Description - DE Medical Assistance Program

L5984 ENDOSKELETAL AXIAL ROTATION 3 $438.30
L5985 LWR EXT DYNAMIC PROSTH PYLON 3 $212.05
L5986 MULTI-AXIAL ROTATION UNIT 3 $487.29
L5987 SHANK FT W VERT LOAD PYLON 3 $5,402.07
L5988 VERTICAL SHOCK REDUCING PYLO 3 $1,500.16
L5989 PYLON W ELCTRNC FORCE SENSOR O $0.00
L5990 USER ADJUSTABLE HEEL HEIGHT 5 $0.00
L5993 HEAVY DUTY FEATURE, FOOT O $0.00
L5994 HEAVY DUTY FEATURE, KNEE O $0.00
L5995 LOWER EXT PROS HEAVYDUTY FEA O $0.00
L5999 LOWR EXTREMITY PROSTHES NOS 5 $0.00
L6000 PAR HAND ROBIN-AIDS THUM REM 3 $1,016.37
L6010 HAND ROBIN-AIDS LITTLE/RING 3 $1,131.05
L6020 PART HAND ROBIN-AIDS NO FING 3 $1,054.53
L6025 PART HAND DISART MYOELECTRIC 5 $0.00
L6050 WRST MLD SCK FLX HNG TRI PAD 3 $1,453.10
L6055 WRST MOLD SOCK W/EXP INTERFA 3 $2,309.76
L6100 ELB MOLD SOCK FLEX HINGE PAD 3 $1,472.21
L6110 ELBOW MOLD SOCK SUSPENSION T 3 $1,561.53
L6120 ELBOW MOLD DOUB SPLT SOC STE 3 $1,819.73
L6130 ELBOW STUMP ACTIVATED LOCK H 3 $1,980.21
L6200 ELBOW MOLD OUTSID LOCK HINGE 3 $2,086.82
L6205 ELBOW MOLDED W/ EXPAND INTER 3 $3,477.47
L6250 ELBOW INTER LOC ELBOW FORARM 3 $2,054.13
L6300 SHLDER DISART INT LOCK ELBOW 3 $2,849.88
L6310 SHOULDER PASSIVE RESTOR COMP 3 $2,343.65
L6320 SHOULDER PASSIVE RESTOR CAP 3 $1,307.24
L6350 THORACIC INTERN LOCK ELBOW 3 $2,996.21
L6360 THORACIC PASSIVE RESTOR COMP 3 $2,459.71
L6370 THORACIC PASSIVE RESTOR CAP 3 $1,851.78
L6380 POSTOP DSG CAST CHG WRST/ELB 3 $1,000.12
L6382 POSTOP DSG CAST CHG ELB DIS/ 3 $1,196.80
L6384 POSTOP DSG CAST CHG SHLDER/T 3 $1,460.42
L6386 POSTOP EA CAST CHG & REALIGN 3 $350.22
L6388 POSTOP APPLICAT RIGID DSG ON 3 $336.28
L6400 BELOW ELBOW PROSTH TISS SHAP 3 $1,778.70
L6450 ELB DISART PROSTH TISS SHAP 3 $2,358.38
L6500 ABOVE ELBOW PROSTH TISS SHAP 3 $2,360.31
L6550 SHLDR DISAR PROSTH TISS SHAP 3 $2,916.91
L6570 SCAP THORAC PROSTH TISS SHAP 3 $3,539.21
L6580 WRIST/ELBOW BOWDEN CABLE MOL 3 $1,235.42
L6582 WRIST/ELBOW BOWDEN CBL DIR F 3 $1,052.79
L6584 ELBOW FAIR LEAD CABLE MOLDED 3 $1,705.33
L6586 ELBOW FAIR LEAD CABLE DIR FO 3 $1,491.81
L6588 SHDR FAIR LEAD CABLE MOLDED 3 $2,462.65
L6590 SHDR FAIR LEAD CABLE DIRECT 3 $2,252.61
L6600 POLYCENTRIC HINGE PAIR 3 $151.99
L6605 SINGLE PIVOT HINGE PAIR 3 $141.87
L6610 FLEXIBLE METAL HINGE PAIR 3 $127.35