0 IDICODEC COSTN DOLLARSN FLATRATEN# INFORMALL-ISDOLLARSL.NAMEC/NAME2C)PERCOMC#TYPEC7UNITNL UNITTYPECVSCUTCWISNOTBILLL_ISTAXL`TAXNa IDMODIFIkIDMODIF2IoISCANCELVSLsACTCOSTNt ISPRN1500L~ l=L0120 0.00 0.00 0.00FFCervical, Flexible, Non-Adjustable (Foam Collar) + 1.00 FF 0.00F 0.00F m=L0172 0.00 0.00 0.00FFCervical, Collar, Semi-Rigid Thermoplasic Foam, Two-Piece + 1.00 FF 0.00F 0.00F o=L3660 0.00 0.00 0.00FFShoulder Orthosis, Figure-8 Design Abduction Restrainer, Canvas and Webbing, Prefabricated, Includes Fitting & Adjustment + 1.00 FF 0.00F 0.00F p=L3650 0.00 0.00 0.00FFShoulder Orthosis, Figure-8 Design Abduction Restrainer, Prefabricated, Includes Fit & Adjust + 1.00 FF 0.00F 0.00F q=L3670 0.00 0.00 0.00FFShoulder Orthosis, Acromio/Clavicular (Canvas & Webbing Type), Prefab., Includes Fitting & Adjustment + 1.00 FF 0.00F 0.00F r=L3651 0.00 0.00 0.00FFShoulder Orthosis, Single Shoulder, Prefabricated, Includes Fitting and Adjustment + 1.00 FF 0.00F 0.00F s=L0628 0.00 0.00 0.00FFLumbar-Sacral Orthosis, Flexible, Provides Lumbo-Sacral Support, Posterior Extends from Sacrococcygeal Junction to T-9 Vertebra, Produces Intracavitary Pressure to Reduce Load on Intervertebral Discs, Includes Straps, Closures, May Include Stays, Shoulder Straps, Pendulous Abdomen Design, Prefab, Incl. Fit/Adjust + 1.00 FF 0.00F 0.00F t=A4465 0.00 0.00 0.00FFNon-Elastic Binder for Extremity + 1.00 FF 0.00F 0.00F u=L3701 0.00 0.00 0.00FFElbow Orthosis, Elastic, Prefabricated, Includes Fitting/Adjustment (e.g. Neoprene, Lycra) + 1.00 FF 0.00F 0.00F v=L3909 0.00 0.00 0.00FFWrist Orthosis, Elastic, Prefabricated, Includes Fitting and Adjustment (e.g. Neoprene, Lycra) + 1.00 FF 0.00F 0.00F w=L3908 0.00 0.00 0.00FFWrist Hand Orthosis, Wrist Extension Control Cock-Up, Non-Molded, Prefabricated, Includes Fit & Adjust + 1.00 FF 0.00F 0.00F x=L3999 0.00 0.00 0.00FFUpper Limb Orthosis, Not Otherwise Specified + 1.00 FF 0.00F 0.00F y=L3911 0.00 0.00 0.00FFWrist Hand Finger Orthosis, Elastic, Prefabricated, Includes Fitting and Adjustment (e.g. Neoprene, Lycra) + 1.00 FF 0.00F 0.00F z=L3923 0.00 0.00 0.00FFHand Finger Orthosis, Without Joint(s), Prefab, Includes Fitting & Adjustments, Any Type + 1.00 FF 0.00F 0.00F {=A4570 0.00 0.00 0.00FFSplint + 1.00 FF 0.00F 0.00F |=L3807 0.00 0.00 0.00FFWrist Hand Finger Orthosis, Without Joint(s), Prefabricated, Includes Fitting & Adjustments, Any Type + 1.00 FF 0.00F 0.00F }=A4565 0.00 0.00 0.00FFSlings + 1.00 FF 0.00F 0.00F ~=L0625 0.00 0.00 0.00FFLumbar Orthosis, Flexible, Provides Lumbar Support, Posterior Extends from L-1 to Below L-5 Vertebra, Produces Intracavitary Pressure to Reduce Load on Intervertebral Discs, Includes Straps, Closures, May Include Pendulous Abdomen Design, Shoulder St + 1.00 FF 0.00F 0.00F =L0626 0.00 0.00 0.00FFLumbar Orthosis, Sagittal Control, w/Rigid Posterior Panel(s), Posterior Extends from L-1 to Below L-5, Vertebrae, Produces Intracavitary Pressure to Reduce Load on Intervertebral Discs, Includes Straps, Closures, May Include Padding, Stays, Shoulder + 1.00 FF 0.00F 0.00F =L0621 0.00 0.00 0.00FFSacroiliac Orthosis, Flexible, Provides Pelvic-Sacral Support, Reduces Motion About the Sacroiliac Joint, Includes Straps, Closures, May Include Pendulous Abdomen Design, Prefabricated, Incl. Fit & Adjust + 1.00 FF 0.00F 0.00F =L0627 0.00 0.00 0.00FFLumbar Orthosis, Sagittal Control, w/Rigid Anterior and Posterior Panels, Posterior Extends from L-1 to Below L-5 Vertebra, Produces Intracavitary Pressure to Reduce Load on the Intervertebral Discs, Includes Straps, Closures, May Include Padding, Sh + 1.00 FF 0.00F 0.00F =L0631 0.00 0.00 0.00FFLumbar Sacral Orthosis, Sagittal Control, with Rigid Anterior and Posterior Panels, Posterior Extends, From Sacrococcygeal Junction to T-9 Vertebra, Produces Intercavitary Pressure to Reduce Load on the Intervertebral Discs, Includes Straps, Pendulou + 1.00 FF 0.00F 0.00F =L0210 0.00 0.00 0.00FFThoracic, Rib Belt + 1.00 FF 0.00F 0.00F =L1832 0.00 0.00 0.00FFKnee Orthosis, Adjustable Knee Joints, Positional Orthosis, Rigid Support, Prefab, Includes Fit & Adjust + 1.00 FF 0.00F 0.00F =L1800 0.00 0.00 0.00FFKnee Orthosis, Elastic with Stays, Prefabricated, Includes Fitting and Adjustment + 1.00 FF 0.00F 0.00F =A6457 0.00 0.00 0.00FFTUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD + 1.00 FF 0.00F 0.00F =A6530 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6531 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6532 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6533 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6534 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6535 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6536 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6537 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6538 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6539 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6540 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6541 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH + 1.00 FF 0.00F 0.00F =A6542 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, CUSTOM MADE + 1.00 FF 0.00F 0.00F =A6543 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, LYMPHEDEMA + 1.00 FF 0.00F 0.00F =A6544 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, GARTER BELT + 1.00 FF 0.00F 0.00F =A6549 0.00 0.00 0.00FFGRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED + 1.00 FF 0.00F 0.00F =A9150 0.00 0.00 0.00FFNON-PRESCRIPTION DRUGS + 1.00 FF 0.00F 0.00F =A9270 0.00 0.00 0.00FFNON-COVERED ITEM OR SERVICE + 1.00 FF 0.00F 0.00F =E0100 0.00 0.00 0.00FFCANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP + 1.00 FF 0.00F 0.00F =E0105 0.00 0.00 0.00FFCANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR 'FIXED, WITH TIPS + 1.00 FF 0.00F 0.00F =E0110 0.00 0.00 0.00FFCRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, 'PAIR, COMPLETE WITH TIPS AND HANDGRIPS + 1.00 FF 0.00F 0.00F =E0111 0.00 0.00 0.00FFCRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, 'EACH, WITH TIP AND HANDGRIPS + 1.00 FF 0.00F 0.00F =E0112 0.00 0.00 0.00FFCRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND 'HANDGRIPS + 1.00 FF 0.00F 0.00F =E0113 0.00 0.00 0.00FFCRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP + 1.00 FF 0.00F 0.00F =E0114 0.00 0.00 0.00FFCRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS 'AND HANDGRIPS + 1.00 FF 0.00F 0.00F =E0116 0.00 0.00 0.00FFCRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP,??CONT. NEXT PAGE + 1.00 FF 0.00F 0.00F =E0116 0.00 0.00 0.00FFCONTINUED??..HANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH + 1.00 FF 0.00F 0.00F =E0117 0.00 0.00 0.00FFCRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH + 1.00 FF 0.00F 0.00F =E0130 0.00 0.00 0.00FFWALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT + 1.00 FF 0.00F 0.00F =E0135 0.00 0.00 0.00FFWALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT + 1.00 FF 0.00F 0.00F =E0141 0.00 0.00 0.00FFWALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT + 1.00 FF 0.00F 0.00F =E0143 0.00 0.00 0.00FFWALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT + 1.00 FF 0.00F 0.00F =E0144 0.00 0.00 0.00FFWALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR SEAT + 1.00 FF 0.00F 0.00F =E0147 0.00 0.00 0.00FFWALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE + 1.00 FF 0.00F 0.00F =E0148 0.00 0.00 0.00FFWALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH + 1.00 FF 0.00F 0.00F =E0149 0.00 0.00 0.00FFWALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE + 1.00 FF 0.00F 0.00F =E0153 0.00 0.00 0.00FFPLATFORM ATTACHMENT, FOREARM CRUTCH, EACH + 1.00 FF 0.00F 0.00F =E0154 0.00 0.00 0.00FFPLATFORM ATTACHMENT, WALKER, EACH + 1.00 FF 0.00F 0.00F =E0155 0.00 0.00 0.00FFWHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR + 1.00 FF 0.00F 0.00F =E0156 0.00 0.00 0.00FFSEAT ATTACHMENT, WALKER + 1.00 FF 0.00F 0.00F =E0157 0.00 0.00 0.00FFCRUTCH ATTACHMENT, WALKER, EACH + 1.00 FF 0.00F 0.00F =E0158 0.00 0.00 0.00FFLEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4) + 1.00 FF 0.00F 0.00F =E0747 0.00 0.00 0.00FFOSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL APPLICATIONS + 1.00 FF 0.00F 0.00F =E1810 0.00 0.00 0.00FFDYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL + 1.00 FF 0.00F 0.00F =E1812 0.00 0.00 0.00FFDYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL + 1.00 FF 0.00F 0.00F =E1815 0.00 0.00 0.00FFDYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL + 1.00 FF 0.00F 0.00F =E1816 0.00 0.00 0.00FFBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ANKLE DEVICE WITH RANGE OF MOTION 'ADJUSTMENT, INCLUDES CUFFS'ADJUSTMENT, INCLU + 1.00 FF 0.00F 0.00F =E1830 0.00 0.00 0.00FFDYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL + 1.00 FF 0.00F 0.00F >L1900 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM FABRICATED + 1.00 FF 0.00F 0.00F >L1901 0.00 0.00 0.00FFANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) + 1.00 FF 0.00F 0.00F >L1902 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT + 1.00 FF 0.00F 0.00F >L1904 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED + 1.00 FF 0.00F 0.00F >L1906 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES 'FITTING AND ADJUSTMENT + 1.00 FF 0.00F 0.00F >L1907 0.00 0.00 0.00FFAFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM FABRICATED + 1.00 FF 0.00F 0.00F >L1910 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER, 'PREFABRICATED, INCLUDES FITTING AND ADJUST + 1.00 FF 0.00F 0.00F >L1920 0.00 0.00 0.00FFANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR 'PERLSTEIN TYPE), CUSTOM-FABRICATED + 1.00 FF 0.00F 0.00F >L2038 0.00 0.00 0.00FFKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE, 'MULTI-AXIS ANKLE, CUSTOM FABRICATED + 1.00 FF 0.00F 0.00F >L2040 0.00 0.00 0.00FFHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS, + 1.00 FF 0.00F 0.00F >L2050 0.00 0.00 0.00FFHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP + 1.00 FF 0.00F 0.00F >L2060 0.00 0.00 0.00FFHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL + 1.00 FF 0.00F 0.00F !>L2240 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT + 1.00 FF 0.00F 0.00F ">L2250 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP ATTACHMENT + 1.00 FF 0.00F 0.00F #>L2260 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE) + 1.00 FF 0.00F 0.00F $>L2265 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP + 1.00 FF 0.00F 0.00F %>L2270 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED 'OR MALLEOLUS PAD + 1.00 FF 0.00F 0.00F &>L2275 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED + 1.00 FF 0.00F 0.00F '>L2280 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, MOLDED INNER BOOT + 1.00 FF 0.00F 0.00F (>L2300 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT), 'JOINTED, ADJUSTABLE + 1.00 FF 0.00F 0.00F )>L2310 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT + 1.00 FF 0.00F 0.00F *>L2320 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY + 1.00 FF 0.00F 0.00F +>L2330 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM 'FABRICATED ORTHOSIS ONLY + 1.00 FF 0.00F 0.00F ,>L2335 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, ANTERIOR SWING BAND + 1.00 FF 0.00F 0.00F ->L2340 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL + 1.00 FF 0.00F 0.00F .>L2350 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT 'MODEL, (USED FOR 'PTB' 'AFO' ORTHOSES) + 1.00 FF 0.00F 0.00F />L2360 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, EXTENDED STEEL SHANK + 1.00 FF 0.00F 0.00F 0>L2370 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, PATTEN BOTTOM + 1.00 FF 0.00F 0.00F 1>L2375 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID STIRRUP + 1.00 FF 0.00F 0.00F 2>L2380 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT + 1.00 FF 0.00F 0.00F 3>L2385 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT + 1.00 FF 0.00F 0.00F 4>L2390 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT + 1.00 FF 0.00F 0.00F 5>L2395 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT + 1.00 FF 0.00F 0.00F 6>L2397 0.00 0.00 0.00FFADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE + 1.00 FF 0.00F 0.00F 7>L3000 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL, EACH + 1.00 FF 0.00F 0.00F 8>L3001 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH + 1.00 FF 0.00F 0.00F 9>L3002 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH + 1.00 FF 0.00F 0.00F :>L3003 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH + 1.00 FF 0.00F 0.00F ;>L3010 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT, EACH + 1.00 FF 0.00F 0.00F <>L3020 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL SUPPORT, EACH + 1.00 FF 0.00F 0.00F =>L3030 0.00 0.00 0.00FFFOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH + 1.00 FF 0.00F 0.00F >>L3031 0.00 0.00 0.00FFFOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH + 1.00 FF 0.00F 0.00F ?>L3040 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH + 1.00 FF 0.00F 0.00F @>L3050 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH + 1.00 FF 0.00F 0.00F A>L3060 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH + 1.00 FF 0.00F 0.00F B>L3070 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH + 1.00 FF 0.00F 0.00F C>L3080 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH + 1.00 FF 0.00F 0.00F D>L3090 0.00 0.00 0.00FFFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL, EACH + 1.00 FF 0.00F 0.00F E>L3100 0.00 0.00 0.00FFHALLUS-VALGUS NIGHT DYNAMIC SPLINT + 1.00 FF 0.00F 0.00F F>L3140 0.00 0.00 0.00FFFOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES (Denis-Browne type) + 1.00 FF 0.00F 0.00F G>L3150 0.00 0.00 0.00FFFOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES (Denis-Browne type + 1.00 FF 0.00F 0.00F H>L3160 0.00 0.00 0.00FFFOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE + 1.00 FF 0.00F 0.00F I>L3170 0.00 0.00 0.00FFFOOT, PLASTIC, SILICONE OR EQUAL, HEEL STABILIZER, EACH + 1.00 FF 0.00F 0.00F J>L3201 0.00 0.00 0.00FFORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT + 1.00 FF 0.00F 0.00F K>L3202 0.00 0.00 0.00FFORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD + 1.00 FF 0.00F 0.00F L>L3203 0.00 0.00 0.00FFORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR + 1.00 FF 0.00F 0.00F M>L3204 0.00 0.00 0.00FFORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT + 1.00 FF 0.00F 0.00F N>L3206 0.00 0.00 0.00FFORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD + 1.00 FF 0.00F 0.00F O>L3207 0.00 0.00 0.00FFORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR + 1.00 FF 0.00F 0.00F P>L3208 0.00 0.00 0.00FFSURGICAL BOOT, EACH, INFANT + 1.00 FF 0.00F 0.00F Q>L3209 0.00 0.00 0.00FFSURGICAL BOOT, EACH, CHILD + 1.00 FF 0.00F 0.00F R>L3211 0.00 0.00 0.00FFSURGICAL BOOT, EACH, JUNIOR + 1.00 FF 0.00F 0.00F S>L3212 0.00 0.00 0.00FFBENESCH BOOT, PAIR, INFANT + 1.00 FF 0.00F 0.00F T>L3213 0.00 0.00 0.00FFBENESCH BOOT, PAIR, CHILD + 1.00 FF 0.00F 0.00F U>L3214 0.00 0.00 0.00FFBENESCH BOOT, PAIR, JUNIOR + 1.00 FF 0.00F 0.00F V>L3215 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH + 1.00 FF 0.00F 0.00F W>L3216 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH + 1.00 FF 0.00F 0.00F X>L3217 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH + 1.00 FF 0.00F 0.00F Y>L3219 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH + 1.00 FF 0.00F 0.00F Z>L3221 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH + 1.00 FF 0.00F 0.00F [>L3222 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH + 1.00 FF 0.00F 0.00F \>L3224 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS) + 1.00 FF 0.00F 0.00F ]>L3225 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS) + 1.00 FF 0.00F 0.00F ^>L3230 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH + 1.00 FF 0.00F 0.00F _>L3250 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, EACH + 1.00 FF 0.00F 0.00F `>L3251 0.00 0.00 0.00FFFOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH + 1.00 FF 0.00F 0.00F a>L3252 0.00 0.00 0.00FFFOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, EACH + 1.00 FF 0.00F 0.00F b>L3253 0.00 0.00 0.00FFFOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH + 1.00 FF 0.00F 0.00F c>L3254 0.00 0.00 0.00FFNON-STANDARD SIZE OR WIDTH + 1.00 FF 0.00F 0.00F d>L3255 0.00 0.00 0.00FFNON-STANDARD SIZE OR LENGTH + 1.00 FF 0.00F 0.00F e>L3257 0.00 0.00 0.00FFORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE + 1.00 FF 0.00F 0.00F f>L3260 0.00 0.00 0.00FFSURGICAL BOOT/SHOE, EACH + 1.00 FF 0.00F 0.00F g>L3265 0.00 0.00 0.00FFPLASTAZOTE SANDAL, EACH + 1.00 FF 0.00F 0.00F h>L3300 0.00 0.00 0.00FFLIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH + 1.00 FF 0.00F 0.00F i>L3310 0.00 0.00 0.00FFLIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH + 1.00 FF 0.00F 0.00F j>L3320 0.00 0.00 0.00FFLIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH + 1.00 FF 0.00F 0.00F k>L3330 0.00 0.00 0.00FFLIFT, ELEVATION, METAL EXTENSION (SKATE) + 1.00 FF 0.00F 0.00F l>L3332 0.00 0.00 0.00FFLIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH + 1.00 FF 0.00F 0.00F m>L3334 0.00 0.00 0.00FFLIFT, ELEVATION, HEEL, PER INCH + 1.00 FF 0.00F 0.00F n>L3340 0.00 0.00 0.00FFHEEL WEDGE, SACH + 1.00 FF 0.00F 0.00F o>L3350 0.00 0.00 0.00FFHEEL WEDGE + 1.00 FF 0.00F 0.00F p>L3360 0.00 0.00 0.00FFSOLE WEDGE, OUTSIDE SOLE + 1.00 FF 0.00F 0.00F q>L3370 0.00 0.00 0.00FFSOLE WEDGE, BETWEEN SOLE + 1.00 FF 0.00F 0.00F r>L3380 0.00 0.00 0.00FFCLUBFOOT WEDGE + 1.00 FF 0.00F 0.00F s>L3390 0.00 0.00 0.00FFOUTFLARE WEDGE + 1.00 FF 0.00F 0.00F t>L3400 0.00 0.00 0.00FFMETATARSAL BAR WEDGE, ROCKER + 1.00 FF 0.00F 0.00F u>L3410 0.00 0.00 0.00FFMETATARSAL BAR WEDGE, BETWEEN SOLE + 1.00 FF 0.00F 0.00F v>L3420 0.00 0.00 0.00FFFULL SOLE AND HEEL WEDGE, BETWEEN SOLE + 1.00 FF 0.00F 0.00F w>L3430 0.00 0.00 0.00FFHEEL, COUNTER, PLASTIC REINFORCED + 1.00 FF 0.00F 0.00F x>L3440 0.00 0.00 0.00FFHEEL, COUNTER, LEATHER REINFORCED + 1.00 FF 0.00F 0.00F y>L3450 0.00 0.00 0.00FFHEEL, SACH CUSHION TYPE + 1.00 FF 0.00F 0.00F z>L3455 0.00 0.00 0.00FFHEEL, NEW LEATHER, STANDARD + 1.00 FF 0.00F 0.00F {>L3460 0.00 0.00 0.00FFHEEL, NEW RUBBER, STANDARD + 1.00 FF 0.00F 0.00F |>L3465 0.00 0.00 0.00FFHEEL, THOMAS WITH WEDGE + 1.00 FF 0.00F 0.00F }>L3470 0.00 0.00 0.00FFHEEL, THOMAS EXTENDED TO BALL + 1.00 FF 0.00F 0.00F ~>L3480 0.00 0.00 0.00FFHEEL, PAD AND DEPRESSION FOR SPUR + 1.00 FF 0.00F 0.00F >L3485 0.00 0.00 0.00FFHEEL, PAD, REMOVABLE FOR SPUR + 1.00 FF 0.00F 0.00F >L3500 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER + 1.00 FF 0.00F 0.00F >L3510 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER + 1.00 FF 0.00F 0.00F >L3520 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER + 1.00 FF 0.00F 0.00F >L3530 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, SOLE, HALF + 1.00 FF 0.00F 0.00F >L3540 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, SOLE, FULL + 1.00 FF 0.00F 0.00F >L3550 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD + 1.00 FF 0.00F 0.00F >L3560 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE + 1.00 FF 0.00F 0.00F >L3570 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS) + 1.00 FF 0.00F 0.00F >L3580 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE + 1.00 FF 0.00F 0.00F >L3590 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER + 1.00 FF 0.00F 0.00F >L3595 0.00 0.00 0.00FFORTHOPEDIC SHOE ADDITION, MARCH BAR + 1.00 FF 0.00F 0.00F >L3600 0.00 0.00 0.00FFTRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING + 1.00 FF 0.00F 0.00F >L3610 0.00 0.00 0.00FFTRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW + 1.00 FF 0.00F 0.00F >L3620 0.00 0.00 0.00FFTRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING + 1.00 FF 0.00F 0.00F >L3630 0.00 0.00 0.00FFTRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW + 1.00 FF 0.00F 0.00F >L3640 0.00 0.00 0.00FFTRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT '(RIVETON), BOTH SHOES + 1.00 FF 0.00F 0.00F >L3649 0.00 0.00 0.00FFORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED + 1.00 FF 0.00F 0.00F >L4350 0.00 0.00 0.00FFANKLE CONTROL ORTHOSIS,(ANKLE AIR CAST) STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE '(E.G., PNEUMATIC, GEL), PREFA + 1.00 FF 0.00F 0.00F >L4360 0.00 0.00 0.00FFWALKING BOOT, PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE 'MATERIAL, PREFABRICATED, INCLUDES FITTING AND + 1.00 FF 0.00F 0.00F >L4370 0.00 0.00 0.00FFPNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT + 1.00 FF 0.00F 0.00F >L4380 0.00 0.00 0.00FFPNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT + 1.00 FF 0.00F 0.00F >L4386 0.00 0.00 0.00FFWALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE 'MATERIAL, PREFABRICATED, INCLUDES FITTING + 1.00 FF 0.00F 0.00F >L4392 0.00 0.00 0.00FFREPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO + 1.00 FF 0.00F 0.00F >L4394 0.00 0.00 0.00FFREPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT + 1.00 FF 0.00F 0.00F >L4396 0.00 0.00 0.00FFSTATIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR 'FIT, FOR POSITIONING, PRESSURE REDUCTION + 1.00 FF 0.00F 0.00F >L4398 0.00 0.00 0.00FFFOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING 'AND ADJUSTMENT + 1.00 FF 0.00F 0.00F >L8641 0.00 0.00 0.00FFMETATARSAL JOINT IMPLANT + 1.00 FF 0.00F 0.00F >L8642 0.00 0.00 0.00FFHALLUX IMPLANT + 1.00 FF 0.00F 0.00F >L8658 0.00 0.00 0.00FFINTERPHALANGEAL JOINT SPACER, SILICONE OR EQUAL, EACH + 1.00 FF 0.00F 0.00F >Q4029 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), PLASTER + 1.00 FF 0.00F 0.00F >Q4030 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4031 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER + 1.00 FF 0.00F 0.00F >Q4032 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4033 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), PLASTER + 1.00 FF 0.00F 0.00F >Q4034 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4035 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), PLASTER + 1.00 FF 0.00F 0.00F >Q4036 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4037 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER + 1.00 FF 0.00F 0.00F >Q4038 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4039 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER + 1.00 FF 0.00F 0.00F >Q4040 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4041 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), PLASTER + 1.00 FF 0.00F 0.00F >Q4042 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4043 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER + 1.00 FF 0.00F 0.00F >Q4044 0.00 0.00 0.00FFCAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4045 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER + 1.00 FF 0.00F 0.00F >Q4046 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4047 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER + 1.00 FF 0.00F 0.00F >Q4048 0.00 0.00 0.00FFCAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS + 1.00 FF 0.00F 0.00F >Q4049 0.00 0.00 0.00FFFINGER SPLINT, STATIC + 1.00 FF 0.00F 0.00F >Q4050 0.00 0.00 0.00FFCAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS + 1.00 FF 0.00F 0.00F >Q4051 0.00 0.00 0.00FFSPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS, + 1.00 FF 0.00F 0.00F >Q4051 0.00 0.00 0.00FFPADDING AND OTHER SUPPLIES) + 1.00 FF 0.00F 0.00F L1810 0.00 0.00 0.00FFKnee Orthosis, Elastic with Joints, Prefabricated, Includes Fitting and Adjustment 1.00 FF 0.00F 0.00F L1820 0.00 0.00 0.00FFKnee Orthosis, Elastic w/ Condylar Pads and Joints, with or without Patellar Control, Prefabricated, Includes Fitting and Adjustment 1.00 FF 0.00F 0.00F L2999 0.00 0.00 0.00FFLower Extremity Orthosis, Not Otherwise Specified 1.00 FF 0.00F 0.00F L1815 0.00 0.00 0.00FFKnee Orthosis, Elastic or Other Elastic Type Material with Condylar Pad(s), Prefab, Incl. Fit & Adjust 1.00 FF 0.00F 0.00F L1830 0.00 0.00 0.00FFKnee Orthosis, Immobilizer, Canvas Longitudinal, Prefabricated, Includes Fitting and Adjustment 1.00 FF 0.00F 0.00F E0860 0.00 0.00 0.00FFTraction Equipment, Overdoor Cervical 1.00 FF 0.00F 0.00F E0710 0.00 0.00 0.00FFRestraint, Any Type (Body, Chest, Wrist or Ankle) 1.00 FF 0.00F 0.00F A6449 0.00 0.00 0.00FFLight Compression Bandage, Elastic, Knitted/Woven, Width Greater than or Equal to 3 Inches and Less than 5 Inches, per Yard 1.00 FF 0.00F 0.00F A4334 0.00 0.00 0.00FFUrinary Catheter Anchoring Device, Leg Strap, Each 1.00 FF 0.00F 0.00F E0230 0.00 0.00 0.00FFIce Cap or Collar 1.00 FF 0.00F 0.00F A6448 0.00 0.00 0.00FFLight Compression Bandage, Elastic, Knitted/Woven, Width Less than 3 Inches, per Yard 1.00 FF 0.00F 0.00F A6450 0.00 0.00 0.00FFLight Compression Bandage, Elastic, Knitted/Woven, Width Greather than or Equal to 5 Inches, per Yard 1.00 FF 0.00F 0.00F L1930 0.00 0.00 0.00FFAFO, Plastic or Other Material, Prefabricated, Includes Fitting and Adjustment 1.00 FF 0.00F 0.00F E0191 0.00 0.00 0.00FFHeel or Elbow Protector, Each 1.00 FF 0.00F 0.00F L8300 0.00 0.00 0.00FFTruss, Single (8300) or Double (8310) with Standard Pads 1.00 FF 0.00F 0.00F L1499 0.00 0.00 0.00FFSpinal Orthosis, Not Otherwise Specified 1.00 FF 0.00F 0.00F A4590 0.00 0.00 0.00FFSpecial Casting Material (e.g. Fiberglass) 1.00 FF 0.00F 0.00F E0992 0.00 0.00 0.00FFManual Wheelchair Accessory, Solid Seat Insert 1.00 FF 0.00F 0.00F K0669 0.00 0.00 0.00FFWheelchair Accessory, Seat or Back Cushion, Does Not Meet Specific Code Criteria or No Written Coding Verification from SADMERC 1.00 FF 0.00F 0.00F E2601 0.00 0.00 0.00FFGeneral Use Wheelchair Seat Cushion, Width Less than 22 Inches, Any Depth 1.00 FF 0.00F 0.00F E2603 0.00 0.00 0.00FFSkin Protection Wheelchair Seat Cushion, Width Less than 22 Inches, Any Depth 1.00 FF 0.00F 0.00F E2607 0.00 0.00 0.00FFSkin Protection and Positioning Wheelchair Seat Cushion, Width Less than 22", Any Depth 1.00 FF 0.00F 0.00F A5510 0.00 0.00 0.00FFFor Diabetics Only, Direct Formed, Compression Molded to Patients Foot without External Heat Source, Multiple-Density Insert(s), Prefabricated, Per Shoe 1.00 FF 0.00F 0.00F A5512 0.00 0.00 0.00FFFor Diabetics Only, Multiple Density Insert, Direct Formed, Molded to Foot after External Heat Source of 230 Fahrenheit or Higher, Total Contact with Patients Foot, Including Arch, Base Layer Minimum of 1/4 Inch Material of Shore A 35 Durometer or 3/16 Inch Material of Shore A 40 (or Higher), Prefabricated, Each 1.00 FF 0.00F 0.00F A5500 0.00 0.00 0.00FFFor Diabetics Only, Fitting (Including Follow-Up), Custom Preparation and Supply of Off-the-Shelf Depth-Inlay Shoe Manufactured to Accommodate Multi-Density Insert(s), Per Shoe 1.00 FF 0.00F 0.00F A5512 0.00 0.00 0.00FFFor Diabetics Only, Multiple Density Insert, Direct Formed, Molded to Foot After External Heat Source of 230 Degrees Fahrenheit or Higher, Total Contact with Patients Foot, Including Arch, Base Layer Minimum of 1/4 Inch Material of Shore A 35 Durometer or 3/16 Inch Material of Shore A 40 Durometer (or Higher), Prefabricated, Each 1.00 FF 0.00F 0.00F