Description - DE Medical Assistance Program

L4370 PNEUMATIC FULL LEG SPLINT 3 $146.11
L4380 PNEUMATIC KNEE SPLINT 3 $82.45
L4386 NON-PNEUM WALK BOOT PREFAB 3 $124.58
L4390 REPLACE MULTI-PODUS SPLINT O $0.00
L4392 REPLACE AFO SOFT INTERFACE 3 $17.63
L4394 REPLACE FOOT DROP SPINT 3 $12.87
L4396 STATIC AFO 3 $125.77
L4398 FOOT DROP SPLINT RECUMBENT 3 $57.91
L5000 SHO INSERT W ARCH TOE FILLER 3 $426.36
L5010 MOLD SOCKET ANK HGT W/ TOE F 3 $931.27
L5020 TIBIAL TUBERCLE HGT W/ TOE F 3 $1,515.92
L5050 ANK SYMES MOLD SCKT SACH FT 3 $1,755.51
L5060 SYMES MET FR LEATH SOCKET AR 3 $2,112.77
L5100 MOLDED SOCKET SHIN SACH FOOT 3 $1,828.78
L5105 PLAST SOCKET JTS/THGH LACER 3 $2,902.64
L5150 MOLD SCKT EXT KNEE SHIN SACH 3 $2,686.23
L5160 MOLD SOCKET BENT KNEE SHIN S 3 $2,921.76
L5200 KNE SING AXIS FRIC SHIN SACH 3 $2,545.10
L5210 NO KNEE/ANKLE JOINTS W/ FT B 3 $1,856.19
L5220 NO KNEE JOINT WITH ARTIC ALI 3 $2,109.89
L5230 FEM FOCAL DEFIC CONSTANT FRI 3 $2,909.97
L5250 HIP CANAD SING AXI CONS FRIC 3 $3,968.93
L5270 TILT TABLE LOCKING HIP SING 3 $3,934.16
L5280 HEMIPELVECT CANAD SING AXIS 3 $3,894.82
L5300 BK SACH SOFT COVER & FINISH O $0.00
L5301 BK MOLD SOCKET SACH FT ENDO 5 $0.00
L5310 KNEE DISART SACH SOFT CV/FIN O $0.00
L5311 KNEE DISART, SACH FT, ENDO 5 $0.00
L5320 AK OPEN END SACH SOFT CV/FIN O $0.00
L5321 AK OPEN END SACH 5 $0.00
L5330 HIP CANADIAN SACH SFT CV/FIN O $0.00
L5331 HIP DISART CANADIAN SACH FT 5 $0.00
L5340 HEMIPELVECTOMY CANAD CV/FIN O $0.00
L5341 HEMIPELVECTOMY CANADIAN SACH 5 $0.00
L5400 POSTOP DRESS & 1 CAST CHG BK 3 $920.64
L5410 POSTOP DSG BK EA ADD CAST CH 3 $403.36
L5420 POSTOP DSG & 1 CAST CHG AK/D 3 $1,162.72
L5430 POSTOP DSG AK EA ADD CAST CH 3 $513.24
L5450 POSTOP APP NON-WGT BEAR DSG 3 $328.33
L5460 POSTOP APP NON-WGT BEAR DSG 3 $483.92
L5500 INIT BK PTB PLASTER DIRECT 3 $982.44
L5505 INIT AK ISCHAL PLSTR DIRECT 3 $1,330.47
L5510 PREP BK PTB PLASTER MOLDED 3 $1,113.65
L5520 PERP BK PTB THERMOPLS DIRECT 3 $1,100.03
L5530 PREP BK PTB THERMOPLS MOLDED 3 $1,392.40
L5535 PREP BK PTB OPEN END SOCKET 3 $1,372.22
L5540 PREP BK PTB LAMINATED SOCKET 3 $1,448.99
L5560 PREP AK ISCHIAL PLAST MOLDED 3 $1,486.72
L5570 PREP AK ISCHIAL DIRECT FORM 3 $1,545.67