Description - DE Medical Assistance Program

L1680 PELVIC & HIP CONTROL THIGH C 3 $874.83
L1685 POST-OP HIP ABDUCT CUSTOM FA 3 $892.79
L1686 HO POST-OP HIP ABDUCTION 3 $824.39
L1690 COMBINATION BILATERAL HO 3 $1,449.30
L1700 LEG PERTHES ORTH TORONTO TYP 3 $1,096.46
L1710 LEGG PERTHES ORTH NEWINGTON 3 $1,283.53
L1720 LEGG PERTHES ORTHOSIS TRILAT 3 $946.12
L1730 LEGG PERTHES ORTH SCOTTISH R 3 $812.63
L1750 LEGG PERTHES SLING O $0.00
L1755 LEGG PERTHES PATTEN BOTTOM T 3 $1,289.59
L1800 KNEE ORTHOSES ELAS W STAYS O $0.00
L1810 KO ELASTIC WITH JOINTS 3 $70.71
L1815 ELASTIC WITH CONDYLAR PADS O $0.00
L1820 KO ELAS W/ CONDYLE PADS & JO 3 $109.56
L1825 KO ELASTIC KNEE CAP O $0.00
L1830 KO IMMOBILIZER CANVAS LONGIT 3 $66.62
L1831 KNEE ORTH POS LOCKING JOINT 6 $0.00
L1832 KO ADJ JNT POS RIGID SUPPORT 3 $507.82
L1834 KO W/0 JOINT RIGID MOLDED TO 3 $557.35
L1836 RIGID KO WO JOINTS 5 $0.00
L1840 KO DEROT ANT CRUCIATE CUSTOM 3 $742.41
L1843 KO SINGLE UPRIGHT CUSTOM FIT 3 $672.48
L1844 KO W/ADJ JT ROT CNTRL MOLDED 3 $1,165.61
L1845 KO W/ ADJ FLEX/EXT ROTAT CUS 3 $697.85
L1846 KO W ADJ FLEX/EXT ROTAT MOLD 3 $791.83
L1847 KO ADJUSTABLE W AIR CHAMBERS 3 $431.07
L1850 KO SWEDISH TYPE 3 $218.25
L1855 KO PLAS DOUB UPRIGHT JNT MOL O $0.00
L1858 KO POLYCENTRIC PNEUMATIC PAD O $0.00
L1860 KO SUPRACONDYLAR SOCKET MOLD 3 $770.45
L1870 KO DOUB UPRIGHT LACERS MOLDE O $0.00
L1880 KO DOUB UPRIGHT CUFFS/LACERS O $0.00
L1885 KNEE UPRIGHT W/RESISTANCE O $0.00
L1900 AFO SPRNG WIR DRSFLX CALF BD 3 $193.70
L1901 PREFAB ANKLE ORTHOSIS O $0.00
L1902 AFO ANKLE GAUNTLET 3 $66.93
L1904 AFO MOLDED ANKLE GAUNTLET 3 $402.52
L1906 AFO MULTILIGAMENTUS ANKLE SU 3 $86.35
L1907 AFO SUPRAMALLEOLAR CUSTOM 6 $0.00
L1910 AFO SING BAR CLASP ATTACH SH 3 $196.12
L1920 AFO SING UPRIGHT W/ ADJUST S 3 $251.01
L1930 AFO PLASTIC 3 $169.85
L1932 AFO RIG ANT TIB PREFAB TCF/= 6 $0.00
L1940 AFO MOLDED TO PATIENT PLASTI 3 $355.08
L1945 AFO MOLDED PLAS RIG ANT TIB 3 $848.95
L1950 AFO SPIRAL MOLDED TO PT PLAS 3 $562.89
L1951 AFO SPIRAL PREFABRICATED 6 $0.00
L1960 AFO POS SOLID ANK PLASTIC MO 3 $424.55
L1970 AFO PLASTIC MOLDED W/ANKLE J 3 $510.90