHEELED W/SEAT & CRUTCH ATTACHMENTSE0146FOLDING WALKER WHEELED W/SEATE0147-HEAVY DUTY MULT BREAK VAR WHEEL RESIST WALKERE0153%PLATFORM ATTACHMENT FOREARM CRUTCH EAE0154PLATFORM ATTACHMENT WALKER EAE0155WHEEL ATT RIGID PICK-UP WALKERE0156SEAT ATTACHMENT WALKERE0157CRUTCH ATTACHMENT WALKER EAE0158"LEG EXTENSIONS WALKER PER SET OF 4E0160.SITZ TYPE BATH/EQUIP-PORTABLE-USE W/WO COMMODEE01610SITZ TYP BATH-PORT-USE W/WO COMMODE-W/FAUCET ATTE0163%COMMODE CHAIR STATIONARY W/FIXED ARMSE0164!COMMODE CHAIR MOBILE W/FIXED ARMSE0165*COMMODE CHAIR STATIONARY W/DETACHABLE ARMSE0166&COMMODE CHAIR MOBILE W/DETACHABLE ARMSE0167PAIL/PAN USE W/COMMODE CHAIRE0175 FOOT REST USE W/COMMODE CHAIR EAE0176'AIR PRESSURE PAD CUSHION NONPOSITIONINGE0177)WATER PRESSURE PAD/CUSHION NONPOSITIONINGE0178$GEL/GEL LIKE PRESS PAD/CUSH NONPOSITE0179'DRY PRESSURE PAD/CUSHION NONPOSITIONINGE0180PRESSURE PAD ALTERNATING W/PUMPE0181*PRESSURE PAD ALTERNATING W/PUMP HEAVY DUTYE0182PUMP ALTERNATING PRESSURE PADE0184DRY PRESSURE MATTRESSE0185.GEL/GEL LIKE PRESS PAD STAN MATRS LENGTH/WIDTHE0186AIR PRESSURE MATTRESSE0187WATER PRESSURE MATTRESSE0191HEEL/ELBOW PROTECTOR EACHE0192$LOW PRESS/POSIT EQUALIZATION W/C PADE0193/POWERED AIR FLOTATION BED (LOW AIR LOW THERAPY)E0194AIR FLUIDIZED BEDE0196GEL PRESSURE MATTRESSE0197%AIR PRESS PAD STAN MATRS LENGTH/WIDTHE0198%H20 PRESS PAD STAN MATRS LENGTH/WIDTHE0199%DRY PRESS PAD STAN MATRS LENGTH/WIDTHE0200-HEAT LAMP WO STAND INCL BULB/INFRARED ELEMENTE0202+PHOTOTHERAPY (BILIRUBIN) LIGHT W/PHOTOMETERE0205,HEAT LAMP W/STAND INCL BULB/INFRARED ELEMENTE0210ELECTRIC HEAT PAD STANDARDE0215ELECTRIC HEAT PAD MOISTE0220HOT WATER BOTTLEE0225HYDROCOLLATOR UNIT INCL PADSE0230ICE CAP/COLLARE0235PARAFFIN BATH UNIT PORTABLEE0236PUMP WATER CIRCULATING PADE0238NON ELECTRIC HEAT PAD MOISTE0239HYDROCOLLATOR UNIT PORTABLEE0249PAD WATER CIRCULATING HEAT UNITE0250-HOSP BED FIX HEIGHT W/ANY SIDE RAILS/MATTRESSE0251+HOSP BED FIX HEIGHT W/ANY RAILS WO MATTRESSE0255.HOSP BED VARIABLE HI-LO W/ANY RAILS W/MATTRESSE0256/HOSP BED VARIABLE HI-LO W/ANY RAILS WO MATTRESSE0260)HOSP BED SEMI-ELEC W/ANY RAILS W/MATTRESSE0261*HOSP BED SEMI-ELEC W/ANY RAILS WO MATTRESSE0265*HOSP BED TOTAL ELEC W/ANY RAILS W/MATTRESSE0266+HOSP BED TOTAL ELEC W/ANY RAILS WO MATTRESSE0271MATTRESS INNERSPRINGE0272MATTRESS FOAM RUBBERE0275BED PAN STANDARD METAL/PLASTICE0276BED PAD FRACTURE METAL/PLASTICE0277 POWERED PRESS-REDUCING AIR MATRSE0280BED CRADLE ANY TYPEE0290'HOSP BED FIX HEIGHT WO RAILS W/MATTRESSE0291(HOSP BED FIX HEIGHT WO RAILS WO MATTRESSE0292+HOSP BED VARIABLE HI-LO WO RAILS W/MATTRESSE0293,HOSP BED VARIABLE HI-LO WO RAILS WO MATTRESSE0294*HOSP BED SEMI-ELECTRIC WO RAILS W/MATTRESSE0295+HOSP BED SEMI-ELECTRIC WO RAILS WO MATTRESSE0296+HOSP BED TOTAL-ELECTRIC WO RAILS W/MATTRESSE0297,HOSP BED TOTAL-ELECTRIC WO RAILS WO MATTRESSE0305BED SIDE RAILS HALF LENGTHE0310BEDSIDE RAILS FULL LENGTHE0325!URINAL MALE JUG TYPE ANY MATERIALE0326#URINAL FEMALE JUG TYPE ANY MATERIALE0424-STATIONARY COMPRESSED O2 SYS RENT; INCL EQUIPE0431)PORTABLE GAS O2 SYSTEM RENTAL; INCL EQUIPE0434,PORTABLE LIQUID O2 SYSTEM RENTAL; INCL EQUIPE0439)STATIONARY LIQUID O2 SYS RENT; INCL EQUIPE0441O2 CONTENTS GASEOUS PER UNITE0442O2 CONTENTS LIQUID PER UNITE0443%PORTABLE O2 CONTENTS GASEOUS PER UNITE0444$PORTABLE O2 CONTENTS LIQUID PER UNITE0450.VOL VENT STAT/PORT/BACKUP RATE/INVAS INTERFACEE0452/INTERMITTENT ASSIST DEV W/CONT POS AIRWAY PRESSE0453,THERAPEUTIC VENTILATOR USE TO 12 HRS PER DAYE0457CHEST SHELL (CUIRASS)E0459 CHEST WRAPE04600NEGATIVE PRESSURE VENTILATOR PORTABLE/STATIONARYE0462ROCKING BED W/WO SIDE RAILSE0480'PERCUSSOR ELECTRIC/PNEUMATIC HOME MODELE0500.IPPB MACHINE ALL MAN/AUTO VALVES INT/EXT POWERE0550-HUMIDIFIER DURABLE SUPPLEMENTAL W/IPPB/OXYGENE0560+HUMIDIFIER DURABLE SUPPLEMENT W/IPPB/OXYGENE0565%COMPRESSOR AIR POWER SOURCE EQUIPMENTE0570NEBULIZER WITH COMPRESSORE0575NEBULIZER ULTRASONICE0585NEBULIZER W/COMPRESSOR & HEATERE0600 SUCTION PUMP HOME MODEL PORTABLEE0601(CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICEE0605VAPORIZER ROOM TYPEE0606POSTURAL DRAINAGE BOARDE0607HOME BLOOD GLUCOSE MONITORE0608 APNEA MONITORE0609(BLOOD GLUCOSE MONITOR W/SPECIAL FEATURESE0610.PACEMAKER MONITOR SELF CONTAIN W/AUD/VIS CHECKE0615.PACEMAKER MONITOR SELF CONTAIN W/DIG/VIS CHECKE0621$SLING/SEAT PATIENT LIFT CANVAS/NYLONE0627,SEAT LIFT INCORPORATE W/LIFT CHAIR MECHANISME0628-SEP SEAT LIFT USE W/PT OWN FURNITURE ELECTRICE0629-SEP SEAT LI< FT USE W/PT OWN FURNITURE NON-ELECE0630#PATIENT LIFT HYDRAULIC W/SEAT/SLINGE0635"PATIENT LIFT ELECTRIC W/SEAT/SLINGE0650,PNEUMATIC COMPRESSOR NONSEGMENTAL HOME MODELE0651.PNEUMATIC COMPRESS SEGMENTAL WO GRADIENT PRESSE0652-PNEUMATIC COMPRESS SEGMENTAL W/GRADIENT PRESSE06550NONSEGMENTAL PNEUMATIC-USE W/COMPRESSOR HALF ARME06600NONSEGMENTAL PNEUMATIC-USE W/COMPRESSOR FULL LEGE06650NONSEGMENTAL PNEUMATIC-USE W/COMPRESSOR FULL ARME06660NONSEGMENTAL PNEUMATIC-USE W/COMPRESSOR HALF LEGE0667-SEGMENTAL PNEUMATIC-USE W/COMPRESSOR FULL LEGE0668-SEGMENTAL PNEUMATIC-USE W/COMPRESSOR FULL ARME0669-SEGMENTAL PNEUMATIC-USE W/COMPRESSOR HALF LEGE0671/SEGMENT GRAD PRESS PNEUMATIC APPLIANCE FULL LEGE0672/SEGMENT GRAD PRESS PNEUMATIC APPLIANCE FULL ARME0673/SEGMENT GRAD PRESS PNEUMATIC APPLIANCE HALF LEGE0690(ULTRAVIOLET CABINET APPROPRIATE HOME USEE0720!TENS 2 LEAD LOCALIZED STIMULATIONE0730/TENS 4 LEAD LARGE AREA/MULTIPLE NERVE STIMULATEE0731%FORM FIT CONDUCTIVE GARMENT TENS/NMESE0744"NEUROMUSCULAR STIMULATOR SCOLIOSISE0745.NEUROMUSCULAR STIMULATOR ELECTRONIC SHOCK UNITE07470O'GENIC STIM ELEC NONINVAS OTH THAN SPINE APPLICE0748.OSTEOGENIC STIM-ELEC-NON INVAS-SPINE APPLICTNSE0749-OSTEOGENESIS STIM ELEC (SURGICALLY IMPLANTED)E0776IV POLEE0781.AMB INFUS PUMP 1/MULTI CHAN ELEC/BATT PT WEARSE0782*INFUSION PUMP-IMPLANTABLE-NON PROGRAMMABLEE07910PARENTERAL INFUSION PUMP STATIONARY 1/MULTICHANLE0840)TRACTION FRAME TO HEADBOARD CERV TRACTIONE0850)TRACTION STAND FREESTANDING CERV TRACTIONE0855(CERV TRACT EQUIP NOT REQ ADD STAND/FRAMEE0860 TRACTION EQUIPMENT OVERDOOR CERVE0870.TRACTION FRAME TO FOOTBOARD EXTREMITY TRACTIONE0880.TRACTION STAND FREESTANDING EXTREMITY TRACTIONE0890+TRACTION FRAME TO FOOTBOARD PELVIC TRACTIONE0900+TRACTION STAND FREESTANDING PELVIC TRACTIONE0910*TRAPEZE BARS TO BED W/GRAB BAR (PT HELPER)E0920"FRACTURE FRAME TO BED INCL WEIGHTSE0930%FRACTURE FRAME FREESTANDING W/WEIGHTSE0935PASSIVE MOTION EXERCISE DEVICEE0940,TRAPEZE BAR FREESTANDING COMPLETE W/GRAB BARE0941'GRAVITY ASSIST TRACTION DEVICE ANY TYPEE0942CERVICAL HEAD HARNESS/HALTERE0943CERVICAL PILLOWE0944PELVIC BELT/HARNESS/HALTERE0945EXTREMITY BELT/HARNESSE0946%FX FRAME DUAL W/CROSS BARS ATTACH BEDE0947&FX FRAME ATTACH COMPLX PELVIC TRACTIONE0948(FX FRAME ATTACH COMPLX CERVICAL TRACTIONE0950TRAYE0951 LOOP HEEL EAE0952 LOOP TOE EAE0953PNEUMATIC TIRE EAE0954SEMI PNEUMATIC CASTER EAE0958,WHEELCHAIR ATTACH CONVERT ANY TO 1 ARM DRIVEE0959,AMPUTEE ADAPTER (COMPENSATE WEIGHT TRANSFER)E0961BRAKE EXTENSION FOR WHEELCHAIRE09621" CUSHION FOR WHEELCHAIRE09632" CUSHION FOR WHEELCHAIRE09643" CUSHION FOR WHEELCHAIRE09654" CUSHION FOR WHEELCHAIRE0966HOOK ON HEAD REST EXTENSIONE0967.WHEELCHAIR HAND RIMS W/8 VERTICAL PROJECT PAIRE0968COMMODE SEAT WHEELCHAIRE0969NARROWING DEVICE WHEELCHAIRE0970(# 2 FOOTPLATES EXCEPT ELEVATING LEG RESTE0971ANTI TIPPING DEVICE WHEELCHAIRSE0972TRANSFER BOARD/DEVICEE0973*ADJUST HT DETACH ARMS DESK/FULL WHEELCHAIRE0974)GRADE AIDE (PREVENT ROLL BACK) WHEELCHAIRE0975%REINFORCED SEAT UPHOLSTERY WHEELCHAIRE0976/REINFORCED BACK WHEELCHAIR UPHOLSTERY/OTHER MATE0977WEDGE CUSHION WHEELCHAIRE0978(BELT SAFETY W/AIRPLANE BUCKLE WHEELCHAIRE0979%BELT SAFETY W/VELCRO CLOSE WHEELCHAIRE0980SAFETY VEST WHEELCHAIRE0990ELEVATING LEGREST EAE0991UPHOLSTERY SEATE0992SOLID SEAT INSRTE0993BACK UPHOLSTERYE0994 ARM REST EAE0995 CALF REST EAE0996 TIRE SOLID EAE0997 CASTER W/FORKE0998CASTER WO FORKE0999PNEUMATIC TIRE W/WHEELE1000TIRE PNEUMATIC CASTERE1001 WHEEL SINGLEE1031+ROLLABOUT CHAIR ALL TYPES W/CASTORS 5"/MOREE1050/FULL RECLINE WHEELCHAIR FIX ARM DETACHABLE LEGSE1060(FULL RECLINE WHEELCHIAR DETACH ARMS/LEGSE1065*POWER ATTACHMENT TO CONVERT ANY WHEELCHAIRE1066BATTERY CHARGERE1069DEEP CYCLE BATTERYE1070,FULL RECLINE WHEELCHAIR DETACH ARMS/FOOTRESTE1083.HEMI WHEELCHAIR FIXED FULL ARMS DETACH LEGRESTE1084)HEMI WHEELCHAIR DETACH ARMS/LEGS FOOTRESTE1085+HEMI WHEELCHAIR FIXED ARMS DETACH FOOTRESTSE1086*HEMI WHEELCHAIR DETACH ARMS DESK FOOTRESTSE1087,HI STR LITE WHEELCHIAR FIX FULL ARM DET LEGSE1088,HI STR LITE WHEELCHAIR DETACH ARMS DESK LEGSE1089/HI STR LITE WHEELCHAIR FIX ARMS DETACH FOOTRESTE10900HI STR LITE WHEELCHAIR DETACH ARMS DESK FOOTRESTE1091YOUTH WHEELCHAIR ANY TYPEE1092.WIDE HEAVY DUTY WHEELCHAIR DETACH ARM DESK LEGE10930WIDE HVY DUTY WHEELCHAIR DETACH FULL ARM DESK FTE11000SEMI RECLINE WHEELCHAIR FIX FULL ARMS DETACH LEGE1110/SEMI RECILNE DETACH ARM (DESK FULL) ELEVATE LEGE1130-STANDARD WHEELCHAIR FIX FULL ARMS DETACH FOOTE1140.WHEELCHAIR DETACH ARMS (DESK FULL) DETACH FOOTE1150-WHEELCHAIR DETACH ARMS (DESK FULL) DETACH LEGE1160(WHEELCHAIR FIX FULL ARMS DETACH LEGRESTSE1170/AMPUTEE WHEELCHAIR FIX FULL ARM DETACH LEGRESTSE1171,AMPUTEE WHEELCHAIR FIX FULL ARM W/O FOOT/LEGE1172*AMPUTEE WHEELCHAIR DETACH ARMS WO FOOT/LEGE1180/AMPUTEE WHEELCHAIR DETACH ARMS DETACH FOOTRESTSE1190.AMPUTEE WHEELCHAIR DETACH ARMS DETACH ELEV LEGE11950HVY DTY WHEELCHAIR FIX FULL ARMS DETACH ELEV LEGE12000AMPUTEE WHEELCHAIR FIX FULL ARMS DETACH FOOTRESTE1210.MOTOR WHEELCHAIR FIX FULL ARMS DETACH ELEV LEGE1211,MOTOR WHEELCHAIR DETACH ARMS DETACH ELEV LEGE1212/MOTOR WHEELCHAIR FIX FULL ARMS DETACH FOOTRESTSE1213-MOTOR WHEELCHAIR DETACH ARMS DETACH FOOTRESTSE1221WHEELCHAIR W/FIX ARM FOOTRESTSE1222'WHEELCHAIR W/FIX ARM ELEVATING LEGRESTSE1223"WHEELCHAIR W/DETACH ARMS FOOTRESTSE1224+WHEELCHAIR W/DETACH ARMS ELEVATING LEGRESTSE1225'SEMI RECLINE BACK FOR CUSTOM WHEELCHAIRE1226'FULL RECLINE BACK FOR CUSTOM WHEELCHAIRE1227"SPECIAL HEIGHT ARMS FOR WHEELCHAIRE1228"SPECIAL BACK HEIGHT FOR WHEELCHAIRE1230/POWER OP VEHICLE (3-4 WHEEL) BRAND/NAME/MODEL #E1240.LITE WHEELCHAIR DETACH ARM DETACH ELEV LEGRESTE1250-LITE WHEELCHAIR FIX FULL ARMS DETACH FOOTRESTE1260+LITE WHEELCHIAR DETACH ARMS DETACH FOOTRESTE1270-LITE WHEELCHAIR FIX FULL ARMS DETACH ELEV LEGE1280/HEAVY DUTY WHEELCHAIR DETACH ARMS ELEV LEGRESTSE12850HVY DTY WHEELCHAIR FIX FULL ARMS DETACH FOOTRESTE12900HEAVY DTY WHEELCHAIR DETACH ARMS DETACH FOOTRESTE12950HEAVY DUTY WHEELCHAIR FIX FULL ARMS ELEV LEGRESTE1296)SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOORE1297+SPECIAL WHEELCHAIR SEAT DEPTH BY UPHOLSTERYE1298,SPECIAL WHEELCHAIR SEAT DEPTH/WIDTH BY CONSTE1310&WHIRLPOOL NON PORTABLE (BUILT IN TYPE)E1372'IMMERSION EXTERNAL HEATER FOR NEBULIZERE1375.NEBULIZER PORTABLE W/SMALL COMPRESS LIMIT FLOWE14000OXYGEN CONCENTRATE MAX 2LITER/MIN 85%CONCENTRATEE14010OXYGEN CONCENTRATE 2-3 LITER/MIN 85% CONCENTRATEE14020OXYGEN CONCENTRATE 3-4 LITER/MIN 85% CONCENTRATEE14030OXYGEN CONCENTRATE 4-5 LITER/MIN 85% CONCENTRATEE1404'OXYGEN CONCENTRATE OVER 5 LITER/MIN 85%L0100-CERV CRANIOSTENOSIS HELMET MOLDED TO PT MODELL0110%CERV CRANIOSTENOSIS HELMET NON MOLDEDL0120*CERV FLEXIBLE NON ADJUSTABLE (FOAM COLLAR)L0130/CERV FLEXIBLE THERMOPLASTIC COLLAR MOLDED TO PTL0140+CERV SEMI-RIGID ADJUSTABLE (PLASTIC COLLAR)L0150*CERV SEMI-RIGID ADJUSTABLE MOLDED CHIN CUPL0160-CERV SEMI RIGID WIRE FRAME OCCIPITAL/MANDIBLEL0170CERV COLLAR MOLDED TO PT MODELL0172,CERV COLLAR SEMI RIGID THERMOPLASTIC 2 PIECEL0174/CERV COLLAR SEMI RIGID THERMOPLASTIC W/THORACICL0180)CERV MULT POST COLLAR OCCIP/MAND SUPP ADJL0190.CERV MULT POST COLLAR OCCIP/MAND ADJ CERV BARSL02000CERV MULT POST COLLAR OCCIP/MAND ADJ CERV W/THORL0210THORACIC RIB BELTL0220#THORACIC RIB BELT CUSTOM FABRICATEDL0300-TLSO FLEXIBLE (DORSO-LUMBAR SURGICAL SUPPORT)L0310TLSO FLEX CUSTOM FABRICATEDL0315.TLSO FLEX ELASTIC TYPE W/RIGID< POSTERIOR PANELL0317.TLSO FLEX HYPEREXTENSION ELASTIC W/RIGID PANELL0320#TLSO ANT/POST CONTROL W/APRON FRONTL0330'TLSO ANT/POST/LAT CONTROL W/APRON FRONTL0340.TLSO ANT/POST/LAT/ROTARY CONTROL W/APRON FRONTL0350/TLSO ANT/POST/LAT/ROTARY CONTROL FLEXION CUSTOML0360.TLSO ANT/POST/LAT/ROTARY FLEX MOLD TO PT MODELL0370'TLSO ANT/POST/LAT/ROTARY HYPEREXTENSIONL0380-TLSO ANT/POST/LAT/ROTARY CONTROL W/EXTENSIONSL0390+TLSO ANT-POST-LAT CONTRL MOLDED TO PT MODELL0400/TLSO ANT-POST-LAT CONTRL MOLDED W/INTERFACE MATL0410-TLSO ANT-POST-LAT CONTRL 2-PIECE MOLDED TO PTL0420,TLSO ANT-POST-LAT CONTRL 2-PIECE W/INTERFACEL0430/TLSO ANT-POST-LAT CONTRL W/INTERFACE-CUSTOM FITL0440,TLSO ANT-POST-LAT CONTRL W/FRONT SECT CUSTOML0500,LSO FLEXIBLE (LUMBO-SACRAL SURGICAL SUPPORT)L0510'LSO FLEX SURG SUPPORT CUSTOM FABRICATEDL0515-LSO FLEX SURG SUPP ELASTIC TYPE W/RIGID PANELL0520&LSO ANT/POST/LAT CONTROL W/APRON FRONTL0530"LSO ANT/POST CONTROL W/APRON FRONTL0540LSO LUMBAR FLEXIONL0550*LSO ANT-POST-LAT CONTRL MOLDED TO PT MODELL0560.LSO AP-LAT CONTRL MOLDED MODEL W/INTERFACE MATL0565"LSO ANT-POST-LAT CONTRL CUSTOM FITL0600-SACROILIAC FLEXIBLE (SACROILIAC SURG SUPPORT)L0610%SACROILIAC FLEXIBLE CUSTOM FABRICATEDL0620#SACROILIAC SEMI RIGID W/APRON FRONTL0700-CTLSO ANT/POST/LAT CONTROL MOLDED TO PT MODELL0710+CTLSO ANT/POST/LAT MOLDED TO PT W/INTERFACEL0810(HALO PROC CERV HALO INC INTO JACKET VESTL08200HALO PROC CERV HALO INC INTO PLASTER BODY JACKETL0830+HALO PROC CERV HALO INC INTO MILWAUKEE TYPEL0860&ADD TO HALO PROC MRI COMPATIBLE SYSTEML0900TORSO SUPP-PTOSIS SUPPL0910#TORSO SUPP PTOSIS CUSTOM FABRICATEDL0920$TORSO SUPP PENDULOUS ABDOMEN SUPPORTL0930.TORSO SUPP PENDULOUS ABDOMEN CUSTOM FABRICATEDL0940"TORSO SUPPORT-POSTSURGICAL SUPPORTL0950*TORSO SUPP POST SURGICAL CUSTOM FABRICATEDL0960)TORSO SUPP POST SURGICAL PADS FOR SUPPORTL0970TLSO CORSET FRONTL0972LSO CORSET FRONTL0974TLSO FULL CORSETL0976LSO FULL CORSETL0978AXILLARY CRUTCH EXTENSIONL0980PERONEAL STRAPS PAIRL0982!STOCKING SUPPORTER GRIPS SET OF 4L1000#CTLSO INCL INIT ORTHOSIS INCL MODELL1010#ADD TO CTLSO SCOLIOSIS AXILLA SLINGL1020)ADD CTLSO/SCOLIOSIS ORTHOSIS KYPHOSIS PADL1025+ADD CTLSO/SCOLIOSIS ORTHOSIS FLOAT KYPHOSISL1030&ADD CTLSO SCOLIOSIS LUMBAR BOLSTER PADL1040"ADD CTLSO SCOLIOSIS LUMBAR/RIB PADL1050ADD CTLSO SCOLIOSIS STERNAL PADL1060 ADD CTLSO SCOLIOSIS THORACIC PADL1070#ADD CTLSO SCOLIOSIS TRAPEZIUS SLINGL1080ADD CTLSO SCOLIOSIS OUTRIGGERL1085/ADD CTLSO SCOLIOSIS OUTRIGGER BILAT W/EXTENSIONL1090 ADD CTLSO SCOLIOSIS LUMBAR SLINGL1100/ADD CTLSO SCOLIOSIS RING FLANGE PLASTIC/LEATHERL11100ADD CTLSO SCOLIOSIS RING FLANGE MOLD TO PT MODELL1120$ADD CTLSO SCOLIOSIS EA UPRIGHT COVERL1200$TLSO INCL FURNISH INIT ORTHOSIS ONLYL1210ADD TLSO LAT THORACIC EXTENSIONL1220$ADD TLSO ANTERIOR THORACIC EXTENSIONL1230'ADD TLSO MILWAUKEE TYPE SUPER STURCTUREL1240ADD TLSO LUMBAR DEROTATION PADL1250ADD TLSO ANTERIOR ASIS PADL1260)ADD TLSO ANTERIOR/THORACIC DEROTATION PADL1270ADD TLSO ABDOMINAL PADL1280 ADD TLSO RIB GUSSET (ELASTIC) EAL1290!ADD TLSO LATERAL TROCHANTERIC PADL13000OTHER SCOLIOSIS PROC BODY JACKET MOLDED TO MODELL1310(OTHER SCOLIOSIS PROC POST OP BODY JACKETL1500THKAO MOBILITY FRAMEL1510THKAO STANDING FRAMEL1520THKAO SWIVEL WALKERL1600+HO ABDUCTION HIP JOINTS FLEX FREJKA W/COVERL1610/HO ABDUCTION CONTROL FLEXIBLE FREJKA COVER ONLYL1620,HO ABDUCTION CONTROL FELXIBLE PAVLIK HARNESSL1630"HO ABDUCTION CONTROL SEMI FLEXIBLEL16400HO ABDUCTION STATIC PELVIC BAND SPREAD BAR CUFFSL1650)HO-ABDUCT CONTRL HIP JT-STATIC-ADJUSTABLEL1660&HO-ABDUCT CONTRL HIP JT-STATIC-PLASTICL1680/HO ABDUCTION DYNAMIC PELVIC/HIP CONTROL W/CUFFSL1685&HO ABDUCTION POST OP CUSTOM FABRICATEDL1686/HO-ABDUCT CONTRL HIP JT-POST-OP HIP ABDUCT TYPEL1700"LEGG PERTHES ORTHOSIS TORONTO TYPEL1710$LEGG PERTHES ORTHOSIS NEWINGTON TYPEL1720 LEGG PERTHES ORTHOSIS TRILATERALL1730(LEGG PERTHES ORTHOSIS SCOTTISH RITE TYPEL1750(LEGG PERTHES ORTHOSIS LEGG PERTHES SLINGL1755*LEGG PERTHES ORTHOSIS PATTERN BOTTOM STYLEL1800KNEE ORTHOSIS ELASTIC W/STAYSL1810KO ELASTIC W/JOINTSL18150KO ELASTIC/OTHER ELASTIC MATERIAL W/CONDYLAR PADL1820#KO ELASTIC W/CONDYLAR PADS & JOINTSL1825KO ELASTIC KNEE CAPL1830"KO IMMOBILIZER CANVAS LONGITUDINALL1832/KO-ADJUST KNEE JTS-POSITION ORTHOSIS-RIGID SUPPL1834%KO WO/ JOINT RIGID MOLDED TO PT MODELL1840-KO DEROTATOIN MED/LAT ANT CRUC LIG CUSTOM FABL1843/KO SNGL UPRT THIGH/CALF W/ADJ FLEX/JNT CUST FITL1844.KO 1 UPRIGHT THIGH & CALF W/ADJUST FLEX MOLDEDL1845)KO UPRIGHT THIGH/CALF ADJ FLEX CUSTOM FITL1846/KO UPRIGHT THIGH/CALF ADJ FLEX MOLD TO PT MODELL1850KO SWEDISH TYPEL1855/KO MOLD PLASTIC THIGH/CALF W/UPRIGHT JTS MOLDEDL1858/KO MOLD PLASTIC POLYCENTRIC JTS PNEUM KNEE PADSL1860+KO MOD SUPRACONDYLAR PROS SOCKET MOLD TO PTL1870-KO UPRIGHT THIGH/CALF LACERS MOLD TO PT W/JTSL1880)KO UPRIGHT NON MOLD THIGH/CALF W/KNEE JTSL1885,KO, SNGL/DBL UPRT, THIGH & CALF, W/FUNCT ARCL1900*AFO SPRING WIRE DORSIFLEX ASSIST CALF BANDL1902Appendix Exhibit 5?Fee Schedule for Durable Medical Equipment & Prosthetic DevicesAFO ANKLE GAUNTLETL1904(AFO MOLD ANKLE GAUNTLET MOLD TO PT MODELL1906!AFO MULTILIGAMENTUS ANKLE SUPPORTL1910+AFO POST 1 BAR CLASP ATTACH TO SHOE COUNTERL1920&AFO 1 UPRIGHT W/STATIC/ADJUSTABLE STOPL1930 AFO-PLASTICL1940AFO MOLD TO PT MODEL PLASTICL1945.AFO MOLDED PT MODEL PLASTIC RIGID ANT/TIB SECTL1950 AFO SPRIAL MOLD PT MODEL PLASTICL1960-AFO POST SOLID ANKLE MOLD TO PT MODEL PLASTICL1970*AFO PLASTIC MOLD TO PT MODEL W/ANKLE JOINTL1980(AFO 1 UPRIGHT FREE PLANTAR SOLID STIRRUPL1990(AFO 2 UPRIGHT FREE PLANTAR SOLID STIRRUPL2000,KAFO 1 UPRIGHT FREE KNEE/ANKLE SOLID STIRRUPL2010.KAFO 1 UPRIGHT FREE ANKLE SOLID STIRRUP W/O JTL2020*KAFO UPRIGHT FREE KNEE/ANKLE SOLID STIRRUPL2030,KAFO UPRIGHT FREE ANKLE SOLID STIRRUP W/O JTL2035#KAFO FULL PLSTC STAT PREFAB PEDS SZL2036.KAFO FULL PLASTIC UPRIGHT FREE KNEE MOLD TO PTL20370KAFO FULL PLASTIC 1 UPRIGHT FREE KNEE MOLD TO PTL2038.KAFO FULL PLASTIC W/O JOINT W/MULTI AXIS ANKLEL2039-KAFO PLSTC HINGE-MED/LAT CONTRL MOLD TO PT-EAL2040,HKAFO BILAT ROTATION STRAPS PELVIC BAND/BELTL2050.HKAFO BILAT TORSION CABLES HIP JNT PELVIC BANDL2060-HKAFO BILAT TORSION CABLE BALLBEARING HIP JNTL2070,HKAFO UNILAT ROTATION STRAP PELVIC BAND/BELTL2080.HKAFO UNILAT TORSION CABLE HIP JNT PELVIC BANDL2090.HKAFO UNILAT TORSION CABLE BALLBEARING HIP JNTL2102.AFO FRACTURE/TIBIA ORTHOSIS PLASTER MOLD TO PTL21040AFO FRACTURE/TIBIA ORTHOSIS SYNTHETIC MOLD TO PTL21060AFO FRACTURE/TIBIA ORTHOSIS THERMOPLASTIC MOLDEDL2108)AFO FRACTURE/TIBIA ORTHOSIS MOLD TO MODELL2112$AFO-FRACTURE/TIBIAL FX ORTHOSIS-SOFTL2114*AFO-FRACTURE/TIBIAL FX ORTHOSIS-SEMI-RIGIDL2116$AFO-FRACTURE/TIBIA FX ORTHOSIS-RIGIDL2122-KAFO FRACTURE/FEMORAL PLASTER CAST MOLD TO PTL2124/KAFO FRACTURE/FEMORAL SYNTHETIC CAST MOLD TO PTL2126.KAFO FRACTURE/FEMORAL THERMOPLASTIC MOLD TO PTL2128&KAFO FRACTURE/FEMORAL MOLD TO PT MODELL2132%KAFO-FX/FEMORAL FX CAST ORTHOSIS-SOFTL2134.KAFO-FRACTURE/FEMORAL CAST ORTHOSIS-SEMI-RIGIDL2136)KAFO-FRACTURE/FEMORAL CAST ORTHOSIS-RIGIDL2180-ADD LOW EXT ORTH PLASTIC SHOE INS W/ANKLE JNTL2182%ADD LOW EXT ORTH DROP LOCK KNEE JOINTL2184*ADD LOW EXT ORTH LIMITED MOTION KNEE JOINTL2186+ADD LOW EXT ORTH ADJ KNEE JOINT LERMAN TYPEL2188#ADD LOW EXT ORTH QUADRILATERAL BRIML2190ADD LOW EXT ORTH WAIST BELTL2192/ADD LOW EXT ORTH HIP JNT THIGH FLANGE PELV BELTL2200)ADD LOW EXT LIMITED ANKLE MOTION EA JOINTL2210(ADD LOW EXT DORSIFELXION ASSIST EA JOINT< L2220/ADD LOW EXT DORSIFLEXION PLANTAR ASST/RESIST EAL2230,ADD LOW EXT SPLIT FLAT CALIPER STIRRUP/PLATEL2240(ADD LOW EXT ROUND CALIPER & PLATE ATTACHL22500ADD LOW EXT FOOT PLATE MOLD TO PT MODELW/STIRRUPL2260$ADD LOW EXT REINFORCED SOLID STIRRUPL2265ADD LOW EXT LONG TONGUE STIRRUPL2270.ADD LOW EXT VARUS/VALGUS CORRECT PAD/LINED PADL22750ADD LOWER EXT VARUS/VULGAS CORRECT PLASTIC MODIFL2280ADD LOW EXT MOLDED INNER BOOTL2300,ADD LOW EXT ABDUCTION BAR JOINTED ADJUSTABLEL2310"ADD LOW EXT ABDUCTION BAR STRAIGHTL2320ADD LOW EXT NON MOLDED LACERL2330$ADD LOW EXT LACER MOLDED TO PT MODELL2335ADD LOW EXT ANTERIOR SWING BANDL2340,ADD LOW EXT PRETIBIAL SHELL MOLD TO PT MODELL2350.ADD LOW EXT PROSTHETIC SOCKET MOLD TO PT MODELL2360 ADD LOW EXT EXTENDED STEEL SHANKL2370ADD LOW EXT PATTEN BOTTOML2375/ADD LOW EXT TORSION CONT ANKLE JNT HALF STIRRUPL2380/ADD LOW EXT TORSION CONT STRAIGHT KNEE JOINT EAL2385,ADD LOW EXT STRAIGHT KNEE JNT HVY DTY EA JNTL2390"ADD LOW EXT OFFSET KNEE JNT EA JNTL2395*ADD LOW EXT OFFSET KNEE JNT HVY DTY EA JNTL2397*ADD LOWER EXTREM ORTHOSIS SUSPENSION SLEVEL2405ADD KNEE JNT DROP LOCK EA JNTL2415ADD KNEE JNT CAM LOCK EA JNTL24250ADD KNEE JNT DISC/DIAL LOCK ADJ KNEE FLEX EA JNTL2430.KNEE JT ADD-RATCHET LOCK KNEE EXTENSTION-EA JTL2435#ADD KNEE JNT POLYCENTRIC JNT EA JNTL2492%ADD KNEE JNT LIFT LOOP DROP LOCK RINGL2500.ADD LOW EXT THIGH/GLUTEAL/ISCHEAL WT BEAR RINGL2510.ADD LOW EXT WT BEAR QUADRILATERAL BRIM MOLD PTL2520-ADD LOW EXT WT BEAR QUADRILATERAL BRIM CUSTOML2525-ADD LOW EXT ISCHIAL M-1 BRIM MOLD TO PT MODELL2526'ADD LOW EXT ISCHIAL M-1 BRIM CUSTOM FITL2530$ADD LOW EXT WT BEAR LACER NON MOLDEDL2540'ADD LOW EXT WT BEAR LACER MOLD PT MODELL2550!ADD LOW EXT WT BEAR HIGHROLL CUFFL2570.ADD LOW EXT PELV HIP JNT CLEVIS TYPE 2 POS JNTL2580ADD LOW EXT PELV SLINGL26000ADD LOW EXT PELV HIP JNT CLEVIS THRUST BEAR FREEL26100ADD LOW EXT PELV HIP JNT CLEVIS THRUST BEAR LOCKL2620#ADD LOW EXT PELV HIP JNT HVY DTY EAL2622'ADD LOW EXT PELV HIP JNT ADJ FLEXION EAL26240ADD LOW EXT PELV HIP JNT ADJ FLEX, EXTEN, ABDUCTL2627/ADD LOW EXT PELV PLAST MOLD TO PT MODEL W/CABLEL26280ADD LOW EXT PELV METAL FRAME RECIP HIP JNT CABLEL2630#ADD LOW EXT PELV BAND & BELT UNILATL2640"ADD LOW EXT PELV BAND & BELT BILATL2650&ADD LOW EXT PELV/THORAC GLUTEAL PAD EAL2660ADD LOW EXT THORACIC BANDL2670(ADD LOW EXT THORACIC PARASPINAL UPRIGHTSL2680-ADD LOW EXT THORACIC LATERAL SUPPORT UPRIGHTSL2750.ADD LOW EXT ORTH PLATING CHROME/NICKEL PER BARL27550LOW EXTREM ADD ORTHOSIS CARBON GRAPHITE LAMINATEL2760'ADD LOW EXT ORTH (PRE)EXTENSION PER BARL2770/ADD LOW EXTREM ORTHOSIS ANY MATERIAL PER BAR/JTL2780-ADD LOW EXT ORTH NON CORROSIVE FINISH PER BARL2785&ADD LOW EXT ORTH DROP LOCK RETAINER EAL2795(ADD LOW EXT ORTH KNEE CONT FULL KNEE CAPL2800+ADD LOW EXT ORTH KNEE CONT CAP MED/LAT PULLL2810'ADD LOW EXT ORTH KNEE CONT CONDYLAR PADL2820/ADD LOW EXT ORTH SOFT INTERFACE MOLD BELOW KNEEL2830/ADD LOW EXT ORTH SOFT INTERFACE MOLD ABOVE KNEEL2840.ADD LOW EXT ORTH TIBIAL SOCK FRACTURE/EQUAL EAL2850/ADD LOW EXT ORTH FEMORAL SOCK FRACTURE/EQUAL EAL3224.ORTHO FOOTWEAR-WOMAN SHOE-OXFORD-PART OF BRACEL3225,ORTHO FOOTWEAR-MAN SHOE-OXFORD-PART OF BRACEL3650$SO FIGURE 8 DESIGN ABDUCT RESTRAINERL3660/SO FIGURE 8 ABDUCTION RESTRAIN CANVAS & WEBBINGL3670&SO ACROMIO/CLAVICULAR CANVAS & WEBBINGL3700EO ELASTIC W/STAYSL3710EO ELASTIC W/METAL JNTL3720.EO DOUBLE UPRIGHT W/(FORE)ARM CUFF FREE MOTIONL3730-EO DOUBLE UPRIGHT W/(FORE)ARM CUFF EXTEN/FLEXL3740+EO DOUBLE UPRIGHT W/(FORE)ARM CUFF ADJ LOCKL3800WHFO SHORT OPPONENS NO ATTACHL3805WHFO LONG OPPONENS NO ATTACHL3810 WHFO ADD THUMB ABDUCTION "C" BARL3815#WHFO ADD SECOND MP ABDUCTION ASSISTL3820(WHFO ADD IP EXTEN ASSIST W/MP EXTEN STOPL3825WHFO ADD MP EXTEN STOPL3830WHFO ADD MP EXTEN ASSISTL3835WHFO ADD MP SPRING EXTEN ASSISTL3840WHFO ADD SPRING SWIVEL THUMBL3845$WHFO THUMB IP EXTEN ASSIST W/MP STOPL3850*WHO ADD ACTION WRIST W/DORSIFLEXION ASSISTL3855WHFO ADD ADJ MP FLEXION CONTROLL3860+WHFO ADD ADJUSTABLE MP FLEXION CONTROL & IPL39000WHFO DYNAMIC FLEX RECIPROCAL WRIST/FINGER DRIVENL3901)WHFO DYNAMIC FLEX RECIPROCAL CABLE DRIVENL3902 WHFO EXTERNAL POWER COMPRESS GASL3904WHFO EXTERNAL POWER ELECTRICL3906#WHO WRIST GAUNTLET MOLD TO PT MODELL3907/WHFO WRIST GAUNTLET W/THUMB SPICA MOLD TO MODELL3908(WHO WRIST EXTEN CONTRL COCK-UP NONMOLDEDL3910WHFO SWANSON DESIGNL3912'HFO FLEX GLOVE W/ELASTIC FINGER CONTROLL3914WHO WRIST EXTENSION COCK-UPL3916(WHFO WRIST EXTENSION COCK-UP W/OUTRIGGERL3918HFO KNUCKLE BENDERL3920HFO KNUCKLE BENDER W/OUTRIGGERL3922+HFO KNUCKLE BENDER 2 SEGMENT TO FLEX JOINTSL3924WHFO OPPENHEIMERL3926WHFO THOMAS SUSPENSIONL3928HFO FINGER EXTEN W/CLOCK SPRINGL3930!WHFO FINGER EXTEN W/WRIST SUPPORTL3932FO SAFETY PIN SPRING WIREL3934FO SAFETY PIN MODIFIEDL3936 WHFO PALMERL3938WHFO DORSAL WRISTL3940$WHFO DORSAL WRIST W/OUTRIGGER ATTACHL3942HFO REVERSE KNUCKLE BENDERL3944&HFO REVERSE KNUCKLE BENDER W/OUTRIGGERL3946HFO COMPOSITE ELASTICL3948FO FINGER KNUCKLE BENDERL3950-WHFO COMB OPPENHEIMER W/KNUCKLE BEND 2 ATTACHL39520WHFO COMP OPPENHEIVER W/REVERSE KNUCKLE 2 ATTACHL3954HFO SPREADING HANDL3960%SEWHO ABDUCT POSITION AIRPLANE DESIGNL3962(SEWHO ABDUCT POSITION ERBS PALSEY DESIGNL3963/SEWHO MOLD SHOULDER/ARM/WRIST W/ARTIC ELBOW JNTL3964.SEO-MOBILE ARM SUPPRT ATT TO WC-BALANCE-ADJUSTL3965-SEO-MOBILE ARM SUPPRT ATT TO WC-ADJUST-RANCHOL3966-SEO-MOBILE ARM SUPPRT ATT TO WC-BAL-RECLININGL3968,SEO-MOBILE ARM SUPPRT ATT TO WC/FRICTION ARML3969,SEO MOBILE ARM MONOSUSPEN/OVERHEAD/YOKE SUPPL3970)SEO ADD MOBILE ARM ELEVATING PROXIMAL ARML3972.SEO ADD MOBILE ARM OFFSET/LAT ROCKER W/ELASTICL3974!SEO ADD MOBILE ARM SUPP SUPINATORL3980UP EXT FRACTURE ORTH HUMERALL3982 UP EXT FRACTURE ORTH RDIUS/ULNARL3984UP EXT FRACTURE ORTH WRISTL3985/UP EXT FRACTURE ORTH FOREARM HAND W/WRIST HINGEL3986UP EXT FRAC ORTH COMBINATIONL3995)ADD UP EXT ORTH SOCK FRACTURE OR EQUAL EAL4000REPLACE GIRDLE MILWAUKEE ORTHL4010REPLACE TRILATERAL SOCKET BRIML4020.REPLACE QUADRILAT SOCKET BRIM MOLD TO PT MODELL4030(REPLACE QUADRILAT SOCKET BRIM CUSTOM FITL4040REPLACE MOLD THIGH LACERL4045REPLACE NON MOLDED THIGH LACERL4050REPLACE MOLD CALF LACERL4055REPLACE NON MOLD CALF LACERL4060REPLACE HIGH ROLL CUFFL4070*REPLACE PROXIMAL & DISTAL UPRIGHT FOR KAFOL4080'REPLACE METAL BANDS KAFO PROXIMAL THIGHL4090-REPLACE METAL BAND KAFO/AFO CALF/DISTAL THIGHL4100(REPLACE LEATHER CUFF KAFO PROXIMAL THIGHL4110/REPLACE LEATHER CUFF KAFO/AFO CALF/DISTAL THIGHL4130REPLACE PRETIBIAL SHELLL4310+MULTI PODUS ORTH PREP MANAGE SYSTEM LOW EXTL4320/ADD AFO/MULT PODUS SYS LOW EXT/FLEX FT W/VELCROL4350PNEUMATIC ANKLE CONTRL & SPLINTL4360PNEUMATIC WALKING SPLINTL4370PNEUMATIC FULL LEG SPLINTL4380PNEUMATIC KNEE SPLINTL4390/REPLAC SOFT INTRAFC MAT MULTI-PODUS TYPE SPLINTL4392*REPLACE SOFT INTERFACE MATERIAL STATIC AFOL4394&REPLACE SOFT INTRFC MAT FT DROP SPLINTL43960STATIC AFO POSIT/PRESS REDUC MAY USE MINIMAL AMBL4398+FT DROP SPLINT-RECUMBENT POSITIONING DEVICEL50000PART FT SHOE INSERT W/LONGITUDINAL ARCH TOE FILLL5010)PART FT MOLD SOCKET ANKLE HT W/TOE FILLERL50200PART FT MOLD SOCKET TUBIAL TUBERCLE HT W/TOEFILLL5050ANKLE SYMES MOLD SOCKET SACH FTL5060+ANKLE SYMES METAL FRAME MOLD LEATHER SOCKETL5100#BELOW KNEE MOLD SOCKET SHIN SACH FTL51050BELOW KNEE PLAST SOCKET/JNTS THIGH LACER SACH FTL5150/KNEE DISARTICULAT MOLD SOCKET EXT KNEE JNT SHINL51600KNEE DISARTICULATE MOLD< SOCKET BENT KNEE EXT JNTL5200-ABOVE KNEE MOLD SOCK 1 AXIS CONSTANT FRICTIONL5210.ABOVE KNEE SHORT PROSTH W/O BLOCK NO ANKLE JNTL5220.ABOVE KNEE SHORT PROS W/ARTIC ANKLE/FT DYNAMICL5230-ABOVE KNEE PROX FEMORAL DEFFICIENCY SACH FOOTL5250,HIP DISARTIC CANADIAN TYPE MOLD SOCK HIP JNTL5270.HIP DISARTIC TILT TABLE MOLD SOCK LOCK HIP JNTL5280.HEMIPELVECTOMY CANADIAN TYPE MOLD SOCK HIP JNTL53000BELOW KNEE MOLD SOCK SACH FT INCL COVER & FINISHL53100KNEE DISARTIC MOLD SOCK SACH FT INC COVER/FINISHL5320)ABOVE KNEE MOLD SOCK OPEN END 1 AXIS KNEEL5330&HIP DISARTIC CANADIAN TYPE 1 AXIS KNEEL5340-HEMIPELVECTOMY CANADIAN TYPE MOLDED INC COVERL54000POST SURG APPLY RIGID DRESS W/1CHANGE BELOW KNEEL5410/POST SURG APPLY RIGID DRESS EA ADD CAST/REALIGNL5420,POST SURG APPLY RIGID DRESS 1 CHANGE AK KNEEL5430/POST SURG APPLY RIGID DRESS AK KNEE EA ADD CASTL5450,POST SURG APPLY NON WT BEAR RIGID BELOW KNEEL5460'POST SURG APPLY NON WT RIGID ABOVE KNEEL5500&INIT BK PTB SOCK NON-ALIGN DIRECT FORML5505(INIT AK/DISARTIC ISCHIAL LEVEL NON-ALIGNL5510#PREP BK PTB NON-ALIGN MOLD TO MODELL5520)PREP BK PTB NON-ALIGN PLASTIC DIRECT FORML5530.PREP BK PTB NON-ALIGN THERMOPLASTIC MOLD-MODELL5535(PREP BK PTB PREFABRICATED ADJUS OPEN ENDL5540/PREP BK PTB NON-ALIGN LAMINATED SOCK MOLD-MODELL5560+PREP AK/DISARTIC NON-ALIGN PLAST MOLD-MODELL5570,PREP AK/DISARTIC NON-ALIGN THERMOPLAS DIRECTL55800PREP AK/DISARTIC NON-ALIGN THERMOPLAS MOLD-MODELL55850PREP AK/DISARTIC NON-ALIGN PREFAB ADJUS OPEN ENDL5590/PREP AK/DISARTIC NON-ALIGN LAMINATED MOLD-MODELL55950PREP HIP/HEMIPELVECTOMY THERMOPLASTIC MOLD MODELL5600+PREP HIP/HEMIPELVECTOMY LAMINATE MOLD MODELL5610'ADD LO EXTREM ENDO AK HYDRACADENCE SYSTL56110ADD LO EXTREM ENDO AK 4-BAR W/FRICT SWING CONTRLL5613-ADD LO EXTREM ENDO AK 4-BAR W/HYDRAULIC SWINGL5614,ADD LO EXTREM EXO AK 4-BAR W/PNEUMATIC SWINGL5616-ADD LO EXTREM UNI ENDO MX SYST FRICTION SWINGL5617.ADD LO EXTREM, QUICK CHANGE, SELF-ALIGN, AK/BKL5618ADD LOW EXT TEST SOCKET SYMESL5620"ADD LOW EXT TEST SOCKET BELOW KNEEL5622,ADD LOW EXT TEST SOCKET KNEE DISARTICULATIONL5624"ADD LOW EXT TEST SOCKET ABOVE KNEEL5626+ADD LOW EXT TEST SOCKET HIP DISARTICULATIONL5628&ADD LOW EXT TEST SOCKET HEMIPELVECTOMYL5629%ADD LOW EXT BELOW KNEE ACRYLIC SOCKETL5630-ADD LOW EXT SYMES TYPE EXPANDABLE WALL SOCKETL5631.ADD LOW EXT ABOVE KNEE/DISARTICULATION ACRYLICL5632(ADD LOW EXT SYMES PTB BRIM DESIGN SOCKETL56340ADD LOW EXT SYMES TYPE POST OPEN CANADIAN SOCKETL5636+ADD LOW EXT SYMES TYPE MEDIAL OPENIN SOCKETL5637$ADD LOW EXT BELOW KNEE TOTAL CONTACTL5638%ADD LOW EXT BELOW KNEE LEATHER SOCKETL5639"ADD LOW EXT BELOW KNEE WOOD SOCKETL5640-ADD LOW EXT KNEE DISARTICULATE LEATHER SOCKETL5642%ADD LOW EXT ABOVE KNEE LEATHER SOCKETL5643-ADD LOW EXT HIP DISARTIC FLEX INNER EXT FRAMEL5644"ADD LOW EXT ABOVE KNEE WOOD SOCKETL5645+ADD LOW EXT BELOW KNEE FLEX INNER EXT FRAMEL5646)ADD LOW EXT BELOW KNEE AIR CUSHION SOCKETL5647%ADD LOW EXT BELOW KNEE SUCTION SOCKETL5648)ADD LOW EXT ABOVE KNEE AIR CUSHION SOCKETL5649-ADD LOW EXT ISCHIAL CONTAIN NARROW M-1 SOCKETL5650-ADD LOW EXT TOTAL CONTACT ABOVE KNEE/DISARTICL5651+ADD LOW EXT ABOVE KNEE FLEX INNER EXT FRAMEL5652.ADD LOW EXT SUCTION SUSPEN ABOVE KNEE/DISARTICL56530ADD LOW EXT KNEE DISARTIC EXPANDABLE WALL SOCKETL5654ADD LOW EXT SOCKET INSERT SYMESL5655$ADD LOW EXT SOCKET INSERT BELOW KNEEL5656.ADD LOW EXT SOCKET INSERT KNEE DISARTICULATIONL5658$ADD LOW EXT SOCKET INSERT ABOVE KNEEL5660,ADD LOW EXT SOCKET INSERT SYMES SILICONE GELL5661/ADD LOW EXT SOCKET INSERT MULTI-DUROMETER SYMESL5662-ADD LOW EXT SOCKET INSERT BELOW KNEE SILICONEL56630ADD LOW EXT SOCKET INSERT KNEE DISARTIC SILICONEL5664-ADD LOW EXT SOCKET INSERT ABOVE KNEE SILICONEL5665/ADD LOW EXT SOCKET INSERT MULTI-DUROMETER BELOWL5666&ADD LOW EXT BELOW KNEE CUFF SUSPENSIONL5667/ADD SOCKET INSRT ABOV/BELO KNEE-SUC SUSP W/LOCKL5668,ADD LOW EXT BELOW KNEE MOLDED DISTAL CUSHIONL56690ADD SOCKET INSRT ABOV/BELO KNEE-SUC SUSP WO LOCKL5670.ADD LOW EXT BELOW KNEE MOLD SUPRACONDYLAR SUSPL5672,ADD LOW EXT BELOW KNEE REMOVABLE MEDIAL BRIML5674+ADD LOW EXT BELOW KNEE LATEX SLEEVE SUSP EAL5675+ADD LOW EXT BELOW KNEE LATEX SLEEVE HVY DTYL5676,ADD LOW EXT BELOW KNEE KNEE JNTS 1 AXIS PAIRL56770ADD LOW EXT BELOW KNEE KNEE JNT POLYCENTRIC PAIRL5678(ADD LOW EXT BELOW KNEE JOINT COVERS PAIRL5680-ADD LOW EXT BELOW KNEE THIGH LACER NON MOLDEDL5682/ADD LOW EXT BELOW KNEE THIGH LACER GLUTEAL/ISCHL5684!ADD LOW EXT BELOW KNEE FORK STRAPL5686-ADD LOW EXT BELOW KNEE BACK CHECK (EXTENSION)L5688)ADD LOW EXT BELOW KNEE WAIST BELT WEBBINGL5690.ADD LOW EXT BELOW KNEE WAIST BELT PADDED/LINEDL5692.ADD LOW EXT ABOVE KNEE PELV CONTROL BELT LIGHTL5694/ADD LOW EXT ABOVE KNEE PELV CONT BELT PAD/LINEDL56950ADD LOW EXT ABOVE KNEE PELV CONT NEOPRENE SLEEVEL5696(ADD LOW EXT ABOVE KNEE/DISARTIC PELV JNTL5697)ADD LOW EXT ABOVE KNEE/DISARTIC PELV BANDL56980ADD LOW EXT ABOVE KNEE/DISARTIC SILESIAN BANDAGEL5699'ALL LOW EXT PROSTHESIS SHOULDER HARNESSL5700(REPLAC SOCKET BELOW KNEE MOLDED PT MODELL57010REPLAC SOCKET ABOVE KNEE/DISART INCL ATTACH PLATL5702&REPLAC SOCKET HIP DISARTIC INCL HIP JTL5704%REPLAC CUSTOM SHAPED COVER BELOW KNEEL5705%REPLAC CUSTOM SHAPED COVER ABOVE KNEEL5706(REPLAC CUSTOM SHAPED COVER KNEE DISARTICL5707'REPLAC CUSTOM SHAPED COVER HIP DISARTICL5710 ADD KNEE/SHIN 1 AXIS MANUAL LOCKL57110ADD KNEE/SHIN 1 AXIS MANUAL LOCK ULTRA LIGHT MATL57120ADD KNEE/SHIN 1 AXIS FRICTION SWING STANCE PHASEL5714,ADD KNEE/SHIN 1 AXIS VARIABLE FRICTION SWINGL57160ADD KNEE/SHIN POLYCENTRIC MECHANICAL STANCE LOCKL5718/ADD KNEE/SHIN POLYCENTRIC FRICTION SWING STANCEL57220ADD KNEE/SHIN 1 AXIS PNEUMATIC SWING FRIC STANCEL5724.ADD KNEE/SHIN 1 AXIS FLUID SWING PHASE CONTROLL5726)ADD KNEE/SHIN 1 AXIS EXT JNTS FLUID SWINGL5728-ADD KNEE/SHIN 1 AXIS FLUID SWING STANCE PHASEL57800ADD KNEE/SHIN 1 AXIS (HYDRA)PNEUMATIC SWING CONTL5785#ADD BELOW KNEE ULTRA LIGHT MATERIALL5790#ADD ABOVE KNEE ULTRA LIGHT MATERIALL5795%ADD HIP DISARTIC ULTRA LIGHT MATERIALL5810L5811,ADD KNEE/SHIN 1 AXIS MANUAL LOCK ULTRA LIGHTL5812L58140ADD KNEE-SHIN SYST HYDRAUL CNTRL STNC PHASE LOCKL58160ADD KNEE/SHIN POLYCENTRIC MECH STANCE PHASE CONTL5818L5822-ADD KNEE/SHIN 1 AXIS PNEUMATIC SWING FRICTIONL5824L5826-ADD KNEE/SHIN 1 AXIS HYDRO SWING PHASE CONTRLL5828L5830/ADD KNEE/SHIN 1 AXIS PNEUMATIC SWING PHASE CONTL5840,ADD ENDOSKEL KNEE-SHIN SYST 4-BAR LINK/MULTIL5845,ADD, ENDO, KNEE-SHIN SYST, STANCE FLEX ADJUSL58460ADD, ENDO, KNEE-SHIN, MICROPRO CNTRL, SWING ONLYL5850/ADD ABOVE KNEE/HIP DISARTIC KNEE EXTENSION ASSTL5855/ADD ENDOSKELETAL SYST HIP DISART MECH HIP EXTENL5910ADD BELOW KNEE ALIGNABLE SYSTEML5920,ADD ABOVE KNEE HIP DISARTIC ALIGNABLE SYSTEML5925-ADD ENDOSKEL SYST AK KNEE/HIP DISARTIC MANUALL5930/ADD, ENDO SYSTEM, HIGH ACTIVITY KNEE CNTRL FRAML5940L5950L5960L5962.ADD ENDOSKELETAL SYST BK FLEX PROTECTIVE COVERL5964.ADD ENDOSKELETAL SYST AK FLEX PROTECTIVE COVERL5966-ADD ENDOSKELETAL SYST HIP DISARTIC FLEX COVERL5970)ALL LOW EXT PROS FT EXTERNAL KEEL SACH FTL5972ALL LOW EXT PROS FLEX KEEL FTL5974(ALL LOW EXT PROS FT SINGLE AXIS ANKLE/FTL5976"ALL LOW EXT PROS ENERGY STORING FTL5978,ALL LO EXTREM PROSTH FT MULTI-AXIAL ANKLE/FTL59790ALL LO EXTREM PROSTH MULTI-AXAL ANKLE/FT DYNAMICL5980ALL LOW EXT PROS FLEX FT SYSTEML5981*ALL LOW EXTREM PROSTH FLEX-WALK SYST/EQUALL5982(ALL EXO LOW EXT PROS AXIAL ROTATION UNITL5984)ALL ENDO LOW EXT PROS AXIAL ROTATION UNITL5985+ALL ENDO LO EXTREM PROSTH, DYN PROSTH PYLONL5986*ALL LOW EXT PROS MULTI AXIAL ROTATION UNIT< L5987/ALL LO EXTREM PROSTH SHANK FT SYST W/LOAD PYLONL6000'PARTIAL HAND ROBIN-AIDS THUMB REMAININGL6010*PARTIAL HAND ROBIN-AIDS LITTLE/RING FINGERL6020+PARTIAL HAND ROBIN-AIDS NO FINGER REMAININGL6050/WRIST DISARTIC MOLD SOCK FLEX ELBOW HING TRICEPL6055+WRIST DISARTIC MOLD SOCK W/EXPAND INTERFACEL6100-BELOW ELBOW MOLD SOCK FLEX ELBOW HINGE TRICEPL6110/BELOW ELBOW MOLD SOCK (MUENSTER/NORTHWEST TYPE)L61200BELOW ELBOW MOLD DBL WALL SPLIT SOCK SETUP HINGEL6130.BELOW ELBOW MOLD DBL WALL SPLIT SOCK STUMP ACTL62000ELBOW DISARTIC MOLDED OUTSIDE LOCK HINGE FOREARML6205-ELBOW DISARTIC MOLDED W/EXP INTERFACE FOREARML6250/ABOVE ELBOW MOLD DBL WALL SOCK INT LOCK FOREARML6300-SHOULDER DISARTIC MOLDED SOCKET SHOULDER DOWNL6310/SHOULDER DISARTIC PASSIVE RESTORE COMPLETE PROSL6320.SHOULDER DISARTIC PASSIVE RESTORE SHOULDER CAPL6350,INTERSCAP/THORAC MOLDED SOCKET SHOULDER DOWNL6360*INTERSCAP/THORAC PASSSIVE RESTORE COMPLETEL6370-INTERSCAP/THORAC PASSIVE RESTORE SHOULDER CAPL6380*POST SURG APPLY RIGID DRESS WRIST DISARTICL6382*POST SURG APPLY RIGID DRESS ELBOW DISARTICL6384-POST SURG APPLY RIGID DRESS SHOULDER DISARTICL63860POST SURG/FITTING EA ADD CAST CHANGE/REALIGNMENTL6388+POST SURG/FITTING APPLY RIGID DRESSING ONLYL6400-BELOW ELBOW MOLD SOCKET INCL SOFT PROSTH TISSL64500ELBOW DISARTIC MOLD SOCKET INCL SOFT PROSTH TISSL6500+ABOVE ELBOW MOLD SOCK INCL SOFT PROSTH TISSL65500SHOULDER DISARTIC MOLD SOCK INCL SOFT PROSTH TISL65700INTERSCAPULA/THORACIC MOLD SOCK INCL SOFT PROSTHL6580-PREP WRIST DISARTIC 1 WALL PLASTIC MOLD TO PTL6582+PREP WRIST DISARTIC 1 WALL SOCK DIRECT FORML6584/PREP ELBOW 1 WALL PLAST FAIR LEAD MOLD PT MODELL6586-PREP ELBOW 1 WALL PLAST FAIR LEAD DIRECT MOLDL6588-PREP SHOULDER 1 WALL PLAST SOCK MOLD PT MODELL6590/PREP SHOULDER 1 WALL SOCK FAIR LEAD DIRECT FORML6600!UP EXT ADD POLYCENTRIC HINGE PAIRL6605UP EXT ADD 1 PIVOT HINGE PAIRL6610 UP EXT ADD FLEX METAL HINGE PAIRL6615(UP EXT ADD DISCONNECT LOCKING WRIST UNITL6616.UP EXT ADD ADD DISCONNECT INSERT LOCK WRIST EAL6620&UP EXT ADD FLEXION/FRICTION WRIST UNITL6623/UP EXT ADD SPRING ASSIST ROTATION WRIST W/LATCHL6625)UP EXT ADD ROTATE WRIST UNIT W/CABLE LOCKL6628/UP EXT ADD QUICK DISCONNECT HOOK ADAP OTTO BACKL6629/UP EXT ADD DISCONNECT LAMINAT COLLAR W/COUPLINGL6630$UP EXT ADD STAINLESS STEEL ANY WRISTL6632!UP EXT ADD LATEX SUSP SLEEVE EACHL6635 UP EXT ADD LIFT ASSIST FOR ELBOWL6637#UP EXT ADD NUDGE CONTROL ELBOW LOCKL6640&UP EXT ADD SHOULDER ABDUCTION JNT PAIRL6641*UP EXT ADD EXCURSION AMPLIFIER PULLEY TYPEL6642)UP EXT ADD EXCURSION AMPLIFIER LEVER TYPEL6645,UP EXT ADD SHOULDER FLEXION-ABDUCTION JNT EAL6650$UP EXT ADD SHOULDER UNIVERSAL JNT EAL6655'UP EXT ADD STANDARD CONTROL CABLE EXTRAL6660 UP EXT ADD HVY DTY CONTROL CABLEL6665'UP EXT ADD TEFLON OR EQUAL CABLE LININGL6670%UP EXT ADD HOOK TO HAND CABLE ADAPTERL6672-UP EXT ADD HARNESS CHEST/SHOULDER SADDLE TYPEL6675/UP EXT ADD HARNESS FIGURE 8 TYPE SINGLE CONTROLL6676-UP EXT ADD HARNESS FIGURE 8 TYPE DUAL CONTROLL6680/UP EXT ADD TEST SOCKET WRIST DISARTIC BELOW ELBL6682/UP EXT ADD TEST SOCKET ELBOW DISARTIC ABOVE ELBL6684/UP EXT ADD TEST SOCKET SHOULDER DISARTIC/THORACL6686UP EXT ADD SUCTION SOCKETL6687#UP EXT ADD FRAME SOCKET BELOW ELBOWL6688#UP EXT ADD FRAME SOCKET ABOVE ELBOWL6689)UP EXT ADD FRAME SOCKET SHOULDER DISARTICL6690.UP EXT ADD FRAME SOCKET INTERSCAPULAR/THORACICL6691UP EXT ADD REMOVABLE INSERT EAL6692'UP EXT ADD SILICONE GEL INSERT/EQUAL EAL6700"TERM DEVICE HOOK DORRANCE MODEL #3L6705"TERM DEVICE HOOK DORRANCE MODEL #5L6710#TERM DEVICE HOOK DORRANCE MODEL #5XL6715$TERM DEVICE HOOK DORRANCE MODEL #5XAL6720"TERM DEVICE HOOK DORRANCE MODEL #6L6725"TERM DEVICE HOOK DORRANCE MODEL #7L6730$TERM DEVICE HOOK DORRANCE MODEL #7LOL6735"TERM DEVICE HOOK DORRANCE MODEL #8L6740#TERM DEVICE HOOK DORRANCE MODEL #8XL6745$TERM DEVICE HOOK DORRANCE MODEL #88XL6750$TERM DEVICE HOOK DORRANCE MODEL #10PL6755$TERM DEVICE HOOK DORRANCE MODEL #10XL6765$TERM DEVICE HOOK DORRANCE MODEL #12PL6770$TERM DEVICE HOOK DORRANCE MODEL #99XL6775$TERM DEVICE HOOK DORRANCE MODEL #555L6780&TERM DEVICE HOOK DORRANCE MODEL #SS555L6790#TERM DEVICE HOOK ACCU HOOK OR EQUALL6795 TERM DEVICE HOOK 2 LOAD OR EQUALL6800!TERM DEVICE HOOK APRL VC OR EQUALL6805$TERM DEVICE MODIFIER WRIST FLEX UNITL6806+TERM DEVICE-HOOK-TRS GRIP-GRIP III-VC OR EQL6807+TERM DEVICE/HOOK/GRIP I/GRIP II VC OR EQUALL68080TERM DEVICE-HOOK-TRS ADEPT-INFANT/CHILD-VC OR EQL6809(TERM DEVICE HOOK TRS SUPER SPORT PASSIVEL6810+TERM DEVICE PINCHER TOOL OTTO BOCK OR EQUALL6825TERM DEVICE HAND DORRANCE VOL6830TERM DEVICE HAND APRL VCL6835TERM DEVICE HAND SIERRA VOL6840 TERM DEVICE HAND BECKER IMPERIALL6845TERM DEVICE BECKER LOCK GRIPL6850TERM DEVICE BECKER PLYLITEL6855TERM DEVICE HAND ROBIN-AIDS VOL6860#TERM DEVICE HAND ROBIN-AIDS VO SOFTL6865TERM DEVICE HAND PASSIVE HANDL6867+TERM DEVICE HAND DETROIT INFANT HAND (MECH)L68680TERM DEVICE HAND PASSIVE INFANT (STEEPER/HOSMER)L6870TERM DEVICE HAND CHILD MITTL6872TERM DEVICE HAND NYU CHILD HANDL6873.TERM DEVICE HAND MECHANICAL INFANT STEEP/EQUALL6875TERM DEVICE HAND BOCK VCL6880TERM DEVICE HAND BOCK VOL6890,TERM DEVICE GLOVE FOR ABOVE PRODUCTION GLOVEL6895(TERM DEVICE GLOVE FOR ABOVE CUSTOM GLOVEL6900-HAND RESTORE PART HAND W/GLOVE THUMB/1 FINGERL6905+HAND RESTORE PART HAND W/GLOVE MULT FINGERSL6910)HAND RESTORE PART HAND W/GLOVE NO FINGERSL6915(HAND RESTORE REPLACEMENT GLOVE FOR ABOVEL6920)WRIST DISARTIC SWITCH CONTROL TERM DEVICEL69250WRIST DISARTIC MYOELECTRONIC CONTROL TERM DEVICEL6930&BELOW ELBOW SWITCH CONTROL TERM DEVICEL6935-BELOW ELBOW MYOELECTRONIC CONTROL TERM DEVICEL6940)ELBOW DISARTIC SWITCH CONTROL TERM DEVICEL69450ELBOW DISARTIC MYOELECTRONIC CONTROL TERM DEVICEL6950&ABOVE ELBOW SWITCH CONTORL TERM DEVICEL6955-ABOVE ELBOW MYOELECTRONIC CONTROL TERM DEVICEL6960,SHOULDER DISARTIC SWITCH CONTROL TERM DEVICEL6965+SHOULDER DISARTIC MYOELECTRONIC TERM DEVICEL6970.INTERSCAPULAR/THORACIC SWITCH CONTROL TER DEVL6975-INTERSCAPULAR/THORACIC MYOELECTRONIC TERM DEVL7010.ELECT HAND OTTO BOCK STEEPER/EQUAL SWITCH CONTL7015-ELECT HAND TEKNIK VARIETY VILLAGE SWITCH CONTL7020&ELECT GREIFER OTTO BOCK SWITCH CONTROLL7025+ELECT HAND OTTO BOCK MYOELECTRONICALLY CONTL7030/ELECT HAND TEKNIK VARIETY VILLAGE MYOELECTRONICL7035.ELECT GREIFER OTTO BOCK MYOELECTRONICALLY CONTL7040)PREHENSILE ACTUATOR HOSMER SWITCH CONTROLL7045(ELECT HOOK CHILD MICHIGAN SWITCH CONTROLL7170!ELECT ELBOW HOSMER SWITCH CONTROLL71800ELEC ELBOW-BOSTON/UT/OR EQ-MYOELECTRONICAL CNTRLL7185-ELECT ELBOW ADOLESCENT VARIETY VILLAGE SWITCHL71860ELECT ELBOW CHILD VARIETY VILLAGE SWITCH CONTROLL7190/ELECT ELBOW ADOLESCENT VARIETY VILL MYOELECTRONL7191-ELECT ELBOW CHILD VARIETY VILLAGE MYOELECTRONL7260#ELECT WRIST ROTATOR OTTO BOCK/EQUALL7261 ELECT WRIST ROTATOR FOR UTAH ARML7266SERVO CONTROL STEEPER OR EQUALL7272ANALOGUE CONTROL UNB OR EQUALL7274/PROPORTIONAL CONTROL 6-12 VOLT-LIBERTY/UT OR EQL7360(SIX VOLT BATTERY OTTO BOCK OR EQUAL EACHL7362+BATTERY CHARGER SIX VOLT OTTO BOCK OR EQUALL7364&TWELVE VOLT BATTERY UTAH OR EQUAL EACHL7366)BATTERY CHARGER TWELVE VOLT UTAH OR EQUALL7900VACUUM ERECTION SYSTEML8300TRUSS SINGLE W/STANDARD PADL8310TRUSS DOUBLE W/STANDARD PADSL8320(TRUSS ADDITION TO STANDARD PAD WATER PADL8330*TRUSS ADDITION TO STANDARD PAD SCROTAL PADL8400PROSTH SHEATH BELOW KNEE EAL8410PROSTH SHEATH ABOVE KNEE EAL8415PROSTH SHEATH UPPER LIMB EAL8417.PROSTH SHEATH SOCK INC GEL CUSH LAYER AK/BK-EAL8420 PROSTHETIC<5 SOCK MULT PLY BK EACHL8430$PROSTH SOCK MULT PLY ABOVE KNEE EACHL8435"PROSTH SOCK MULT PLY UPPER LIMB EAL8440PROSTH SHRINKER BELOW KNEE EAL8460PROSTH SHRINKER ABOVE KNEE EAL8465PROSTH SHRINKER UPPER LIMB EAL8470.PROSTH SOCK SINGLE PLY FITTING BELOW KNEE EACHL8480.PROSTH SOCK SINGLE PLY FITTING ABOVE KNEE EACHL8485,PROSTH SOCK SINGLE PLY FITTING UPPER LIMB EAL8490.ADD PROSTH SHEATH/SOCK AIR SEAL SUCTION RETENTL8500ARTIFICIAL LARYNX ANY TYPEL8501TRACHEOSTOMY SPEAKING VALVEL86030COLLAGEN IMPLANT-URIN TRACT/2.5CC SYR-INCLU SUPPL8610OCULAR IMPLANTL8612 AQUEOUS SHUNTL8613OSSICULA IMPLANTL8630!METACARPOPHALANGEAL JOINT IMPLANTL8641METATARSAL JOINT IMPLANTL8642HALLUX IMPLANTL8658INTERPHALANGEAL JOINT IMPLANTL8670#VASCULAR GRAFT MATERIAL-SYN-IMPLANTV2623PROSTHETIC EYE PLASTIC CUSTOMV2624*POLISHING/RESURFACING OF OCULAR PROSTHESISV2625 ENLARGEMENT OF OCULAR PROSTHESISV2626REDUCTION OF OCULAR PROSTHESISHCPCSMod DescriptionAmountA4214STERILE SALINE/WATER 30CC VIALA4310!INSERT TRAY WO DRAIN BAG/CATHETERA4311-INSERT TRAY WO DRAIN BAG W/INDWELL CATH LATEXA4312/INSERT TRAY WO DRAIN BAG W/INDWELL CATH SILICONA4313-INSERT TRAY WO DRAIN BAG W/3 WAY INDWELL CATHA4314,INSERT TRAY W/DRAIN BAG & INDWELL CATH LATEXA4315/INSERT TRAY W/DRAIN BAG & INDWELL CATH SILICONEA4316,INSERT TRAY W/DRAIN BAG & 3/WAY INDWELL CATHA4320%IRRIGATION TRAY W/BULB/PISTON SYRINGEA4322#IRRIGATION SYRINGE BULB/PISTON EACHA4323*STERILE SALINE IRRIGATION SOLUTION 1000 MLA4326%MALE EXT CATHETER SPECIALTY TYPE EACHA4327/FEMALE EXT URINARY COLLECT DEVICE; METAL CUP EAA4328,FEMALE EXT URINARY COLLECT DEVICE POUCH EACHA43290EXT CATH STARTER SET MALE/FEMALE W/SUPPLIES 7DAYA4330/PERIANAL FECAL COLLECTION POUCH W/ADHESIVE EACHA4338)INDW CATH FOLEY 2 WAY ATEX W/COATING EACHA4340 INDWELL CATH SPECIALTY TYPE EACHA4344#INDW CATH FOLEY 2 WAY SILICONE EACHA4346*INDW CATH FOLEY 3 WAY CONT IRRIGATION EACHA4347/MALE EXTERNAL CATH W/WO ADHESIVE/ANTIREFLUX /12A4351+INTERMITTENT URINARY CATH STRAIGHT TIP EACHA4352(INTERMITTENT URINARY CATH COUDE TIP EACHA4354#INSERTION TRAY W/DRAIN BAG W/O CATHA4355'IRRIG TUB SET CONT IRRIG VIA FOLEY EACHA4356'EXT URETHRAL CLAMP/COMPRESS DEVICE EACHA4357,BDSD DRBG DAY/NIGHT W/WO TUB/ANTIREFLUX EACHA4358#URINARY LEG BAG VINYL W/WO TUB EACHA4359"URINARY SUSPENSORY WO LEG BAG EACHA4361OSTOMY FACEPLATE, EACHA4362 R r 4_ lSr  R : d4TFt JꝩCqlp "#%lp`%& lp(*(O,Y- /0 52? 3 5%5I7S8:<p>z@!BCE7GIJ{LaNwO]P Ru tT rUX#W XUZ;$\ ] H_./abdxf^IhitkSmnpg $Wr t cuNw]xSz{{|~X(&~th1[RpebR݈= T |V *O:?d&,)Ңwl$pZ9e-fRpj} Z4 I  $>0ZefN#'Nt=$J#j$7TT 0$b$bl0bF}DbO<bnx0 SOCK MULT PLY BK EACHL8430$PROSTH SOCK MULT PLY ABOVE KNEE EACHL8435"PROSTH SOCK MULT PLY UPPER LIMB EAL8440PROSTH SHRINKER BELOW KNEE EAL8460PROSTH SHRINKER ABOVE KNEE EAL8465PROSTH SHRINKER UPPER LIMB EAL8470.PROSTH SOCK SINGLE PLY FITTING BELOW KNEE EACHL8480.PROSTH SOCK SINGLE PLY FITTING ABOVE KNEE EACHL8485,PROSTH SOCK SINGLE PLY FITTING UPPER LIMB EAL8490.ADD PROSTH SHEATH/SOCK AIR SEAL SUCTION RETENTL8500ARTIFICIAL LARYNX ANY TYPEL8501TRACHEOSTOMY SPEAKING VALVEL86030COLLAGEN IMPLANT-URIN TRACT/2.5CC SYR-INCLU SUPPL8610OCULAR IMPLANTL8612 AQUEOUS SHUNTL8613OSSICULA IMPLANTL8630!METACARPOPHALANGEAL JOINT IMPLANTL8641METATARSAL JOINT IMPLANTL8642HALLUX IMPLANTL8658INTERPHALANGEAL JOINT IMPLANTL8670#VASCULAR GRAFT MATERIAL-SYN-IMPLANTV2623PROSTHETIC EYE PLASTIC CUS  l^FJ &j09CMDW ajtd~,:BJRZb'j/r7z?GOWZ  dMbP?_*+%M\\INGENIX_TREE\SLCP-80001SE.NDPW odXLetterPRIV''''"dX??U} m} } :} HCPCSModl,T0,b,bbb  * -  0  3 58<@! b0NP #W UZ;]/a d IhkS           ~ @c@    ~ H@   ~ В@  ~ ؖ@  ~  @  ~ @  ~ :@  ~ @  ~ ~@  ~ q@  ~ (@   ~ @ ! 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RbS0TUNVP WX#W YUZ;Z][/a \d ]Ih^kS_ @> @ @?~ @s@ A@ A AA~ A@ BB B BC~ B)@ CB C CC~ Ct@ DB D DC~ D_@ ED E EE~ ES@ FF F FG~ Fh@ GH G GI~ G%@ HJ H HK~ H"@ IL I IM~ IE@ JN J JO~ J@ KP K KQ~ K@ LP L LQ~ LPr@ MP M MQ~ M8@ NR N NS~ N@ OT O OU~ O@ PT P PU~ P@ QT Q QU~ Q@ RV R RW~ R@ SX S SY~ S@ TX T TY~ T@N@ UX U UY~ UA(@ VZ V V[~ V(@ WZ W W[~ W@ XZ X X[~ X@ Y\ Y Y]~ Y@ Z\ Z Z]~ Z̵@ [\ [ []~ [s@ \^ \ \_~ \g@ ]^ ] ]_~ ]@ ^^ ^ ^_~ ^@ _` _ _a~ _@D l8888888888888888888888888888888`T0abbbcdefgbhbij*k- l0 m3 n5o8p<q@! rbs0tuNvP wx#W yUZ;z]{/a |d }Ih~kS `` ` `a~ `@ a` a aa~ a@ bb b bc~ b@ cb c cc~ c@ db d dc~ d@ ed e ee~ e@ fd f fe~ f@ gd g ge~ g@ hf h hg~ h @ ih i ii~ i`@ jj j jk~ j!w@ kj k kk~ k@ lj l lk~ l@ ml m mm~ m!c@ nl n nm~ n@ ol o om~ oa @ pn p po~ p;A qn q qo~ q@ rn r ro~ rA sp s sq~ sz@ tp t tq~ t@ up u uq~ u5@ vr v vs~ v@ wr w ws~ wȘ@ xr x xs~ x@ yt y yu~ y@ zt z zu~ z@ {t { {u~ {J@ |v | |w~ |@ }v } }w~ }8@ ~v ~ ~w~ ~L@ x  y~ (@D l8888888888888888888888888888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS x  y~ "@ x  y~ A@ z  {~ A~@ z  {~ @ z  {~ A=@ |  }~ 6@ |  }~ @ |  }~ R@ ~  ~ !X@ ~  ~ @ ~  ~ @   ~ @   ~ @   ~ A@   ~ @   ~ @   ~ @   ~ q@   ~ I@   ~ .@   ~ @   ~ !B@  ~ @   ~ @   ~ @   ~ A   ~ @   ~  A   ~ fA   ~ t@   ~ !A   ~ @Dr l8888888888888888888888*88888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS   ~ @   ~ ̛@   ~ @   ~ @   ~ QA   ~ @   ~ }A   ~  @   ~ 5@   ~ @   ~ e@   ~ @   ~ H@   ~ @   ~ h@   ~ @   ~ @   ~ ^@   ~ h@   ~ @   ~ @   ~ @   ~ \@   ~ @   ~ `@   ~ @   ~ @   ~ v@   ~ @   ~ J@   ~ @   ~ q@D l8888888888888888888888888888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS   ~ (@   ~ @   ~ @   ~ @   ~ @   ~ ܬ@   ~ @   ~ k@   ~ ,@   ~ @   ~ Ps@   ~ @   ~ @   ~ p{@   ~ @   ~ @   ~ pz@   ~ @   ~  @   ~ >@   ~ o@   ~ /@   ~ Q@   ~ ٵ@   ~ D@   ~ ]@   ~ @   ~  @   ~ @   ~ f@   ~ @   ~ @D l8888888888888888888888888888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS   ~ f@   ~ @   ~ |@   ~ w@   ~ ֥@   ~ .@   ~ @   ~ d@   ~ @   ~ y@   ~ x@   ~ @   ~ ֢@   ~ o@   ~ H@   ~ *@   ~ @   ~ @   ~ z@   ~ @   ~ @   ~ @   ~ Ї@   ~ *@   ~ @   ~ H@   ~ @   ~ N@   ~ H@   ~ @   ~ @   ~ @D l8888888888888888888888888888888T0bbbb  * -  0  3 58<@! b0NP #W UZ;]/a d IhkS   ~ w@   ~ @   ~ <@   ~ ̕@   ~ m@   ~ @   ~ y@   ~ @   ~ y@   ~ @   ~ @   ~ @   ~ p|@   ~ h@   ~ k@   ~ P@   ~ T@   ~ p@   ~ Ȉ@   ~ @   ~ @   ~ }@   ~ Ы@   ~ @   ~ }@   ~ @   ~ #@   ~ @   ~ \@   ~ @   ~ @   ~ @D l8888888888888888888888888888888 T0!b"b#$%&'b(b)**+- ,0 -3 .5/80<1@! 2b3045N6P 78#W 9UZ;:];/a <d =Ih>kS?   ~ 4@ ! ! !~ !s@ " " "~ "@ # # #~ #@ $ $ $~ $s@ % % %~ %`@ & & &~ &@ ' ' '~ '@ ( ( (~ (@ ) ) )~ )@ * * *~ *0z@ + + +~ +Ʃ@ , , ,~ ,"@ - - -~ -@ . . .~ .@ / / /~ /t@ 0 0 0~ 0w@ 1 1 1~ 10@ 2 2 2~ 2@ 3 3 3~ 3d@ 4 4 4~ 4̒@ 5 5 5 ~ 5@ 6 6 6 ~ 6o@ 7 7 7 ~ 7@ 8  8 8 ~ 8@@ 9  9 9 ~ 9`p@ :  : : ~ :,@ ;  ; ; ~ ;ȸ@ <  < < ~ <@@ =  = = ~ =@ > > >~ >@ ? ? ?~ ?w@D l8888888888888888888888888888888@T0AbBbCDEFGbHbIJ*K- L0 M3 N5O8P<Q@! RbS0TUNVP WX#W YUZ;Z][/a \d ]Ih^kS_ @ @ @~ @j@ A A A~ Ak@ B B B~ B$@ C C C~ CT@ D D D~ DԪ@ E E E~ Ew@ F F F~ F9@ G G G~ GD@ H H H~ H@ I I I~ Ig@ J J J~ JҲ@ K K K~ K@ L L L~ L@ M M M~ MA N N N~ N@ O O O~ OIc A P P P~ PA@ Q Q Q~ Q@ R R R~ Rj@ S  S S!~ S@ T  T T!~ TԐ@ U  U U!~ Ue@ V" V V#~ Vg@ W$ W W%~ W@ X& X X'~ XF@ Y( Y Y)~ Yɹ@ Z* Z Z+~ ZP@ [, [ [-~ [@ \. \ \/~ \@ ]0 ] ]1~ ]@ ^2 ^ ^3~ ^@ _4 _ _5~ _@D l8888888888888888888888888888888`T0abbbcdefgbhbij*k- l0 m3 n5o8p<q@! rbs0tuNvP wx#W yUZ;z]{/a |d }Ih~kS `6 ` `7~ `@ a8 a a9~ a@ b: b b;~ bW@ c< c c=~ c@ d> d d?~ d@ e@ e eA~ e%@ fB f fC~ f@ gD g gE~ g@ hF h hG~ h@ iH i iI~ i`P@ jJ j jK~ js@ kL k kM~ k@ lN l lO~ lQ@ mP m mQ~ m@ nR n nS~ nB@ oT o oU~ o@ pV p pW~ p}@ qX q qY~ q@ rZ r r[~ rD@ s\ s s]~ s<@ t^ t t_~ tB@ u` u ua~ u@ vb v vc~ v=@ wd w we~ wװ@ xf x xg~ xi@ yf y yg~ y@ zf z zg~ z@ {h { {i~ {A@ |h | |i~ |X@ }h } }i~ }c@ ~j ~ ~k~ ~@ l  m~ AD l8888888888888888888888888888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS l  m~ @ l  m~ )A n  o~ 1@ p  q~ @ r  s~ ]@ t  u~ @ v  w~ @ x  y~ @ z  {~ P@ |  }~ @ ~  ~ v@ ~  ~ @ ~  ~ A2@   ~ @   ~ p@   ~ ٸ@   ~ a@   ~ v@   ~ @   ~ @   ~ @   ~ A   ~ _@   ~ @   ~ @   ~ A{@   ~ @   ~ @   ~ X@   ~ X@   ~ X@   ~ X@D l8888888888888888888888888888888T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS   ~ X@  ~ p@  ~ @  ~ x@  ~ 4@  ~ DZ@  ~ +@  ~ D@  ~ b@  ~ Q@  ~ A@  ~ '@  ~ !@  ~ A(@  ~ D@  ~ o@  ~ C@  ~ A@  ~ `@  ~ @  ~ @  ~ @  ~ !@  ~ !@  ~ 11@  ~ @  ~ @  ~ @  ~ YA  ~ A  ~ ُA  ~ A@Dl8******************************T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS  ~ @  ~ @  ~ @  ~ @  ~ A@  ~ @  ~ a@  ~ р@  ~ @  ~ av@  ~ ޺@  ~ A@  ~ a@  ~ IA  ~ A6A  ~ 1A  ~ A  ~ A6 A  ~ $@  ~ ;@  ~ @  ~ @  ~ @  ~ @  ~ A@  ~ /@  ~ l@   ~ @    ~ @    ~ 3@  ~ @  ~ d@Dl*******************************T0bbbb*- 0 3 58<@! b0NP #W UZ;]/a d IhkS  ~ @  ~ AA  ~ @  ~ @  ~ @  ~ @  ~ @   !~ @ " #~ @ $ %~ @ & '~ @ ( )~ _@ * +~ @ , -~ @ . /~ @ 0 1~ @ 2 3~ 1@ 4 5~ 8@ 6 7~ @ 8 9~ !O@ : ;~ õ@ < =~ @ > ?~ @ @ A~ @ B C~ @ D E~ ӵ@ F G~ SA H I~ @A J K~ {A L M~ @ N O~  A P Q~ @Dl*******************************T0bbbb  * -  0  3 58<@! b0NP #W UZ;]/a d IhkS R S~ @ T U~ @ V W~ @ X Y~ @ Z [~ @ \ ]~ @ ^ _~ %@ ` a~ @ b c~ @ d e~ @ f g~ @ h i~ F@ j k~ A+@ l m~ A6@ n o~ H@ p q~ y@ r s~ Խ@ t u~ @ v w~ o@ x y~ @ z {~ ̼@ | }~ a#@ ~ ~ @  ~ @  ~ aA@  ~ `@  ~ q@  ~ @  ~ @  ~ m@  ~ @  ~ @Dl******************************* T0!b"b#$%&'b(b)**+- ,0 -3 .5/80<1@! 2b3045N6P 78#W 9UZ;:];/a <d =Ih>kS?  ~ qb@ ! !~ !A@ " "~ "@ # #~ #@ $ $~ $@ % %~ %a@ & &~ &@ ' '~ '@ ( (~ (@ ) )~ )Al@ * *~ *A@ + +~ +@ , ,~ ,<@ - -~ -a@ . .~ .1a@ / /~ /A@ 0 0~ 0s@ 1 1~ 1@ 2 2~ 2e@ 3 3~ 3Q@ 4 4~ 4!@ 5 5~ 5@ 6 6~ 6wA 7 7~ 7A 8 8~ 8LA 9 9~ 9!A : :~ :@ ; ;~ ;@ < <~ <AV@ = =~ =@ > >~ >~@ ? ?~ ?q@Dl*******************************@T0AbBbCDEFGbHbIJ*K- L0 M3 N5O8P<Q@! 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RbS0TUNVP WX#W YUZ;Z][/a \d ]Ih^kS_ @ @~ @*A A A~ A1A B B~ BA C C~ CN@ D D~ DA E E~ EmA F F~ Fl@ G G~ G@ H H~ H@ I I~ Iw@ J J~ JA@ K K~ K@ L L~ L@ M M~ M@ N N~ N6@ O O~ OԘ@ P P~ P@3@ Q Q~ Qt@ R R~ Rϵ@ S S~ S@ T T~ TԞ@ U U~ U@ V V~ V@ W W~ W@ X X~ Xެ@ Y Y~ Y@ Z Z~ Zȅ@ [ [~ [p@ \ \~ \@ ] ]~ ]@ ^ ^~ ^@ _ _~ _A&@Dl*******************************`T0abbbcdefgbhbij*k-  ` `~ `@ a a~ a|@ b b~ bA@ c c~ c@ d d~ d@ e e~ eA@ f f~ f@ g g~ g@ h h~ hn@ i i~ i@ j j~ j_@ k k~ k@***********>@A  Oh+'0@H`t Karen Beckstead Jean BickalMicrosoft Excel@2@s[o՜.+,D՜.+, PXl t|  Medicodecs2j hcpcs2  Worksheets 6> _PID_GUIDAN{C2D0A624-DAEB-11D3-B10E-000629D0BED6}  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-/012345789:;<=Root EntryF Ff{fWorkbookV[SummaryInformationJF0E``(.DocumentSummaryInformation86