Description - DE Medical Assistance Program

L0974 TLSO FULL CORSET 3 $128.76
L0976 LSO FULL CORSET 3 $114.81
L0978 AXILLARY CRUTCH EXTENSION 3 $151.56
L0980 PERONEAL STRAPS PAIR 3 $16.53
L0982 STOCKING SUPP GRIPS SET OF F 3 $11.69
L0984 PROTECTIVE BODY SOCK EACH 3 $48.54
L0986 SPINAL ORTH ABDM PNL PREFAB O $0.00
L0999 ADD TO SPINAL ORTHOSIS NOS 5 $0.00
L1000 CTLSO MILWAUKE INITIAL MODEL 3 $1,472.64
L1001 CTLSO INFANT IMMOBILIZER 6 $0.00
L1005 TENSION BASED SCOLIOSIS ORTH 5 $0.00
L1010 CTLSO AXILLA SLING 3 $48.19
L1020 KYPHOSIS PAD 3 $62.06
L1025 KYPHOSIS PAD FLOATING 3 $118.46
L1030 LUMBAR BOLSTER PAD 3 $45.67
L1040 LUMBAR OR LUMBAR RIB PAD 3 $59.77
L1050 STERNAL PAD 3 $72.03
L1060 THORACIC PAD 3 $86.42
L1070 TRAPEZIUS SLING 3 $84.40
L1080 OUTRIGGER 3 $47.48
L1085 OUTRIGGER BIL W/ VERT EXTENS 3 $128.42
L1090 LUMBAR SLING 3 $84.96
L1100 RING FLANGE PLASTIC/LEATHER 3 $135.65
L1110 RING FLANGE PLAS/LEATHER MOL 3 $183.38
L1120 COVERS FOR UPRIGHT EACH 3 $31.00
L1200 FURNSH INITIAL ORTHOSIS ONLY 3 $1,124.98
L1210 LATERAL THORACIC EXTENSION 3 $187.88
L1220 ANTERIOR THORACIC EXTENSION 3 $179.47
L1230 MILWAUKEE TYPE SUPERSTRUCTUR 3 $460.04
L1240 LUMBAR DEROTATION PAD 3 $62.18
L1250 ANTERIOR ASIS PAD 3 $62.18
L1260 ANTERIOR THORACIC DEROTATION 3 $63.50
L1270 ABDOMINAL PAD 3 $64.52
L1280 RIB GUSSET (ELASTIC) EACH 3 $74.19
L1290 LATERAL TROCHANTERIC PAD 3 $58.74
L1300 BODY JACKET MOLD TO PATIENT 3 $1,322.50
L1310 POST-OPERATIVE BODY JACKET 3 $1,358.90
L1499 SPINAL ORTHOSIS NOS 5 $0.00
L1500 THKAO MOBILITY FRAME 3 $1,363.82
L1510 THKAO STANDING FRAME 3 $862.81
L1520 THKAO SWIVEL WALKER 3 $1,638.02
L1600 ABDUCT HIP FLEX FREJKA W CVR 3 $92.52
L1610 ABDUCT HIP FLEX FREJKA COVR 3 $40.82
L1620 ABDUCT HIP FLEX PAVLIK HARNE 3 $115.65
L1630 ABDUCT CONTROL HIP SEMI-FLEX 3 $121.67
L1640 PELV BAND/SPREAD BAR THIGH C 3 $370.37
L1650 HO ABDUCTION HIP ADJUSTABLE 3 $187.41
L1652 HO BI THIGHCUFFS W SPRDR BAR 5 $0.00
L1660 HO ABDUCTION STATIC PLASTIC 3 $122.87