The table below deals only with prosthetic L-Codes and shows what the
Code number refers to and the range of rates (depending on your state)
that your prosthetic provider will be billing for your product.
Durable Medical Equipment - Prosthetics, Orthotics,
and Supplies
(DMEPOS) 1999 Fee Schedule 11/9/98 |
| |
|
|
|
| HCPCS |
Ceiling |
Floor |
Description |
| L2330 |
$368.50 |
$276.37 |
Lacer molded to patient mode |
| L2335 |
$213.19 |
$159.90 |
Anterior swing band |
| L2340 |
$419.44 |
$314.58 |
Pre-tibial shell molded to p |
| L2350 |
$836.22 |
$627.17 |
Prosthetic type socket molde |
| L2360 |
$48.56 |
$36.42 |
Extended steel shank |
| L2370 |
$240.91 |
$180.68 |
Patten bottom |
| L2375 |
$106.04 |
$79.53 |
Torsion ank & half solid sti |
| L2380 |
$115.54 |
$86.65 |
Torsion straight knee joint |
| L2385 |
$125.70 |
$94.27 |
Straight knee joint heavy du |
| L2390 |
$102.73 |
$77.04 |
Offset knee joint each |
| L2395 |
$146.83 |
$110.12 |
Offset knee joint heavy duty |
| L2397 |
$105.48 |
$79.11 |
Suspension sleeve lower ext |
| L2405 |
$47.76 |
$35.82 |
Knee joint drop lock ea jnt |
| L2415 |
$172.35 |
$129.26 |
Knee joint cam lock each joi |
| L2425 |
$170.84 |
$128.13 |
Knee disc/dial lock/adj flex |
| L2430 |
$88.13 |
$66.10 |
Knee jnt ratchet lock ea jnt |
| L2435 |
$155.31 |
$116.49 |
Knee joint polycentric joint |
| L2492 |
$95.70 |
$71.77 |
Knee lift loop drop lock rin |
| L2500 |
$296.06 |
$222.05 |
Thi/glut/ischia wgt bearing |
| L2510 |
$681.68 |
$511.26 |
Th/wght bear quad-lat brim m |
| L2520 |
$432.33 |
$324.25 |
Th/wght bear quad-lat brim c |
| L2525 |
$1,143.99 |
$857.99 |
Th/wght bear nar m-l brim mo |
| L2526 |
$642.80 |
$482.10 |
Th/wght bear nar m-l brim cu |
| L2530 |
$220.50 |
$165.38 |
Thigh/wght bear lacer non-mo |
| L2540 |
$396.76 |
$297.57 |
Thigh/wght bear lacer molded |
| L2550 |
$269.53 |
$202.15 |
Thigh/wght bear high roll cu |
| L2570 |
$447.00 |
$335.25 |
Hip clevis type 2 posit jnt |
| L2580 |
$435.55 |
$326.66 |
Pelvic control pelvic sling |
| L2600 |
$192.73 |
$144.55 |
Hip clevis/thrust bearing fr |
| L2610 |
$227.91 |
$170.93 |
Hip clevis/thrust bearing lo |
| L2620 |
$250.93 |
$188.19 |
Pelvic control hip heavy dut |
| L2622 |
$287.79 |
$215.84 |
Hip joint adjustable flexion |
| L2624 |
$310.77 |
$233.08 |
Hip adj flex ext abduct cont |
| L2627 |
$1,608.81 |
$1,206.61 |
Plastic mold recipro hip & c |
| L2628 |
$1,572.30 |
$1,179.23 |
Metal frame recipro hip & ca |
| L2630 |
$232.39 |
$174.29 |
Pelvic control band & belt u |
| L2640 |
$315.38 |
$236.54 |
Pelvic control band & belt b |
| L2650 |
$112.63 |
$84.47 |
Pelv & thor control gluteal |
| L2660 |
$174.91 |
$131.18 |
Thoracic control thoracic ba |
| L2670 |
$160.09 |
$120.06 |
Thorac cont paraspinal uprig |
| L2680 |
$146.86 |
$110.14 |
Thorac cont lat support upri |
| L2750 |
$78.44 |
$58.83 |
Plating chrome/nickel pr bar |
| L2755 |
$117.14 |
$87.86 |
Carbon graphite lamination |
| L2760 |
$57.02 |
$42.76 |
Extension per extension per |
| L2770 |
$57.95 |
$43.46 |
Low ext orthosis per bar/jnt |
| L2780 |
$63.51 |
$47.63 |
Non-corrosive finish |
| L2785 |
$29.74 |
$22.31 |
Drop lock retainer each |
| L2795 |
$79.74 |
$59.80 |
Knee control full kneecap |
| L2800 |
$100.10 |
$75.08 |
Knee cap medial or lateral p |
| L2810 |
$73.30 |
$54.97 |
Knee control condylar pad |
| L2820 |
$81.50 |
$61.12 |
Soft interface below knee se |
| L2830 |
$88.17 |
$66.13 |
Soft interface above knee se |
| L2840 |
$41.01 |
$30.75 |
Tibial length sock fx or equ |
| L2850 |
$58.11 |
$43.58 |
Femoral lgth sock fx or equa |
| L3224 |
$55.19 |
$41.39 |
Woman's shoe oxford brace |
| L3225 |
$63.48 |
$47.61 |
Man's shoe oxford brace |
| L3650 |
$54.46 |
$40.85 |
Shlder fig 8 abduct restrain |
| L3660 |
$94.39 |
$70.79 |
Abduct restrainer canvas&web |
| L3670 |
$103.85 |
$77.88 |
Acromio/clavicular canvas&we |
| L3675 |
$0.00 |
$0.00 |
Canvas vest SO |
| L3700 |
$64.10 |
$48.08 |
Elbow orthoses elas w stays |
| L3710 |
$113.53 |
$85.14 |
Elbow elastic with metal joi |
| L3720 |
$600.66 |
$450.50 |
Forearm/arm cuffs free motio |
| L3730 |
$827.85 |
$620.88 |
Forearm/arm cuffs ext/flex a |
| L3740 |
$981.47 |
$736.10 |
Cuffs adj lock w/ active con |
| L3800 |
$183.63 |
$137.73 |
Whfo short opponen no attach |
| L3805 |
$293.82 |
$220.36 |
Whfo long opponens no attach |
| L3810 |
$59.51 |
$44.63 |
Whfo thumb abduction bar |
| L3815 |
$55.25 |
$41.44 |
Whfo second m.p. abduction a |
| L3820 |
$94.90 |
$71.17 |
Whfo ip ext asst w/ mp ext s |
| L3825 |
$59.56 |
$44.67 |
Whfo m.p. extension stop |
| L3830 |
$77.74 |
$58.31 |
Whfo m.p. extension assist |
| L3835 |
$84.28 |
$63.21 |
Whfo m.p. spring extension a |
| L3840 |
$57.73 |
$43.29 |
Whfo spring swivel thumb |
| L3845 |
$74.55 |
$55.91 |
Whfo thumb ip ext ass w/ mp |
| L3850 |
$106.49 |
$79.87 |
Action wrist w/ dorsiflex as |
| L3855 |
$107.34 |
$80.51 |
Whfo adj m.p. flexion contro |
| L3860 |
$146.93 |
$110.20 |
Whfo adj m.p. flex ctrl & i. |
| L3900 |
$1,188.29 |
$891.21 |
Hinge extension/flex wrist/f |
| L3901 |
$1,475.79 |
$1,106.84 |
Hinge ext/flex wrist finger |
| L3902 |
$2,236.96 |
$1,677.72 |
Whfo ext power compress gas |
| L3904 |
$2,689.31 |
$2,016.98 |
Whfo electric custom fitted |
| L3906 |
$362.87 |
$272.16 |
Wrist gauntlet molded to pt |
| L3907 |
$466.49 |
$349.87 |
Whfo wrst gauntlt thmb spica |
| L3908 |
$55.02 |
$41.27 |
Wrist cock-up non-molded |
| L3910 |
$344.47 |
$258.35 |
Whfo swanson design |
| L3912 |
$87.09 |
$65.32 |
Flex glove w/elastic finger |
| L3914 |
$78.71 |
$59.03 |
WHO wrist extension cock-up |
| L3916 |
$116.63 |
$87.47 |
Whfo wrist extens w/ outrigg |
| L3918 |
$71.98 |
$53.98 |
HFO knuckle bender |
| L3920 |
$89.94 |
$67.45 |
Knuckle bender with outrigge |
| L3922 |
$89.80 |
$67.35 |
Knuckle bend 2 seg to flex j |
| L3924 |
$97.92 |
$73.44 |
Oppenheimer |
| L3926 |
$85.26 |
$63.94 |
Thomas suspension |
| L3928 |
$53.45 |
$40.09 |
Finger extension w/ clock sp |
| L3930 |
$56.50 |
$42.38 |
Finger extension with wrist |
| L3932 |
$43.16 |
$32.37 |
Safety pin spring wire |
| L3934 |
$44.25 |
$33.18 |
Safety pin modified |
| L3936 |
$81.80 |
$61.35 |
Palmer |
| L3938 |
$85.66 |
$64.24 |
Dorsal wrist |
| L3940 |
$98.72 |
$74.04 |
Dorsal wrist w/ outrigger at |
| L3942 |
$68.28 |
$51.21 |
Reverse knuckle bender |
| L3944 |
$90.19 |
$67.64 |
Reverse knuckle bend w/ outr |
| L3946 |
$81.39 |
$61.04 |
HFO composite elastic |
| L3948 |
$50.61 |
$37.96 |
Finger knuckle bender |
| L3950 |
$137.72 |
$103.29 |
Oppenheimer w/ knuckle bend |
| L3952 |
$152.84 |
$114.63 |
Oppenheimer w/ rev knuckle 2 |
| L3954 |
$101.41 |
$76.06 |
Spreading hand |
| L3956 |
$0.00 |
$0.00 |
Add joint upper ext orthosis |
| L3960 |
$674.91 |
$506.18 |
Sewho airplan desig abdu pos |
| L3962 |
$658.91 |
$494.18 |
Sewho erbs palsey design abd |
| L3963 |
$1,532.08 |
$1,149.06 |
Molded w/ articulating elbow |
| L3964 |
$592.43 |
$503.57 |
Seo mobile arm sup att to wc |
| L3964 |
$59.23 |
$50.35 |
Seo mobile arm sup att to wc |
| L3964 |
$444.29 |
$377.65 |
Seo mobile arm sup att to wc |
| L3965 |
$945.35 |
$803.55 |
Arm supp att to wc rancho ty |
| L3965 |
$94.55 |
$80.37 |
Arm supp att to wc rancho ty |
| L3965 |
$709.01 |
$602.66 |
Arm supp att to wc rancho ty |
| L3966 |
$712.17 |
$605.34 |
Mobile arm supports reclinin |
| L3966 |
$71.22 |
$60.54 |
Mobile arm supports reclinin |
| L3966 |
$534.13 |
$454.01 |
Mobile arm supports reclinin |
| L3968 |
$901.23 |
$766.05 |
Friction dampening arm supp |
| L3968 |
$90.12 |
$76.60 |
Friction dampening arm supp |
| L3968 |
$675.93 |
$574.54 |
Friction dampening arm supp |
| L3969 |
$630.23 |
$535.70 |
Monosuspension arm/hand supp |
| L3969 |
$63.03 |
$53.58 |
Monosuspension arm/hand supp |
| L3969 |
$472.66 |
$401.76 |
Monosuspension arm/hand supp |
| L3970 |
$252.10 |
$214.29 |
Elevat proximal arm support |
| L3970 |
$25.21 |
$21.43 |
Elevat proximal arm support |
| L3970 |
$189.07 |
$160.71 |
Elevat proximal arm support |
| L3972 |
$160.31 |
$136.26 |
Offset/lat rocker arm w/ ela |
| L3972 |
$16.04 |
$13.63 |
Offset/lat rocker arm w/ ela |
| L3972 |
$120.23 |
$102.20 |
Offset/lat rocker arm w/ ela |
| L3974 |
$135.97 |
$115.57 |
Mobile arm support supinator |
| L3974 |
$13.61 |
$11.57 |
Mobile arm support supinator |
| L3974 |
$101.98 |
$86.68 |
Mobile arm support supinator |
| L3980 |
$283.90 |
$212.93 |
Upp ext fx orthosis humeral |
| L3982 |
$342.83 |
$257.12 |
Upper ext fx orthosis rad/ul |
| L3984 |
$316.09 |
$237.06 |
Upper ext fx orthosis wrist |
| L3985 |
$536.75 |
$402.56 |
Forearm hand fx orth w/ wr h |
| L3986 |
$514.74 |
$386.05 |
Humeral rad/ulna wrist fx or |
| L3995 |
$30.03 |
$22.53 |
Sock fracture or equal each |
| L4000 |
$1,196.59 |
$897.44 |
Repl girdle milwaukee orth |
| L4010 |
$629.83 |
$472.37 |
Replace trilateral socket br |
| L4020 |
$808.33 |
$606.25 |
Replace quadlat socket brim |
| L4030 |
$473.81 |
$355.36 |
Replace socket brim cust fit |
| L4040 |
$383.08 |
$287.31 |
Replace molded thigh lacer |
| L4045 |
$307.84 |
$230.88 |
Replace non-molded thigh lac |
| L4050 |
$387.44 |
$290.58 |
Replace molded calf lacer |
| L4055 |
$250.88 |
$188.16 |
Replace non-molded calf lace |
| L4060 |
$298.25 |
$223.69 |
Replace high roll cuff |
| L4070 |
$264.11 |
$198.08 |
Replace prox & dist upright |
| L4080 |
$94.92 |
$71.19 |
Repl met band kafo-afo prox |
| L4090 |
$84.74 |
$63.56 |
Repl met band kafo-afo calf/ |
| L4100 |
$97.88 |
$73.41 |
Repl leath cuff kafo prox th |
| L4110 |
$79.59 |
$59.69 |
Repl leath cuff kafo-afo cal |
| L4130 |
$465.61 |
$349.21 |
Replace pretibial shell |
| L4310 |
$383.01 |
$287.26 |
Mult-podus/eq orth prep mgmt |
| L4320 |
$116.21 |
$87.16 |
Low ext mgmt sys ft pos afo |
| L4350 |
$83.89 |
$62.92 |
Pneumatic ankle cntrl splint |
| L4360 |
$259.85 |
$194.89 |
Pneumatic walking splint |
| L4370 |
$177.17 |
$132.88 |
Pneumatic full leg splint |
| L4380 |
$100.80 |
$75.60 |
Pneumatic knee splint |
| L4390 |
$142.03 |
$106.52 |
Replace multi-podus splint |
| L4392 |
$21.06 |
$15.80 |
Replace ankle contrac splint |
| L4394 |
$15.37 |
$11.53 |
Replace foot drop spint |
| L4396 |
$150.20 |
$112.65 |
Ankle contracture splint |
| L4398 |
$69.14 |
$51.86 |
Foot drop splint recumbent |
| L5000 |
$505.17 |
$378.88 |
Sho insert w arch toe filler |
| L5010 |
$1,217.22 |
$912.92 |
Mold socket ank hgt w/ toe f |
| L5020 |
$1,981.40 |
$1,486.05 |
Tibial tubercle hgt w/ toe f |
| L5050 |
$2,294.55 |
$1,720.91 |
Ank symes mold sckt sach ft |
| L5060 |
$2,761.52 |
$2,071.14 |
Symes met fr leath socket ar |
| L5100 |
$2,323.74 |
$1,742.81 |
Molded socket shin sach foot |
| L5105 |
$3,473.34 |
$2,605.00 |
Plast socket jts/thgh lacer |
| L5150 |
$3,511.07 |
$2,633.30 |
Mold sckt ext knee shin sach |
| L5160 |
$3,818.92 |
$2,864.19 |
Mold socket bent knee shin s |
| L5200 |
$3,302.89 |
$2,477.17 |
Kne sing axis fric shin sach |
| L5210 |
$2,426.15 |
$1,819.61 |
No knee/ankle joints w/ ft b |
| L5220 |
$2,757.76 |
$2,068.32 |
No knee joint with artic ali |
| L5230 |
$3,803.50 |
$2,852.63 |
Fem focal defic constant fri |
| L5250 |
$5,187.63 |
$3,890.72 |
Hip canad sing axi cons fric |
| L5270 |
$5,142.19 |
$3,856.64 |
Tilt table locking hip sing |
| L5280 |
$5,090.77 |
$3,818.07 |
Hemipelvect canad sing axis |
| L5300 |
$2,822.09 |
$2,116.57 |
Bk sach soft cover & finish |
| L5310 |
$4,209.09 |
$3,156.82 |
Knee disart sach soft cv/fin |
| L5320 |
$4,214.88 |
$3,161.16 |
Ak open end sach soft cv/fin |
| L5330 |
$5,886.81 |
$4,415.11 |
Hip canadian sach sft cv/fin |
| L5340 |
$6,289.89 |
$4,717.42 |
Hemipelvectomy canad cv/fin |
| L5400 |
$1,203.33 |
$902.50 |
Postop dress & 1 cast chg bk |
| L5410 |
$417.75 |
$313.31 |
Postop dsg bk ea add cast ch |
| L5420 |
$1,519.75 |
$1,139.81 |
Postop dsg & 1 cast chg ak/d |
| L5430 |
$503.12 |
$377.34 |
Postop dsg ak ea add cast ch |
| L5450 |
$407.33 |
$305.50 |
Postop app non-wgt bear dsg |
| L5460 |
$545.18 |
$408.89 |
Postop app non-wgt bear dsg |
| L5500 |
$1,284.11 |
$963.08 |
Init bk ptb plaster direct |
| L5505 |
$1,739.01 |
$1,304.26 |
Init ak ischal plstr direct |
| L5510 |
$1,455.61 |
$1,091.71 |
Prep BK ptb plaster molded |
| L5520 |
$1,437.80 |
$1,078.35 |
Perp BK ptb thermopls direct |
| L5530 |
$1,726.94 |
$1,295.20 |
Prep BK ptb thermopls molded |
| L5535 |
$1,695.51 |
$1,271.63 |
Prep BK ptb open end socket |
| L5540 |
$1,809.65 |
$1,357.24 |
Prep BK ptb laminated socket |
| L5560 |
$1,943.24 |
$1,457.43 |
Prep AK ischial plast molded |
| L5570 |
$2,020.28 |
$1,515.21 |
Prep AK ischial direct form |
| L5580 |
$2,358.53 |
$1,768.90 |
Prep AK ischial thermo mold |
| L5585 |
$2,558.12 |
$1,918.59 |
Prep AK ischial open end |
| L5590 |
$2,403.51 |
$1,802.63 |
Prep AK ischial laminated |
| L5595 |
$4,025.79 |
$3,019.34 |
Hip disartic sach thermopls |
| L5600 |
$4,445.67 |
$3,334.26 |
Hip disart sach laminat mold |
| L5610 |
$2,070.02 |
$1,552.52 |
Above knee hydracadence |
| L5611 |
$1,610.89 |
$1,208.17 |
Ak 4 bar link w/fric swing |
| L5613 |
$2,450.26 |
$1,837.70 |
Ak 4 bar ling w/hydraul swig |
| L5614 |
$1,515.94 |
$1,136.95 |
4-bar link above knee w/swng |
| L5616 |
$1,357.92 |
$1,018.44 |
Ak univ multiplex sys frict |
| L5617 |
$505.87 |
$379.40 |
AK/BK self-aligning unit ea |
| L5618 |
$281.18 |
$210.89 |
Test socket symes |
| L5620 |
$277.97 |
$208.47 |
Test socket below knee |
| L5622 |
$362.46 |
$271.85 |
Test socket knee disarticula |
| L5624 |
$363.49 |
$272.62 |
Test socket above knee |
| L5626 |
$476.70 |
$357.52 |
Test socket hip disarticulat |
| L5628 |
$482.73 |
$362.05 |
Test socket hemipelvectomy |
| L5629 |
$317.75 |
$238.31 |
Below knee acrylic socket |
| L5630 |
$448.71 |
$336.53 |
Syme typ expandabl wall sckt |
| L5631 |
$439.30 |
$329.48 |
Ak/knee disartic acrylic soc |
| L5632 |
$222.00 |
$166.50 |
Symes type ptb brim design s |
| L5634 |
$304.13 |
$228.10 |
Symes type poster opening so |
| L5636 |
$254.76 |
$191.07 |
Symes type medial opening so |
| L5637 |
$288.84 |
$216.63 |
Below knee total contact |
| L5638 |
$486.58 |
$364.94 |
Below knee leather socket |
| L5639 |
$1,120.98 |
$840.74 |
Below knee wood socket |
| L5640 |
$639.32 |
$479.49 |
Knee disarticulat leather so |
| L5642 |
$619.45 |
$464.59 |
Above knee leather socket |
| L5643 |
$1,556.17 |
$1,167.13 |
Hip flex inner socket ext fr |
| L5644 |
$590.54 |
$442.91 |
Above knee wood socket |
| L5645 |
$797.75 |
$598.31 |
Ak flexibl inner socket ext |
| L5646 |
$547.81 |
$410.86 |
Below knee air cushion socke |
| L5647 |
$795.32 |
$596.49 |
Below knee suction socket |
| L5648 |
$658.26 |
$493.69 |
Above knee air cushion socke |
| L5649 |
$1,903.60 |
$1,427.70 |
Isch containmt/narrow m-l so |
| L5650 |
$488.10 |
$366.07 |
Tot contact ak/knee disart s |
| L5651 |
$1,200.70 |
$900.53 |
Ak flex inner socket ext fra |
| L5652 |
$435.90 |
$326.93 |
Suction susp ak/knee disart |
| L5653 |
$581.89 |
$436.42 |
Knee disart expand wall sock |
| L5654 |
$331.58 |
$248.68 |
Socket insert symes |
| L5655 |
$265.19 |
$198.89 |
Socket insert below knee |
| L5656 |
$370.88 |
$278.16 |
Socket insert knee articulat |
| L5658 |
$363.53 |
$272.65 |
Socket insert above knee |
| L5660 |
$576.41 |
$432.31 |
Sock insrt syme silicone gel |
| L5661 |
$608.43 |
$456.32 |
Multi-durometer symes |
| L5662 |
$528.56 |
$396.42 |
Socket insert bk silicone ge |
| L5663 |
$688.96 |
$516.72 |
Sock knee disartic silicone |
| L5664 |
$663.78 |
$497.84 |
Socket insert ak silicone ge |
| L5665 |
$511.94 |
$383.95 |
Multi-durometer below knee |
| L5666 |
$69.99 |
$52.49 |
Below knee cuff suspension |
| L5667 |
$1,605.37 |
$1,204.02 |
Socket insert w lock lower |
| L5668 |
$100.97 |
$75.72 |
Socket insert w/o lock lower |
| L5669 |
$1,116.24 |
$837.18 |
Below knee socket w/o lock |
| L5670 |
$271.30 |
$203.48 |
Bk molded supracondylar susp |
| L5672 |
$298.14 |
$223.60 |
Bk removable medial brim sus |
| L5674 |
$63.90 |
$47.93 |
Bk latex sleeve suspension/e |
| L5675 |
$86.62 |
$64.96 |
Bk latex sleeve susp/eq hvy |
| L5676 |
$362.31 |
$271.73 |
Bk knee joints single axis p |
| L5677 |
$492.97 |
$369.73 |
Bk knee joints polycentric p |
| L5678 |
$39.70 |
$29.77 |
Bk joint covers pair |
| L5680 |
$304.32 |
$228.24 |
Bk thigh lacer non-molded |
| L5682 |
$625.28 |
$468.96 |
Bk thigh lacer glut/ischia m |
| L5684 |
$48.12 |
$36.09 |
Bk fork strap |
| L5686 |
$51.08 |
$38.31 |
Bk back check |
| L5688 |
$61.07 |
$45.80 |
Bk waist belt webbing |
| L5690 |
$97.83 |
$73.37 |
Bk waist belt padded and lin |
| L5692 |
$132.85 |
$99.64 |
Ak pelvic control belt light |
| L5694 |
$181.38 |
$136.04 |
Ak pelvic control belt pad/l |
| L5695 |
$163.05 |
$122.29 |
Ak sleeve susp neoprene/equa |
| L5696 |
$184.99 |
$138.75 |
Ak/knee disartic pelvic join |
| L5697 |
$80.26 |
$60.20 |
Ak/knee disartic pelvic band |
| L5698 |
$104.29 |
$78.22 |
Ak/knee disartic silesian ba |
| L5699 |
$186.42 |
$139.82 |
Shoulder harness |
| L5700 |
$2,738.06 |
$2,053.55 |
Replace socket below knee |
| L5701 |
$3,399.53 |
$2,549.65 |
Replace socket above knee |
| L5702 |
$4,343.89 |
$3,257.91 |
Replace socket hip |
| L5704 |
$526.46 |
$394.84 |
Custom shape covr below knee |
| L5705 |
$928.75 |
$696.56 |
Custm shape cover above knee |
| L5706 |
$911.18 |
$683.39 |
Custm shape cvr knee disart |
| L5707 |
$1,236.83 |
$927.62 |
Custm shape cover hip disart |
| L5710 |
$359.60 |
$269.70 |
Kne-shin exo sng axi mnl loc |
| L5711 |
$522.06 |
$391.55 |
Knee-shin exo mnl lock ultra |
| L5712 |
$430.82 |
$323.12 |
Knee-shin exo frict swg & st |
| L5714 |
$418.20 |
$313.65 |
Knee-shin exo variable frict |
| L5716 |
$728.71 |
$546.53 |
Knee-shin exo mech stance ph |
| L5718 |
$910.81 |
$683.10 |
Knee-shin exo frct swg & sta |
| L5722 |
$902.71 |
$677.04 |
Knee-shin pneum swg frct exo |
| L5724 |
$1,509.15 |
$1,131.86 |
Knee-shin exo fluid swing ph |
| L5726 |
$1,739.26 |
$1,304.45 |
Knee-shin ext jnts fld swg e |
| L5728 |
$2,379.07 |
$1,784.31 |
Knee-shin fluid swg & stance |
| L5780 |
$1,144.70 |
$858.53 |
Knee-shin pneum/hydra pneum |
| L5785 |
$519.46 |
$389.60 |
Exoskeletal bk ultralt mater |
| L5790 |
$718.90 |
$539.18 |
Exoskeletal ak ultra-light m |
| L5795 |
$1,073.50 |
$805.13 |
Exoskel hip ultra-light mate |
| L5810 |
$486.78 |
$365.08 |
Endoskel knee-shin mnl lock |
| L5811 |
$729.18 |
$546.89 |
Endo knee-shin mnl lck ultra |
| L5812 |
$565.19 |
$423.89 |
Endo knee-shin frct swg & st |
| L5814 |
$3,336.39 |
$2,502.29 |
Endo knee-shin hydral swg ph |
| L5816 |
$850.29 |
$637.72 |
Endo knee-shin polyc mch sta |
| L5818 |
$960.16 |
$720.12 |
Endo knee-shin frct swg & st |
| L5822 |
$1,702.60 |
$1,276.95 |
Endo knee-shin pneum swg frc |
| L5824 |
$1,533.29 |
$1,149.97 |
Endo knee-shin fluid swing p |
| L5826 |
$2,823.07 |
$2,117.31 |
Miniature knee joint |
| L5828 |
$2,823.43 |
$2,117.58 |
Endo knee-shin fluid swg/sta |
| L5830 |
$1,897.19 |
$1,422.90 |
Endo knee-shin pneum/swg pha |
| L5840 |
$3,388.80 |
$2,541.60 |
Multi-axial knee/shin system |
| L5845 |
$1,610.19 |
$1,207.64 |
Knee-shin sys stance flexion |
| L5846 |
$4,900.90 |
$3,675.67 |
Knee-shin sys microprocessor |
| L5850 |
$127.90 |
$95.93 |
Endo ak/hip knee extens assi |
| L5855 |
$308.77 |
$231.58 |
Mech hip extension assist |
| L5910 |
$362.11 |
$271.58 |
Endo below knee alignable sy |
| L5920 |
$530.49 |
$397.87 |
Endo ak/hip alignable system |
| L5925 |
$335.95 |
$251.96 |
Above knee manual lock |
| L5930 |
$3,043.17 |
$2,282.37 |
High activity knee frame |
| L5940 |
$501.52 |
$376.14 |
Endo bk ultra-light material |
| L5950 |
$777.87 |
$583.40 |
Endo ak ultra-light material |
| L5960 |
$963.87 |
$722.90 |
Endo hip ultra-light materia |
| L5962 |
$587.69 |
$440.77 |
Below knee flex cover system |
| L5964 |
$936.36 |
$702.27 |
Above knee flex cover system |
| L5966 |
$1,193.15 |
$894.86 |
Hip flexible cover system |
| L5968 |
$0.00 |
$0.00 |
Multiaxial shck absorb ankle |
| L5970 |
$203.06 |
$152.29 |
Foot external keel sach foot |
| L5972 |
$352.37 |
$264.28 |
Flexible keel foot |
| L5974 |
$232.99 |
$174.74 |
Foot single axis ankle/foot |
| L5975 |
$0.00 |
$0.00 |
Combo ankle/foot prosthesis |
| L5976 |
$559.93 |
$419.95 |
Energy storing foot |
| L5978 |
$291.78 |
$218.83 |
Ft prosth multiaxial ankl/ft |
| L5979 |
$2,281.36 |
$1,711.02 |
Multi-axial ankle/ft prosth |
| L5980 |
$3,707.06 |
$2,780.29 |
Flex foot system |
| L5981 |
$2,879.66 |
$2,159.75 |
Flex-walk sys low ext prosth |
| L5982 |
$578.01 |
$433.51 |
Exoskeletal axial rotation u |
| L5984 |
$569.58 |
$427.18 |
Endoskeletal axial rotation |
| L5985 |
$255.30 |
$191.47 |
Lwr ext dynamic prosth pylon |
| L5986 |
$633.57 |
$475.18 |
Multi-axial rotation unit |
| L5987 |
$6,462.55 |
$4,846.91 |
Shank ft w vert load pylon |
| L5988 |
$0.00 |
$0.00 |
Verticalshock/rotation pylon |
| L6000 |
$1,328.45 |
$996.34 |
Par hand robin-aids thum rem |
| L6010 |
$1,478.35 |
$1,108.77 |
Hand robin-aids little/ring |
| L6020 |
$1,378.33 |
$1,033.75 |
Part hand robin-aids no fing |
| L6050 |
$1,899.29 |
$1,424.46 |
Wrst MLd sck flx hng tri pad |
| L6055 |
$2,647.11 |
$1,985.34 |
Wrst mold sock w/exp interfa |
| L6100 |
$1,924.27 |
$1,443.20 |
Elb mold sock flex hinge pad |
| L6110 |
$2,041.01 |
$1,530.76 |
Elbow mold sock suspension t |
| L6120 |
$2,378.51 |
$1,783.88 |
Elbow mold doub splt soc ste |
| L6130 |
$2,588.26 |
$1,941.20 |
Elbow stump activated lock h |
| L6200 |
$2,727.61 |
$2,045.70 |
Elbow mold outsid lock hinge |
| L6205 |
$3,640.92 |
$2,730.69 |
Elbow molded w/ expand inter |
| L6250 |
$2,684.88 |
$2,013.66 |
Elbow inter loc elbow forarm |
| L6300 |
$3,724.97 |
$2,793.72 |
Shlder disart int lock elbow |
| L6310 |
$3,034.06 |
$2,275.55 |
Shoulder passive restor comp |
| L6320 |
$1,708.64 |
$1,281.48 |
Shoulder passive restor cap |
| L6350 |
$3,916.23 |
$2,937.18 |
Thoracic intern lock elbow |
| L6360 |
$3,184.62 |
$2,388.46 |
Thoracic passive restor comp |
| L6370 |
$2,030.72 |
$1,523.04 |
Thoracic passive restor cap |
| L6380 |
$1,150.06 |
$862.55 |
Postop dsg cast chg wrst/elb |
| L6382 |
$1,480.41 |
$1,110.31 |
Postop dsg cast chg elb dis/ |
| L6384 |
$1,906.27 |
$1,429.70 |
Postop dsg cast chg shlder/t |
| L6386 |
$401.51 |
$301.13 |
Postop ea cast chg & realign |
| L6388 |
$439.54 |
$329.66 |
Postop applicat rigid dsg on |
| L6400 |
$2,319.99 |
$1,739.99 |
Below elbow prosth tiss shap |
| L6450 |
$3,082.54 |
$2,311.91 |
Elb disart prosth tiss shap |
| L6500 |
$3,085.07 |
$2,313.80 |
Above elbow prosth tiss shap |
| L6550 |
$3,812.58 |
$2,859.43 |
Shldr disar prosth tiss shap |
| L6570 |
$4,376.10 |
$3,282.07 |
Scap thorac prosth tiss shap |
| L6580 |
$1,562.88 |
$1,172.16 |
Wrist/elbow bowden cable mol |
| L6582 |
$1,376.07 |
$1,032.05 |
Wrist/elbow bowden cbl dir f |
| L6584 |
$2,046.44 |
$1,534.83 |
Elbow fair lead cable molded |
| L6586 |
$1,883.09 |
$1,412.32 |
Elbow fair lead cable dir fo |
| L6588 |
$2,826.02 |
$2,119.52 |
Shdr fair lead cable molded |
| L6590 |
$2,630.44 |
$1,972.83 |
Shdr fair lead cable direct |
| L6600 |
$187.54 |
$140.66 |
Polycentric hinge pair |
| L6605 |
$185.18 |
$138.88 |
Single pivot hinge pair |
| L6610 |
$166.46 |
$124.85 |
Flexible metal hinge pair |
| L6615 |
$173.69 |
$130.27 |
Disconnect locking wrist uni |
| L6616 |
$64.85 |
$48.64 |
Disconnect insert locking wr |
| L6620 |
$303.15 |
$227.36 |
Flexion-friction wrist unit |
| L6623 |
$641.35 |
$481.01 |
Spring-ass rot wrst w/ latch |
| L6625 |
$531.76 |
$398.82 |
Rotation wrst w/ cable lock |
| L6628 |
$478.96 |
$359.22 |
Quick disconn hook adapter o |
| L6629 |
$146.28 |
$109.71 |
Lamination collar w/ couplin |
| L6630 |
$215.49 |
$161.61 |
Stainless steel any wrist |
| L6632 |
$64.96 |
$48.72 |
Latex suspension sleeve each |
| L6635 |
$176.10 |
$132.08 |
Lift assist for elbow |
| L6637 |
$367.12 |
$275.34 |
Nudge control elbow lock |
| L6640 |
$280.07 |
$210.05 |
Shoulder abduction joint pai |
| L6641 |
$160.40 |
$120.30 |
Excursion amplifier pulley t |
| L6642 |
$217.41 |
$163.06 |
Excursion amplifier lever ty |
| L6645 |
$319.17 |
$239.38 |
Shoulder flexion-abduction j |
| L6650 |
$338.43 |
$253.82 |
Shoulder universal joint |
| L6655 |
$75.10 |
$56.33 |
Standard control cable extra |
| L6660 |
$91.77 |
$68.83 |
Heavy duty control cable |
| L6665 |
$46.05 |
$34.54 |
Teflon or equal cable lining |
| L6670 |
$47.95 |
$35.96 |
Hook to hand cable adapter |
| L6672 |
$168.58 |
$126.44 |
Harness chest/shlder saddle |
| L6675 |
$120.07 |
$90.05 |
Harness figure of 8 sing con |
| L6676 |
$121.25 |
$90.94 |
Harness figure of 8 dual con |
| L6680 |
$231.97 |
$173.98 |
Test sock wrist disart/bel e |
| L6682 |
$256.47 |
$192.35 |
Test sock elbw disart/above |
| L6684 |
$348.51 |
$261.38 |
Test socket shldr disart/tho |
| L6686 |
$590.26 |
$442.69 |
Suction socket |
| L6687 |
$576.71 |
$432.53 |
Frame typ socket bel elbow/w |
| L6688 |
$529.65 |
$397.24 |
Frame typ sock above elb/dis |
| L6689 |
$673.68 |
$505.26 |
Frame typ socket shoulder di |
| L6690 |
$687.49 |
$515.62 |
Frame typ sock interscap-tho |
| L6691 |
$345.13 |
$258.85 |
Removable insert each |
| L6692 |
$559.13 |
$419.35 |
Silicone gel insert or equal |
| L6693 |
$0.00 |
$0.00 |
Lockingelbow forearm cntrbal |
| L6700 |
$518.65 |
$388.98 |
Terminal device model #3 |
| L6705 |
$304.48 |
$228.36 |
Terminal device model #5 |
| L6710 |
$345.07 |
$258.81 |
Terminal device model #5x |
| L6715 |
$342.76 |
$257.07 |
Terminal device model #5xa |
| L6720 |
$852.96 |
$639.72 |
Terminal device model #6 |
| L6725 |
$412.95 |
$309.71 |
Terminal device model #7 |
| L6730 |
$638.90 |
$479.18 |
Terminal device model #7lo |
| L6735 |
$297.92 |
$223.44 |
Terminal device model #8 |
| L6740 |
$388.41 |
$291.31 |
Terminal device model #8x |
| L6745 |
$355.39 |
$266.54 |
Terminal device model #88x |
| L6750 |
$351.28 |
$263.46 |
Terminal device model #10p |
| L6755 |
$350.28 |
$262.71 |
Terminal device model #10x |
| L6765 |
$365.97 |
$274.47 |
Terminal device model #12p |
| L6770 |
$352.79 |
$264.59 |
Terminal device model #99x |
| L6775 |
$418.02 |
$313.51 |
Terminal device model#555 |
| L6780 |
$446.83 |
$335.12 |
Terminal device model #ss555 |
| L6790 |
$451.79 |
$338.84 |
Hooks-accu hook or equal |
| L6795 |
$1,237.40 |
$928.05 |
Hooks-2 load or equal |
| L6800 |
$1,013.03 |
$759.77 |
Hooks-aprl vc or equal |
| L6805 |
$340.17 |
$255.13 |
Modifier wrist flexion unit |
| L6806 |
$1,452.93 |
$1,089.70 |
Trs grip vc or equal |
| L6807 |
$1,317.51 |
$988.14 |
Term device grip1/2 or equal |
| L6808 |
$1,125.02 |
$843.76 |
Term device infant or child |
| L6809 |
$370.98 |
$278.23 |
Trs super sport passive |
| L6810 |
$186.50 |
$139.88 |
Pincher tool otto bock or eq |
| L6825 |
$1,031.54 |
$773.66 |
Hands dorrance vo |
| L6830 |
$1,353.95 |
$1,015.46 |
Hand aprl vc |
| L6835 |
$1,179.42 |
$884.57 |
Hand sierra vo |
| L6840 |
$819.37 |
$614.53 |
Hand becker imperial |
| L6845 |
$760.64 |
$570.48 |
Hand becker lock grip |
| L6850 |
$688.88 |
$516.66 |
Term dvc-hand becker plylite |
| L6855 |
$876.18 |
$657.14 |
Hand robin-aids vo |
| L6860 |
$664.51 |
$498.38 |
Hand robin-aids vo soft |
| L6865 |
$325.57 |
$244.18 |
Hand passive hand |
| L6867 |
$960.55 |
$720.41 |
Hand detroit infant hand |
| L6868 |
$239.71 |
$179.78 |
Passive inf hand steeper/hos |
| L6870 |
$237.64 |
$178.23 |
Hand child mitt |
| L6872 |
$941.65 |
$706.24 |
Hand nyu child hand |
| L6873 |
$467.71 |
$350.78 |
Hand mech inf steeper or equ |
| L6875 |
$777.12 |
$582.84 |
Hand bock vc |
| L6880 |
$504.16 |
$378.12 |
Hand bock vo |
| L6890 |
$170.05 |
$127.54 |
Production glove |
| L6895 |
$558.29 |
$418.72 |
Custom glove |
| L6900 |
$1,510.20 |
$1,132.65 |
Hand restorat thumb/1 finger |
| L6905 |
$1,467.95 |
$1,100.96 |
Hand restoration multiple fi |
| L6910 |
$1,430.09 |
$1,072.57 |
Hand restoration no fingers |
| L6915 |
$625.91 |
$469.43 |
Hand restoration replacmnt g |
| L6920 |
$6,672.56 |
$5,004.42 |
Wrist disarticul switch ctrl |
| L6925 |
$7,703.36 |
$5,777.52 |
Wrist disart myoelectronic c |
| L6930 |
$6,713.93 |
$5,035.45 |
Below elbow switch control</ |
