Procedure Code Procedure Description Pricing Indicator Rate Type Mod1 Mod2 Mod3 Mod4 Max Fee Max Fee Eff. Date Max Fee End Date PA
A4206 1 CC STERILE SYRINGE&NEEDLE PRXOVR DEF         NA NA NA E
A4206 1 CC STERILE SYRINGE&NEEDLE MANUAL DEF         NA NA NA E
A4207 2 CC STERILE SYRINGE&NEEDLE PRXOVR DEF         NA NA NA S
A4207 2 CC STERILE SYRINGE&NEEDLE MAXFEE DEF         0.23 5/1/1990 12/31/2299 S
A4208 3 CC STERILE SYRINGE&NEEDLE PRXOVR DEF         NA NA NA S
A4208 3 CC STERILE SYRINGE&NEEDLE MAXFEE DEF         0.17 5/1/1990 12/31/2299 S
A4209 5+ CC STERILE SYRINGE&NEEDLE PRXOVR DEF         NA NA NA S
A4209 5+ CC STERILE SYRINGE&NEEDLE MAXFEE DEF         0.27 5/1/1990 12/31/2299 S
A4210 NONNEEDLE INJECTION DEVICE PRXOVR DEF         NA NA NA E
A4210 NONNEEDLE INJECTION DEVICE MANUAL DEF         NA NA NA E
A4211 SUPP FOR SELF-ADM INJECTIONS PRXOVR DEF         NA NA NA E
A4211 SUPP FOR SELF-ADM INJECTIONS MANUAL DEF         NA NA NA E
A4212 NON CORING NEEDLE OR STYLET PRXOVR DEF         NA NA NA S
A4212 NON CORING NEEDLE OR STYLET MAXFEE DEF         3.60 4/1/1997 12/31/2299 S
A4213 20+ CC SYRINGE ONLY PRXOVR DEF         NA NA NA S
A4213 20+ CC SYRINGE ONLY MAXFEE DEF         0.60 11/22/1990 12/31/2299 S
A4214 30 CC STERILE WATER/SALINE PRXOVR DEF         NA NA NA S
A4214 30 CC STERILE WATER/SALINE MAXFEE DEF         NA     S
A4215 STERILE NEEDLE PRXOVR DEF         NA NA NA E
A4215 STERILE NEEDLE MANUAL DEF         NA NA NA E
A4216 STERILE WATER/SALINE; 10 ML PRXOVR DEF         NA NA NA N
A4216 STERILE WATER/SALINE; 10 ML MAXFEE DEF         0.38 1/1/2024 12/31/2299 N
A4217 STERILE WATER/SALINE; 500 ML PRXOVR DEF         NA NA NA S
A4217 STERILE WATER/SALINE; 500 ML MAXFEE DEF         3.13 1/1/2024 12/31/2299 S
A4218 STERILE SALINE OR WATER PRXOVR DEF         NA NA NA E
A4218 STERILE SALINE OR WATER MANUAL DEF         NA NA NA E
A4221 SUPP NON-INSULIN INF CATH/WK PRXOVR DEF         NA NA NA S
A4221 SUPP NON-INSULIN INF CATH/WK MAXFEE DEF         20.55 8/1/1998 12/31/2299 S
A4222 INFUSION SUPPLIES WITH PUMP PRXOVR DEF         NA NA NA S
A4222 INFUSION SUPPLIES WITH PUMP MAXFEE DEF         40 1/1/2005 12/31/2299 S
A4223 INFUSION SUPPLIES W/O PUMP PRXOVR DEF         NA NA NA S
A4223 INFUSION SUPPLIES W/O PUMP MAXFEE DEF         15 3/21/2007 12/31/2299 S
A4224 SUPPLY INSULIN INF CATH/WK PRXOVR DEF         NA NA NA S
A4224 SUPPLY INSULIN INF CATH/WK MAXFEE DEF         20 1/1/2024 12/31/2299 S
A4225 SUP/EXT INSULIN INF PUMP SYR PRXOVR DEF         NA NA NA S
A4225 SUP/EXT INSULIN INF PUMP SYR MAXFEE DEF         2.08 1/1/2017 12/31/2299 S
A4226 WEEKLY SUPPLY MAINT CGS PUMP PRXOVR DEF         NA NA NA S
A4226 WEEKLY SUPPLY MAINT CGS PUMP MAXFEE DEF         20.25 7/1/2021 12/31/2299 S
A4230 INFUS INSULIN PUMP NON NEEDL PRXOVR DEF         NA NA NA N
A4230 INFUS INSULIN PUMP NON NEEDL MAXFEE DEF         12 1/1/2024 12/31/2299 N
A4231 INFUSION INSULIN PUMP NEEDLE PRXOVR DEF         NA NA NA N
A4231 INFUSION INSULIN PUMP NEEDLE MAXFEE DEF         9.45 1/1/2024 12/31/2299 N
A4232 SYRINGE W/NEEDLE INSULIN 3CC PRXOVR DEF         NA NA NA N
A4232 SYRINGE W/NEEDLE INSULIN 3CC MAXFEE DEF         4 10/15/2006 12/31/2299 N
A4238 ADJU CGM SUPPLY ALLOWANCE PRXOVR DEF         NA NA NA S
A4238 ADJU CGM SUPPLY ALLOWANCE MANUAL DEF         NA NA NA S
A4239 NON-ADJU CGM SUPPLY ALLOW PRXOVR DEF         NA NA NA Y
A4239 NON-ADJU CGM SUPPLY ALLOW MAXFEE DEF         220 1/1/2024 12/31/2299 Y
A4244 ALCOHOL OR PEROXIDE PER PINT PRXOVR DEF         NA NA NA S
A4244 ALCOHOL OR PEROXIDE PER PINT MAXFEE DEF         0.56 5/1/1990 12/31/2299 S
A4245 ALCOHOL WIPES PER BOX PRXOVR DEF         NA NA NA E
A4245 ALCOHOL WIPES PER BOX MANUAL DEF         NA NA NA E
A4246 BETADINE/PHISOHEX SOLUTION PRXOVR DEF         NA NA NA S
A4246 BETADINE/PHISOHEX SOLUTION MAXFEE DEF         10 6/20/1990 12/31/2299 S
A4247 BETADINE/IODINE SWABS/WIPES PRXOVR DEF         NA NA NA S
A4247 BETADINE/IODINE SWABS/WIPES MAXFEE DEF         19 1/1/2005 12/31/2299 S
A4255 GLUCOSE MONITOR PLATFORMS PRXOVR DEF         NA NA NA E
A4255 GLUCOSE MONITOR PLATFORMS MANUAL DEF         NA NA NA E
A4259 LANCETS PER BOX PRXOVR DEF         NA NA NA E
A4259 LANCETS PER BOX MANUAL DEF         NA NA NA E
A4260 LEVONORGESTREL IMPLANT PRXOVR DEF         NA NA NA N
A4260 LEVONORGESTREL IMPLANT MAXFEE DEF         NA     N
A4261 CERVICAL CAP CONTRACEPTIVE PRXOVR DEF         NA NA NA N
A4261 CERVICAL CAP CONTRACEPTIVE MAXFEE DEF         17.65 1/1/1999 12/31/2299 N
A4265 PARAFFIN PRXOVR DEF         NA NA NA S
A4265 PARAFFIN MAXFEE DEF         3.37 12/15/2002 12/31/2299 S
A4266 DIAPHRAGM PRXOVR DEF         NA NA NA S
A4266 DIAPHRAGM MAXFEE DEF         25.46 4/1/2003 12/31/2299 S
A4267 MALE CONDOM PRXOVR DEF         NA NA NA S
A4267 MALE CONDOM MAXFEE DEF         0.40 4/1/2003 12/31/2299 S
A4268 FEMALE CONDOM PRXOVR DEF         NA NA NA S
A4268 FEMALE CONDOM MAXFEE DEF         2.10 4/1/2003 12/31/2299 S
A4269 SPERMICIDE PRXOVR DEF         NA NA NA S
A4269 SPERMICIDE MAXFEE DEF         10.05 4/1/2003 12/31/2299 S
A4271 HOME LANCING/TEST CARTRIDGES PRXOVR DEF         NA NA NA S
A4271 HOME LANCING/TEST CARTRIDGES MAXFEE DEF         5.25 4/1/2024 12/31/2299 S
A4280 BRST PRSTHS ADHSV ATTCHMNT PRXOVR DEF         NA NA NA E
A4280 BRST PRSTHS ADHSV ATTCHMNT MANUAL DEF         NA NA NA E
A4281 REPLACEMENT BREASTPUMP TUBE PRXOVR DEF         NA NA NA N
A4281 REPLACEMENT BREASTPUMP TUBE MAXFEE DEF         4.75 1/1/2022 12/31/2299 N
A4282 REPLACEMENT BREASTPUMP ADPT PRXOVR DEF         NA NA NA N
A4282 REPLACEMENT BREASTPUMP ADPT MAXFEE DEF         4.60 1/1/2022 12/31/2299 N
A4283 REPLACEMENT BREASTPUMP CAP PRXOVR DEF         NA NA NA N
A4283 REPLACEMENT BREASTPUMP CAP MAXFEE DEF         1.55 1/1/2022 12/31/2299 N
A4284 REPLCMNT BREAST PUMP SHIELD PRXOVR DEF         NA NA NA N
A4284 REPLCMNT BREAST PUMP SHIELD MAXFEE DEF         8.55 1/1/2022 12/31/2299 N
A4285 REPLCMNT BREAST PUMP BOTTLE PRXOVR DEF         NA NA NA N
A4285 REPLCMNT BREAST PUMP BOTTLE MAXFEE DEF         3.90 1/1/2022 12/31/2299 N
A4286 REPLCMNT BREASTPUMP LOK RING PRXOVR DEF         NA NA NA N
A4286 REPLCMNT BREASTPUMP LOK RING MAXFEE DEF         2.20 1/1/2022 12/31/2299 N
A4287 DISP COL STO BAG BREAST MILK PRXOVR DEF         NA NA NA S
A4287 DISP COL STO BAG BREAST MILK MAXFEE DEF         0.33 1/1/2024 12/31/2299 S
A4305 DRUG DELIVERY SYSTEM >=50 ML PRXOVR DEF         NA NA NA S
A4305 DRUG DELIVERY SYSTEM >=50 ML MAXFEE DEF         12.73 4/1/2001 12/31/2299 S
A4306 DRUG DELIVERY SYSTEM <=50 ML PRXOVR DEF         NA NA NA S
A4306 DRUG DELIVERY SYSTEM <=50 ML MAXFEE DEF         12.73 4/1/2001 12/31/2299 S
A4310 INSERT TRAY W/O BAG/CATH PRXOVR DEF         NA NA NA S
A4310 INSERT TRAY W/O BAG/CATH MAXFEE DEF         4.10 1/1/2024 12/31/2299 S
A4311 CATHETER W/O BAG 2-WAY LATEX PRXOVR DEF         NA NA NA S
A4311 CATHETER W/O BAG 2-WAY LATEX MAXFEE DEF         6.75 5/1/1990 12/31/2299 S
A4312 CATH W/O BAG 2-WAY SILICONE PRXOVR DEF         NA NA NA S
A4312 CATH W/O BAG 2-WAY SILICONE MAXFEE DEF         10 5/1/1990 12/31/2299 S
A4313 CATHETER W/BAG 3-WAY PRXOVR DEF         NA NA NA S
A4313 CATHETER W/BAG 3-WAY MAXFEE DEF         14 5/1/1990 12/31/2299 S
A4314 CATH W/DRAINAGE 2-WAY LATEX PRXOVR DEF         NA NA NA S
A4314 CATH W/DRAINAGE 2-WAY LATEX MAXFEE DEF         11.29 1/1/2024 12/31/2299 S
A4315 CATH W/DRAINAGE 2-WAY SILCNE PRXOVR DEF         NA NA NA S
A4315 CATH W/DRAINAGE 2-WAY SILCNE MAXFEE DEF         14.70 1/1/2024 12/31/2299 S
A4316 CATH W/DRAINAGE 3-WAY PRXOVR DEF         NA NA NA S
A4316 CATH W/DRAINAGE 3-WAY MAXFEE DEF         18 5/1/1990 12/31/2299 S
A4319 STERILE H2O IRRIGATION SOLUT PRXOVR DEF         NA NA NA S
A4319 STERILE H2O IRRIGATION SOLUT MAXFEE DEF         NA     S
A4320 IRRIGATION TRAY PRXOVR DEF         NA NA NA S
A4320 IRRIGATION TRAY MAXFEE DEF         2.50 4/1/1992 12/31/2299 S
A4321 CATH THERAPEUTIC IRRIG AGENT PRXOVR DEF         NA NA NA E
A4321 CATH THERAPEUTIC IRRIG AGENT MANUAL DEF         NA NA NA E
A4322 IRRIGATION SYRINGE PRXOVR DEF         NA NA NA S
A4322 IRRIGATION SYRINGE MAXFEE DEF         1.60 6/20/1990 12/31/2299 S
A4323 SALINE IRRIGATION SOLUTION PRXOVR DEF         NA NA NA S
A4323 SALINE IRRIGATION SOLUTION MAXFEE DEF         NA     S
A4324 MALE EXT CATH W/ADH COATING PRXOVR DEF         NA NA NA S
A4324 MALE EXT CATH W/ADH COATING MAXFEE DEF         NA     S
A4326 MALE EXTERNAL CATHETER PRXOVR DEF         NA NA NA S
A4326 MALE EXTERNAL CATHETER MAXFEE DEF         9 8/1/1997 12/31/2299 S
A4327 FEM URINARY COLLECT DEV CUP PRXOVR DEF         NA NA NA S
A4327 FEM URINARY COLLECT DEV CUP MAXFEE DEF         37 8/1/1997 12/31/2299 S
A4328 FEM URINARY COLLECT POUCH PRXOVR DEF         NA NA NA S
A4328 FEM URINARY COLLECT POUCH MAXFEE DEF         8.33 4/1/2001 12/31/2299 S
A4330 STOOL COLLECTION POUCH PRXOVR DEF         NA NA NA S
A4330 STOOL COLLECTION POUCH MAXFEE DEF         5.80 4/1/2001 12/31/2299 S
A4331 EXTENSION DRAINAGE TUBING PRXOVR DEF         NA NA NA S
A4331 EXTENSION DRAINAGE TUBING MAXFEE DEF         3.04 4/1/2001 12/31/2299 S
A4333 URINARY CATH ANCHOR DEVICE PRXOVR DEF         NA NA NA S
A4333 URINARY CATH ANCHOR DEVICE MAXFEE DEF         2 7/1/2018 12/31/2299 S
A4334 URINARY CATH LEG STRAP PRXOVR DEF         NA NA NA S
A4334 URINARY CATH LEG STRAP MAXFEE DEF         3 1/1/2001 12/31/2299 S
A4335 INCONTINENCE SUPPLY PRXOVR DEF         NA NA NA Y
A4335 INCONTINENCE SUPPLY PADOLR DEF         NA NA NA Y
A4338 INDWELLING CATHETER LATEX PRXOVR DEF         NA NA NA S
A4338 INDWELLING CATHETER LATEX MAXFEE DEF         10 1/1/2024 12/31/2299 S
A4340 INDWELLING CATHETER SPECIAL PRXOVR DEF         NA NA NA S
A4340 INDWELLING CATHETER SPECIAL MAXFEE DEF         24 8/1/1997 12/31/2299 S
A4341 IDUC VALVE PAT INST REPL PRXOVR DEF         NA NA NA S
A4341 IDUC VALVE PAT INST REPL MAXFEE DEF         208 4/1/2023 12/31/2299 S
A4342 IDUC VALVE SPLY REPL PRXOVR DEF         NA NA NA S
A4342 IDUC VALVE SPLY REPL MAXFEE DEF         524.80 4/1/2023 12/31/2299 S
A4344 CATH INDW FOLEY 2 WAY SILICN PRXOVR DEF         NA NA NA S
A4344 CATH INDW FOLEY 2 WAY SILICN MAXFEE DEF         9.86 1/1/2024 12/31/2299 S
A4346 CATH INDW FOLEY 3 WAY PRXOVR DEF         NA NA NA S
A4346 CATH INDW FOLEY 3 WAY MAXFEE DEF         12.50 5/1/1990 12/31/2299 S
A4349 DISPOSABLE MALE EXTERNAL CAT PRXOVR DEF         NA NA NA S
A4349 DISPOSABLE MALE EXTERNAL CAT MAXFEE DEF         1.39 1/1/2005 12/31/2299 S
A4351 STRAIGHT TIP URINE CATHETER PRXOVR DEF         NA NA NA S
A4351 STRAIGHT TIP URINE CATHETER MAXFEE DEF         2 1/1/2024 12/31/2299 S
A4352 COUDE TIP URINARY CATHETER PRXOVR DEF         NA NA NA S
A4352 COUDE TIP URINARY CATHETER MAXFEE DEF         6.45 1/1/2024 12/31/2299 S
A4353 INTERMITTENT URINARY CATH PRXOVR DEF         NA NA NA S
A4353 INTERMITTENT URINARY CATH MAXFEE DEF         5.50 1/1/2024 12/31/2299 S
A4354 CATH INSERTION TRAY W/BAG PRXOVR DEF         NA NA NA S
A4354 CATH INSERTION TRAY W/BAG MAXFEE DEF         7.40 5/1/1990 12/31/2299 S
A4355 BLADDER IRRIGATION TUBING PRXOVR DEF         NA NA NA S
A4355 BLADDER IRRIGATION TUBING MAXFEE DEF         2.70 5/1/1990 12/31/2299 S
A4356 EXT URETH CLMP OR COMPR DVC PRXOVR DEF         NA NA NA S
A4356 EXT URETH CLMP OR COMPR DVC MAXFEE DEF         30.01 5/1/1990 12/31/2299 S
A4357 BEDSIDE DRAINAGE BAG PRXOVR DEF         NA NA NA S
A4357 BEDSIDE DRAINAGE BAG MAXFEE DEF         6.30 1/1/2024 12/31/2299 S
A4358 URINARY LEG OR ABDOMEN BAG PRXOVR DEF         NA NA NA S
A4358 URINARY LEG OR ABDOMEN BAG MAXFEE DEF         6.57 1/1/2024 12/31/2299 S
A4359 URINARY SUSPENSORY W/O LEG B PRXOVR DEF         NA NA NA S
A4359 URINARY SUSPENSORY W/O LEG B MAXFEE DEF         0 1/1/2007 12/31/2299 S
A4361 OSTOMY FACE PLATE PRXOVR DEF         NA NA NA S
A4361 OSTOMY FACE PLATE MAXFEE DEF         17.52 4/1/2001 12/31/2299 S
A4362 SOLID SKIN BARRIER PRXOVR DEF         NA NA NA S
A4362 SOLID SKIN BARRIER MAXFEE DEF         3.22 4/1/2001 12/31/2299 S
A4363 OSTOMY CLAMP; REPLACEMENT PRXOVR DEF         NA NA NA E
A4363 OSTOMY CLAMP; REPLACEMENT MANUAL DEF         NA NA NA E
A4364 ADHESIVE; LIQUID OR EQUAL PRXOVR DEF         NA NA NA S
A4364 ADHESIVE; LIQUID OR EQUAL MAXFEE DEF         2.38 4/1/2001 12/31/2299 S
A4366 OSTOMY VENT PRXOVR DEF         NA NA NA E
A4366 OSTOMY VENT MANUAL DEF         NA NA NA E
A4367 OSTOMY BELT PRXOVR DEF         NA NA NA S
A4367 OSTOMY BELT MAXFEE DEF         6.96 4/1/2001 12/31/2299 S
A4368 OSTOMY FILTER PRXOVR DEF         NA NA NA E
A4368 OSTOMY FILTER MANUAL DEF         NA NA NA E
A4369 SKIN BARRIER LIQUID PER OZ PRXOVR DEF         NA NA NA S
A4369 SKIN BARRIER LIQUID PER OZ MAXFEE DEF         2.30 1/1/2000 12/31/2299 S
A4371 SKIN BARRIER POWDER PER OZ PRXOVR DEF         NA NA NA S
A4371 SKIN BARRIER POWDER PER OZ MAXFEE DEF         3.48 4/1/2001 12/31/2299 S
A4372 SKIN BARRIER SOLID 4X4 EQUIV PRXOVR DEF         NA NA NA S
A4372 SKIN BARRIER SOLID 4X4 EQUIV MAXFEE DEF         3.78 1/1/2000 12/31/2299 S
A4373 SKIN BARRIER WITH FLANGE PRXOVR DEF         NA NA NA S
A4373 SKIN BARRIER WITH FLANGE MAXFEE DEF         5.99 4/1/2001 12/31/2299 S
A4375 DRAINABLE PLASTIC PCH W FCPL PRXOVR DEF         NA NA NA S
A4375 DRAINABLE PLASTIC PCH W FCPL MAXFEE DEF         15.56 1/1/2000 12/31/2299 S
A4376 DRAINABLE RUBBER PCH W FCPLT PRXOVR DEF         NA NA NA N
A4376 DRAINABLE RUBBER PCH W FCPLT MAXFEE DEF         43.11 7/26/2007 12/31/2299 N
A4377 DRAINABLE PLSTIC PCH W/O FP PRXOVR DEF         NA NA NA S
A4377 DRAINABLE PLSTIC PCH W/O FP MAXFEE DEF         3.89 1/1/2000 12/31/2299 S
A4378 DRAINABLE RUBBER PCH W/O FP PRXOVR DEF         NA NA NA S
A4378 DRAINABLE RUBBER PCH W/O FP MAXFEE DEF         27.86 1/1/2000 12/31/2299 S
A4379 URINARY PLASTIC POUCH W FCPL PRXOVR DEF         NA NA NA S
A4379 URINARY PLASTIC POUCH W FCPL MAXFEE DEF         13.61 1/1/2000 12/31/2299 S
A4380 URINARY RUBBER POUCH W FCPLT PRXOVR DEF         NA NA NA N
A4380 URINARY RUBBER POUCH W FCPLT MAXFEE DEF         33.82 7/26/2007 12/31/2299 N
A4381 URINARY PLASTIC POUCH W/O FP PRXOVR DEF         NA NA NA S
A4381 URINARY PLASTIC POUCH W/O FP MAXFEE DEF         4.18 1/1/2000 12/31/2299 S
A4382 URINARY HVY PLSTC PCH W/O FP PRXOVR DEF         NA NA NA N
A4382 URINARY HVY PLSTC PCH W/O FP MAXFEE DEF         22.31 7/26/2007 12/31/2299 N
A4383 URINARY RUBBER POUCH W/O FP PRXOVR DEF         NA NA NA N
A4383 URINARY RUBBER POUCH W/O FP MAXFEE DEF         25.55 7/26/2007 12/31/2299 N
A4384 OSTOMY FACEPLT/SILICONE RING PRXOVR DEF         NA NA NA S
A4384 OSTOMY FACEPLT/SILICONE RING MAXFEE DEF         8.72 1/1/2000 12/31/2299 S
A4385 OST SKN BARRIER SLD EXT WEAR PRXOVR DEF         NA NA NA S
A4385 OST SKN BARRIER SLD EXT WEAR MAXFEE DEF         4.20 1/1/2024 12/31/2299 S
A4387 OST CLSD POUCH W ATT ST BARR PRXOVR DEF         NA NA NA S
A4387 OST CLSD POUCH W ATT ST BARR MAXFEE DEF         2 7/1/2018 12/31/2299 S
A4388 DRAINABLE PCH W EX WEAR BARR PRXOVR DEF         NA NA NA S
A4388 DRAINABLE PCH W EX WEAR BARR MAXFEE DEF         3.87 4/1/2001 12/31/2299 S
A4389 DRAINABLE PCH W ST WEAR BARR PRXOVR DEF         NA NA NA S
A4389 DRAINABLE PCH W ST WEAR BARR MAXFEE DEF         5.55 4/1/2001 12/31/2299 S
A4390 DRAINABLE PCH EX WEAR CONVEX PRXOVR DEF         NA NA NA S
A4390 DRAINABLE PCH EX WEAR CONVEX MAXFEE DEF         8.94 4/1/2001 12/31/2299 S
A4391 URINARY POUCH W EX WEAR BARR PRXOVR DEF         NA NA NA S
A4391 URINARY POUCH W EX WEAR BARR MAXFEE DEF         6.04 4/1/2001 12/31/2299 S
A4392 URINARY POUCH W ST WEAR BARR PRXOVR DEF         NA NA NA S
A4392 URINARY POUCH W ST WEAR BARR MAXFEE DEF         6.34 4/1/2001 12/31/2299 S
A4393 URINE PCH W EX WEAR BAR CONV PRXOVR DEF         NA NA NA S
A4393 URINE PCH W EX WEAR BAR CONV MAXFEE DEF         7.81 4/1/2001 12/31/2299 S
A4394 OSTOMY POUCH LIQ DEODORANT PRXOVR DEF         NA NA NA E
A4394 OSTOMY POUCH LIQ DEODORANT MANUAL DEF         NA NA NA E
A4395 OSTOMY POUCH SOLID DEODORANT PRXOVR DEF         NA NA NA E
A4395 OSTOMY POUCH SOLID DEODORANT MANUAL DEF         NA NA NA E
A4396 PERISTOMAL HERNIA SUPPRT BLT PRXOVR DEF         NA NA NA N
A4396 PERISTOMAL HERNIA SUPPRT BLT MAXFEE DEF         24.20 10/1/2004 12/31/2299 N
A4397 IRRIGATION SUPPLY SLEEVE PRXOVR DEF         NA NA NA S
A4397 IRRIGATION SUPPLY SLEEVE MAXFEE DEF         NA     S
A4398 OSTOMY IRRIGATION BAG PRXOVR DEF         NA NA NA S
A4398 OSTOMY IRRIGATION BAG MAXFEE DEF         13.17 4/1/2001 12/31/2299 S
A4399 OSTOMY IRRIG CONE/CATH W BRS PRXOVR DEF         NA NA NA S
A4399 OSTOMY IRRIG CONE/CATH W BRS MAXFEE DEF         9.95 1/1/1998 12/31/2299 S
A4400 OSTOMY IRRIGATION SET PRXOVR DEF         NA NA NA S
A4400 OSTOMY IRRIGATION SET MAXFEE DEF         45 8/1/1997 12/31/2299 S
A4402 LUBRICANT PER OUNCE PRXOVR DEF         NA NA NA S
A4402 LUBRICANT PER OUNCE MAXFEE DEF         0.98 1/1/2024 12/31/2299 S
A4404 OSTOMY RING EACH PRXOVR DEF         NA NA NA S
A4404 OSTOMY RING EACH MAXFEE DEF         1.47 4/1/2001 12/31/2299 S
A4405 NONPECTIN BASED OSTOMY PASTE PRXOVR DEF         NA NA NA S
A4405 NONPECTIN BASED OSTOMY PASTE MAXFEE DEF         3.27 4/1/2003 12/31/2299 S
A4406 PECTIN BASED OSTOMY PASTE PRXOVR DEF         NA NA NA S
A4406 PECTIN BASED OSTOMY PASTE MAXFEE DEF         3.27 4/1/2003 12/31/2299 S
A4407 EXT WEAR OST SKN BARR <=4SQ,PRXOVR,DEF,,,,,NA,NA,NA,S, =A4407,EXT WEAR OST SKN BARR <=4SQ MAXFEE DEF         8.05 1/1/2024 12/31/2299 S
A4408 EXT WEAR OST SKN BARR >4SQ,PRXOVR,DEF,,,,,NA,NA,NA,S, =A4408,EXT WEAR OST SKN BARR >4SQ MAXFEE DEF         7.67 4/1/2003 12/31/2299 S
A4409 OST SKN BARR CONVEX <=4 SQ I PRXOVR DEF         NA NA NA S
A4409 OST SKN BARR CONVEX <=4 SQ I MAXFEE DEF         5.96 1/1/2024 12/31/2299 S
A4410 OST SKN BARR EXTND >4 SQ PRXOVR DEF         NA NA NA S
A4410 OST SKN BARR EXTND >4 SQ MAXFEE DEF         5.68 4/1/2003 12/31/2299 S
A4412 OST POUCH DRAIN HIGH OUTPUT PRXOVR DEF         NA NA NA S
A4412 OST POUCH DRAIN HIGH OUTPUT MAXFEE DEF         2.13 7/1/2021 12/31/2299 S
A4413 2 PC DRAINABLE OST POUCH PRXOVR DEF         NA NA NA S
A4413 2 PC DRAINABLE OST POUCH MAXFEE DEF         2.13 7/1/2021 12/31/2299 S
A4414 OST SKNBAR W/O CONV<=4 SQ IN PRXOVR DEF         NA NA NA S
A4414 OST SKNBAR W/O CONV<=4 SQ IN MAXFEE DEF         4.24 4/1/2003 12/31/2299 S
A4415 OST SKN BARR W/O CONV >4 SQI PRXOVR DEF         NA NA NA S
A4415 OST SKN BARR W/O CONV >4 SQI MAXFEE DEF         4.24 4/1/2003 12/31/2299 S
A4416 OST PCH CLSD W BARRIER/FILTR PRXOVR DEF         NA NA NA S
A4416 OST PCH CLSD W BARRIER/FILTR MAXFEE DEF         1.91 7/1/2021 12/31/2299 S
A4417 OST PCH W BAR/BLTINCONV/FLTR PRXOVR DEF         NA NA NA S
A4417 OST PCH W BAR/BLTINCONV/FLTR MAXFEE DEF         2 7/1/2021 12/31/2299 S
A4418 OST PCH CLSD W/O BAR W FILTR PRXOVR DEF         NA NA NA S
A4418 OST PCH CLSD W/O BAR W FILTR MAXFEE DEF         1.36 7/1/2021 12/31/2299 S
A4419 OST PCH FOR BAR W FLANGE/FLT PRXOVR DEF         NA NA NA S
A4419 OST PCH FOR BAR W FLANGE/FLT MAXFEE DEF         1.35 7/1/2021 12/31/2299 S
A4421 OSTOMY SUPPLY MISC PRXOVR DEF         NA NA NA Y
A4421 OSTOMY SUPPLY MISC PADOLR DEF         NA NA NA Y
A4422 OST POUCH ABSORBENT MATERIAL PRXOVR DEF         NA NA NA E
A4422 OST POUCH ABSORBENT MATERIAL MANUAL DEF         NA NA NA E
A4423 OST PCH FOR BAR W LK FL/FLTR PRXOVR DEF         NA NA NA S
A4423 OST PCH FOR BAR W LK FL/FLTR MAXFEE DEF         1.35 7/1/2021 12/31/2299 S
A4424 OST PCH DRAIN W BAR & FILTER PRXOVR DEF         NA NA NA S
A4424 OST PCH DRAIN W BAR & FILTER MAXFEE DEF         2.45 7/1/2021 12/31/2299 S
A4425 OST PCH DRAIN FOR BARRIER FL PRXOVR DEF         NA NA NA S
A4425 OST PCH DRAIN FOR BARRIER FL MAXFEE DEF         2.13 7/1/2021 12/31/2299 S
A4426 OST PCH DRAIN 2 PIECE SYSTEM PRXOVR DEF         NA NA NA S
A4426 OST PCH DRAIN 2 PIECE SYSTEM MAXFEE DEF         2.13 7/1/2021 12/31/2299 S
A4427 OST PCH DRAIN/BARR LK FLNG/F PRXOVR DEF         NA NA NA S
A4427 OST PCH DRAIN/BARR LK FLNG/F MAXFEE DEF         2.13 7/1/2021 12/31/2299 S
A4428 URINE OST POUCH W FAUCET/TAP PRXOVR DEF         NA NA NA E
A4428 URINE OST POUCH W FAUCET/TAP MANUAL DEF         NA NA NA E
A4429 URINE OST POUCH W BLTINCONV PRXOVR DEF         NA NA NA E
A4429 URINE OST POUCH W BLTINCONV MANUAL DEF         NA NA NA E
A4430 OST URINE PCH W B/BLTIN CONV PRXOVR DEF         NA NA NA E
A4430 OST URINE PCH W B/BLTIN CONV MANUAL DEF         NA NA NA E
A4431 OST PCH URINE W BARRIER/TAPV PRXOVR DEF         NA NA NA E
A4431 OST PCH URINE W BARRIER/TAPV MANUAL DEF         NA NA NA E
A4432 OS PCH URINE W BAR/FANGE/TAP PRXOVR DEF         NA NA NA E
A4432 OS PCH URINE W BAR/FANGE/TAP MANUAL DEF         NA NA NA E
A4433 URINE OST PCH BAR W LOCK FLN PRXOVR DEF         NA NA NA S
A4433 URINE OST PCH BAR W LOCK FLN MAXFEE DEF         2.98 7/1/2021 12/31/2299 S
A4434 OST PCH URINE W LOCK FLNG/FT PRXOVR DEF         NA NA NA S
A4434 OST PCH URINE W LOCK FLNG/FT MAXFEE DEF         2.98 7/1/2021 12/31/2299 S
A4435 1PC OST PCH DRAIN HGH OUTPUT PRXOVR DEF         NA NA NA E
A4435 1PC OST PCH DRAIN HGH OUTPUT MANUAL DEF         NA NA NA E
A4436 IRR SUPPLY SLEEV REUS PER MO PRXOVR DEF         NA NA NA E
A4436 IRR SUPPLY SLEEV REUS PER MO MANUAL DEF         NA NA NA E
A4437 IRR SUPPLY SLEEV DISP PER MO PRXOVR DEF         NA NA NA E
A4437 IRR SUPPLY SLEEV DISP PER MO MANUAL DEF         NA NA NA E
A4438 ADHESIVE CLIP EXT ENS CONTR PRXOVR DEF         NA NA NA S
A4438 ADHESIVE CLIP EXT ENS CONTR PADOLR DEF         NA NA NA S
A4450 NON-WATERPROOF TAPE PRXOVR DEF         NA NA NA S
A4450 NON-WATERPROOF TAPE MAXFEE DEF         0.08 10/1/2004 12/31/2299 S
A4452 WATERPROOF TAPE PRXOVR DEF         NA NA NA S
A4452 WATERPROOF TAPE MAXFEE DEF         0.32 10/1/2004 12/31/2299 S
A4453 REC CATH MAN PUMP ENEMA REPL PRXOVR DEF         NA NA NA E
A4453 REC CATH MAN PUMP ENEMA REPL MANUAL DEF         NA NA NA E
A4455 ADHESIVE REMOVER PER OUNCE PRXOVR DEF         NA NA NA S
A4455 ADHESIVE REMOVER PER OUNCE MAXFEE DEF         1.36 4/1/2001 12/31/2299 S
A4456 ADHESIVE REMOVER; WIPES PRXOVR DEF         NA NA NA E
A4456 ADHESIVE REMOVER; WIPES MANUAL DEF         NA NA NA E
A4457 ENEMA TUBE ANY TYPE REPL PRXOVR DEF         NA NA NA Y
A4457 ENEMA TUBE ANY TYPE REPL MANUAL DEF         NA NA NA Y
A4458 REUSABLE ENEMA BAG PRXOVR DEF         NA NA NA N
A4458 REUSABLE ENEMA BAG MAXFEE DEF         8 10/1/2004 12/31/2299 N
A4459 MANUAL PUMP ENEMA; REUSABLE PRXOVR DEF         NA NA NA E
A4459 MANUAL PUMP ENEMA; REUSABLE MANUAL DEF         NA NA NA E
A4460 ELASTIC COMPRESSION BANDAGE PRXOVR DEF         NA NA NA S
A4460 ELASTIC COMPRESSION BANDAGE MAXFEE DEF         NA     S
A4466 ELASTIC GARMENT/COVERING PRXOVR DEF         NA NA NA S
A4466 ELASTIC GARMENT/COVERING MAXFEE DEF         NA     S
A4467 BELT STRAP SLEEV GRMNT COVER PRXOVR DEF         NA NA NA S
A4467 BELT STRAP SLEEV GRMNT COVER MAXFEE DEF         40 1/1/2017 12/31/2299 S
A4468 EXSUFF BELT INCL ALL SUP ACC PRXOVR DEF         NA NA NA Y
A4468 EXSUFF BELT INCL ALL SUP ACC MANUAL DEF         NA NA NA Y
A4483 MOISTURE EXCHANGER PRXOVR DEF         NA NA NA S
A4483 MOISTURE EXCHANGER MAXFEE DEF         4.15 1/1/2005 12/31/2299 S
A4490 ABOVE KNEE SURGICAL STOCKING PRXOVR DEF         NA NA NA Y
A4490 ABOVE KNEE SURGICAL STOCKING MAXFEE DEF         25 10/15/2006 12/31/2299 Y
A4495 THIGH LENGTH SURG STOCKING PRXOVR DEF         NA NA NA Y
A4495 THIGH LENGTH SURG STOCKING MAXFEE DEF         25 10/15/2006 12/31/2299 Y
A4500 BELOW KNEE SURGICAL STOCKING PRXOVR DEF         NA NA NA Y
A4500 BELOW KNEE SURGICAL STOCKING MAXFEE DEF         22 10/15/2006 12/31/2299 Y
A4510 FULL LENGTH SURG STOCKING PRXOVR DEF         NA NA NA Y
A4510 FULL LENGTH SURG STOCKING MAXFEE DEF         75 1/1/2008 12/31/2299 Y
A4520 INCONTINENCE GARMENT ANYTYPE PRXOVR DEF         NA NA NA E
A4520 INCONTINENCE GARMENT ANYTYPE MANUAL DEF         NA NA NA E
A4521 ADULT SIZE DIAPER SM EACH PRXOVR DEF         NA NA NA S
A4521 ADULT SIZE DIAPER SM EACH MAXFEE DEF         NA     S
A4522 ADULT SIZE DIAPER MED EACH PRXOVR DEF         NA NA NA S
A4522 ADULT SIZE DIAPER MED EACH MAXFEE DEF         NA     S
A4523 ADULT SIZE DIAPER LG EACH PRXOVR DEF         NA NA NA S
A4523 ADULT SIZE DIAPER LG EACH MAXFEE DEF         NA     S
A4524 ADULT SIZE DIAPER XL EACH PRXOVR DEF         NA NA NA S
A4524 ADULT SIZE DIAPER XL EACH MAXFEE DEF         NA     S
A4525 ADULT SIZE BRIEF SM EACH PRXOVR DEF         NA NA NA S
A4525 ADULT SIZE BRIEF SM EACH MAXFEE DEF         NA     S
A4526 ADULT SIZE BRIEF MED EACH PRXOVR DEF         NA NA NA S
A4526 ADULT SIZE BRIEF MED EACH MAXFEE DEF         NA     S
A4527 ADULT SIZE BRIEF LG EACH PRXOVR DEF         NA NA NA S
A4527 ADULT SIZE BRIEF LG EACH MAXFEE DEF         NA     S
A4528 ADULT SIZE BRIEF XL EACH PRXOVR DEF         NA NA NA S
A4528 ADULT SIZE BRIEF XL EACH MAXFEE DEF         NA     S
A4529 CHILD SIZE DIAPER SM/MED EA PRXOVR DEF         NA NA NA S
A4529 CHILD SIZE DIAPER SM/MED EA MAXFEE DEF         NA     S
A4530 CHILD SIZE DIAPER LG EACH PRXOVR DEF         NA NA NA S
A4530 CHILD SIZE DIAPER LG EACH MAXFEE DEF         NA     S
A4531 CHILD SIZE BRIEF SM/MED EACH PRXOVR DEF         NA NA NA S
A4531 CHILD SIZE BRIEF SM/MED EACH MAXFEE DEF         NA     S
A4532 CHILD SIZE BRIEF LG EACH PRXOVR DEF         NA NA NA S
A4532 CHILD SIZE BRIEF LG EACH MAXFEE DEF         NA     S
A4533 YOUTH SIZE DIAPER EACH PRXOVR DEF         NA NA NA S
A4533 YOUTH SIZE DIAPER EACH MAXFEE DEF         NA     S
A4534 YOUTH SIZE BRIEF EACH PRXOVR DEF         NA NA NA S
A4534 YOUTH SIZE BRIEF EACH MAXFEE DEF         NA     S
A4535 DISP INCONT LINER/SHIELD EA PRXOVR DEF         NA NA NA S
A4535 DISP INCONT LINER/SHIELD EA MAXFEE DEF         NA     S
A4536 PROT UNDERWR WSHBL ANY SZ EA PRXOVR DEF         NA NA NA S
A4536 PROT UNDERWR WSHBL ANY SZ EA MAXFEE DEF         NA     S
A4537 UNDER PAD REUSABLE ANY SZ EA PRXOVR DEF         NA NA NA S
A4537 UNDER PAD REUSABLE ANY SZ EA MANUAL DEF         NA NA NA S
A4538 REUSABLE DIAPER FROM DPR SVC PRXOVR DEF         NA NA NA S
A4538 REUSABLE DIAPER FROM DPR SVC MAXFEE DEF         NA     S
A4540 TRANS ELEC NERV PERIPH NERV PRXOVR DEF         NA NA NA Y
A4540 TRANS ELEC NERV PERIPH NERV MANUAL DEF         NA NA NA Y
A4541 MONTHLY SUPP USE WITH E0733 PRXOVR DEF         NA NA NA Y
A4541 MONTHLY SUPP USE WITH E0733 MANUAL DEF         NA NA NA Y
A4542 SUPP EXT UP LIMB TREMOR STIM PRXOVR DEF         NA NA NA Y
A4542 SUPP EXT UP LIMB TREMOR STIM MANUAL DEF         NA NA NA Y
A4553 NONDISP UNDERPADS; ALL SIZES PRXOVR DEF         NA NA NA E
A4553 NONDISP UNDERPADS; ALL SIZES MANUAL DEF         NA NA NA E
A4554 DISPOSABLE UNDERPADS PRXOVR DEF         NA NA NA E
A4554 DISPOSABLE UNDERPADS MANUAL DEF         NA NA NA E
A4556 ELECTRODES; PAIR PRXOVR DEF         NA NA NA S
A4556 ELECTRODES; PAIR MAXFEE DEF         9.41 10/1/2004 12/31/2299 S
A4557 LEAD WIRES; PAIR PRXOVR DEF         NA NA NA S
A4557 LEAD WIRES; PAIR MAXFEE DEF         16.36 10/1/2004 12/31/2299 S
A4558 CONDUCTIVE GEL OR PASTE PRXOVR DEF         NA NA NA S
A4558 CONDUCTIVE GEL OR PASTE MAXFEE DEF         4.23 10/1/2004 12/31/2299 S
A4561 PESSARY REUSABLE RUB ANYTYPE PRXOVR DEF         NA NA NA S
A4561 PESSARY REUSABLE RUB ANYTYPE MAXFEE DEF         10.24 1/1/2001 12/31/2299 S
A4562 PESSARY REUSABLE NONRUBBER PRXOVR DEF         NA NA NA S
A4562 PESSARY REUSABLE NONRUBBER MAXFEE DEF         10.24 1/1/2001 12/31/2299 S
A4563 VAG INSER RECTAL CONTROL SYS PRXOVR DEF         NA NA NA E
A4563 VAG INSER RECTAL CONTROL SYS MANUAL DEF         NA NA NA E
A4564 PESSARY; DISPOSABLE ANY TYPE PRXOVR DEF         NA NA NA S
A4564 PESSARY; DISPOSABLE ANY TYPE MAXFEE DEF         20.75 4/1/2024 12/31/2299 S
A4565 SLINGS PRXOVR DEF         NA NA NA S
A4565 SLINGS MAXFEE DEF         6.30 7/1/2002 12/31/2299 S
A4570 SPLINT PRXOVR DEF         NA NA NA S
A4570 SPLINT MAXFEE DEF         10 5/1/1990 12/31/2299 S
A4575 HYPERBARIC O2 CHAMBER DISPS PRXOVR DEF         NA NA NA E
A4575 HYPERBARIC O2 CHAMBER DISPS MANUAL DEF         NA NA NA E
A4580 CAST SUPPLIES (PLASTER) PRXOVR DEF         NA NA NA N
A4580 CAST SUPPLIES (PLASTER) MAXFEE DEF         2.55 11/1/1992 12/31/2299 N
A4590 SPECIAL CASTING MATERIAL PRXOVR DEF         NA NA NA S
A4590 SPECIAL CASTING MATERIAL MAXFEE DEF         15 11/1/1992 12/31/2299 S
A4595 TENS SUPPL 2 LEAD PER MONTH PRXOVR DEF         NA NA NA N
A4595 TENS SUPPL 2 LEAD PER MONTH MAXFEE DEF         25 1/1/1996 12/31/2299 N
A4596 CES SYSTEM MONTHLY SUPP PRXOVR DEF         NA NA NA E
A4596 CES SYSTEM MONTHLY SUPP MANUAL DEF         NA NA NA E
A4600 SLEEVE; INTER LIMB COMP DEV PRXOVR DEF         NA NA NA E
A4600 SLEEVE; INTER LIMB COMP DEV MANUAL DEF         NA NA NA E
A4601 LITH ION NON PROSTH RECHARGE PRXOVR DEF         NA NA NA E
A4601 LITH ION NON PROSTH RECHARGE MANUAL DEF         NA NA NA E
A4602 REPLACE LITHIUM BATTERY 1.5V PRXOVR DEF         NA NA NA E
A4602 REPLACE LITHIUM BATTERY 1.5V MANUAL DEF         NA NA NA E
A4604 TUBING WITH HEATING ELEMENT PRXOVR DEF         NA NA NA N
A4604 TUBING WITH HEATING ELEMENT MAXFEE DEF         53.40 2/1/2016 12/31/2299 N
A4605 TRACH SUCTION CATH CLOSE SYS PRXOVR DEF         NA NA NA S
A4605 TRACH SUCTION CATH CLOSE SYS MAXFEE DEF         19.68 1/1/2024 12/31/2299 S
A4606 OXYGEN PROBE USED W OXIMETER PRXOVR DEF         NA NA NA Y S
A4606 OXYGEN PROBE USED W OXIMETER MAXFEE UC2         18.50 7/1/2021 12/31/2299 Y S
A4606 OXYGEN PROBE USED W OXIMETER MAXFEE DEF         110.25 7/1/2021 12/31/2299 Y S
A4606 OXYGEN PROBE USED W OXIMETER MAXFEE UC1         242.50 7/1/2021 12/31/2299 Y S
A4611 HEAVY DUTY BATTERY PRXOVR DEF         NA NA NA Y
A4611 HEAVY DUTY BATTERY MAXFEE DEF         100 5/1/1990 12/31/2299 Y
A4612 BATTERY CABLES PRXOVR DEF         NA NA NA Y
A4612 BATTERY CABLES MAXFEE DEF         60 5/1/1990 12/31/2299 Y
A4613 BATTERY CHARGER PRXOVR DEF         NA NA NA Y
A4613 BATTERY CHARGER MAXFEE DEF         60 5/1/1990 12/31/2299 Y
A4614 HAND-HELD PEFR METER PRXOVR DEF         NA NA NA E
A4614 HAND-HELD PEFR METER MANUAL DEF         NA NA NA E
A4616 TUBING (OXYGEN) PER FOOT PRXOVR DEF         NA NA NA N
A4616 TUBING (OXYGEN) PER FOOT MAXFEE DEF         0.05 1/1/2008 12/31/2299 N
A4617 MOUTH PIECE PRXOVR DEF         NA NA NA S
A4617 MOUTH PIECE MAXFEE DEF         1 5/1/1990 12/31/2299 S
A4618 BREATHING CIRCUITS PRXOVR DEF         NA NA NA Y
A4618 BREATHING CIRCUITS MAXFEE DEF         2.60 5/1/1990 12/31/2299 Y
A4619 FACE TENT PRXOVR DEF         NA NA NA S
A4619 FACE TENT MAXFEE DEF         1.21 1/1/2002 12/31/2299 S
A4620 VARIABLE CONCENTRATION MASK PRXOVR DEF         NA NA NA N
A4620 VARIABLE CONCENTRATION MASK MAXFEE DEF         0.62 4/1/2009 12/31/2299 N
A4621 TRACHEOTOMY MASK OR COLLAR PRXOVR DEF         NA NA NA S
A4621 TRACHEOTOMY MASK OR COLLAR MAXFEE DEF         NA     S
A4622 TRACHEOSTOMY OR LARNGECTOMY PRXOVR DEF         NA NA NA S
A4622 TRACHEOSTOMY OR LARNGECTOMY MAXFEE DEF         NA     S
A4623 TRACHEOSTOMY INNER CANNULA PRXOVR DEF         NA NA NA S
A4623 TRACHEOSTOMY INNER CANNULA MAXFEE DEF         4.60 1/1/2024 12/31/2299 S
A4624 TRACHEAL SUCTION TUBE PRXOVR DEF         NA NA NA S
A4624 TRACHEAL SUCTION TUBE MAXFEE DEF         1.60 1/1/2024 12/31/2299 S
A4625 TRACH CARE KIT FOR NEW TRACH PRXOVR DEF         NA NA NA S
A4625 TRACH CARE KIT FOR NEW TRACH MAXFEE DEF         3.55 1/1/1996 12/31/2299 S
A4626 TRACHEOSTOMY CLEANING BRUSH PRXOVR DEF         NA NA NA S
A4626 TRACHEOSTOMY CLEANING BRUSH MAXFEE DEF         1.38 1/1/1993 12/31/2299 S
A4627 SPACER BAG/RESERVOIR PRXOVR DEF         NA NA NA E
A4627 SPACER BAG/RESERVOIR MANUAL DEF         NA NA NA E
A4628 OROPHARYNGEAL SUCTION CATH PRXOVR DEF         NA NA NA S
A4628 OROPHARYNGEAL SUCTION CATH MAXFEE DEF         2.84 1/1/2024 12/31/2299 S
A4629 TRACHEOSTOMY CARE KIT PRXOVR DEF         NA NA NA S
A4629 TRACHEOSTOMY CARE KIT MAXFEE DEF         3.83 1/1/2024 12/31/2299 S
A4633 UVL REPLACEMENT BULB PRXOVR DEF         NA NA NA N
A4633 UVL REPLACEMENT BULB MAXFEE DEF         36.94 7/1/2019 12/31/2299 N
A4634 REPLACEMENT BULB TH LIGHTBOX PRXOVR DEF         NA NA NA E
A4634 REPLACEMENT BULB TH LIGHTBOX MANUAL DEF         NA NA NA E
A4635 UNDERARM CRUTCH PAD PRXOVR DEF         NA NA NA S
A4635 UNDERARM CRUTCH PAD MAXFEE DEF         1.50 5/25/1991 12/31/2299 S
A4636 HANDGRIP FOR CANE ETC PRXOVR DEF         NA NA NA S
A4636 HANDGRIP FOR CANE ETC MAXFEE DEF         1.66 5/25/1991 12/31/2299 S
A4637 REPL TIP CANE/CRUTCH/WALKER PRXOVR DEF         NA NA NA S
A4637 REPL TIP CANE/CRUTCH/WALKER MAXFEE DEF         1.90 5/25/1991 12/31/2299 S
A4638 REPL BATT PULSE GEN SYS PRXOVR DEF         NA NA NA E
A4638 REPL BATT PULSE GEN SYS MANUAL DEF         NA NA NA E
A4639 INFRARED HT SYS REPLCMNT PAD PRXOVR DEF         NA NA NA E
A4639 INFRARED HT SYS REPLCMNT PAD MANUAL DEF         NA NA NA E
A4640 ALTERNATING PRESSURE PAD PRXOVR DEF         NA NA NA S
A4640 ALTERNATING PRESSURE PAD MAXFEE DEF         31.28 5/25/1991 12/31/2299 S
A4649 SURGICAL SUPPLIES PRXOVR DEF         NA NA NA Y
A4649 SURGICAL SUPPLIES PADOLR DEF         NA NA NA Y
A4653 PD CATHETER ANCHOR BELT PRXOVR DEF         NA NA NA E
A4653 PD CATHETER ANCHOR BELT MANUAL DEF         NA NA NA E
A4657 SYRINGE W/WO NEEDLE PRXOVR DEF         NA NA NA E
A4657 SYRINGE W/WO NEEDLE MANUAL DEF         NA NA NA E
A4660 SPHYG/BP APP W CUFF AND STET PRXOVR DEF         NA NA NA S
A4660 SPHYG/BP APP W CUFF AND STET MAXFEE DEF         30 8/1/1997 12/31/2299 S
A4663 DIALYSIS BLOOD PRESSURE CUFF PRXOVR DEF         NA NA NA S
A4663 DIALYSIS BLOOD PRESSURE CUFF MAXFEE DEF         13 5/1/1990 12/31/2299 S
A4670 AUTOMATIC BP MONITOR; DIAL PRXOVR DEF         NA NA NA S
A4670 AUTOMATIC BP MONITOR; DIAL MAXFEE DEF         47 8/1/1997 12/31/2299 S
A4719 Y SET TUBING PRXOVR DEF         NA NA NA N
A4719 Y SET TUBING MAXFEE DEF         5 10/1/2004 12/31/2299 N
A4927 NON-STERILE GLOVES PRXOVR DEF         NA NA NA S
A4927 NON-STERILE GLOVES MAXFEE DEF         8.69 4/1/2003 12/31/2299 S
A4928 SURGICAL MASK PRXOVR DEF         NA NA NA E
A4928 SURGICAL MASK MANUAL DEF         NA NA NA E
A4930 STERILE; GLOVES PER PAIR PRXOVR DEF         NA NA NA S
A4930 STERILE; GLOVES PER PAIR MAXFEE DEF         0.55 4/1/2003 12/31/2299 S
A5051 POUCH CLSD W BARR ATTACHED PRXOVR DEF         NA NA NA S
A5051 POUCH CLSD W BARR ATTACHED MAXFEE DEF         1.91 4/1/2001 12/31/2299 S
A5052 CLSD OSTOMY POUCH W/O BARR PRXOVR DEF         NA NA NA S
A5052 CLSD OSTOMY POUCH W/O BARR MAXFEE DEF         1.36 4/1/2001 12/31/2299 S
A5053 CLSD OSTOMY POUCH FACEPLATE PRXOVR DEF         NA NA NA S
A5053 CLSD OSTOMY POUCH FACEPLATE MAXFEE DEF         1.58 1/1/1998 12/31/2299 S
A5054 CLSD OSTOMY POUCH W/FLANGE PRXOVR DEF         NA NA NA S
A5054 CLSD OSTOMY POUCH W/FLANGE MAXFEE DEF         1.79 1/1/2024 12/31/2299 S
A5055 STOMA CAP PRXOVR DEF         NA NA NA S
A5055 STOMA CAP MAXFEE DEF         1.27 4/1/2001 12/31/2299 S
A5056 1 PC OST POUCH W FILTER PRXOVR DEF         NA NA NA S
A5056 1 PC OST POUCH W FILTER MAXFEE DEF         3.87 7/1/2021 12/31/2299 S
A5057 1 PC OST POU W BUILT-IN CONV PRXOVR DEF         NA NA NA S
A5057 1 PC OST POU W BUILT-IN CONV MAXFEE DEF         8.94 7/1/2021 12/31/2299 S
A5061 POUCH DRAINABLE W BARRIER AT PRXOVR DEF         NA NA NA S
A5061 POUCH DRAINABLE W BARRIER AT MAXFEE DEF         3.53 1/1/2024 12/31/2299 S
A5062 DRNBLE OSTOMY POUCH W/O BARR PRXOVR DEF         NA NA NA S
A5062 DRNBLE OSTOMY POUCH W/O BARR MAXFEE DEF         1.90 8/1/1997 12/31/2299 S
A5063 DRAIN OSTOMY POUCH W/FLANGE PRXOVR DEF         NA NA NA S
A5063 DRAIN OSTOMY POUCH W/FLANGE MAXFEE DEF         2.70 1/1/2024 12/31/2299 S
A5071 URINARY POUCH W/BARRIER PRXOVR DEF         NA NA NA S
A5071 URINARY POUCH W/BARRIER MAXFEE DEF         5.99 1/1/2024 12/31/2299 S
A5072 URINARY POUCH W/O BARRIER PRXOVR DEF         NA NA NA S
A5072 URINARY POUCH W/O BARRIER MAXFEE DEF         3.10 4/1/2001 12/31/2299 S
A5073 URINARY POUCH ON BARR W/FLNG PRXOVR DEF         NA NA NA S
A5073 URINARY POUCH ON BARR W/FLNG MAXFEE DEF         2.98 4/1/2001 12/31/2299 S
A5081 STOMA PLUG OR SEAL; ANY TYPE PRXOVR DEF         NA NA NA S
A5081 STOMA PLUG OR SEAL; ANY TYPE MAXFEE DEF         3 1/1/1998 12/31/2299 S
A5082 CONTINENT STOMA CATHETER PRXOVR DEF         NA NA NA S
A5082 CONTINENT STOMA CATHETER MAXFEE DEF         10.75 1/1/1998 12/31/2299 S
A5083 STOMA ABSORPTIVE COVER PRXOVR DEF         NA NA NA E
A5083 STOMA ABSORPTIVE COVER MANUAL DEF         NA NA NA E
A5093 OSTOMY ACCESSORY CONVEX INSE PRXOVR DEF         NA NA NA S
A5093 OSTOMY ACCESSORY CONVEX INSE MAXFEE DEF         1.58 4/1/2001 12/31/2299 S
A5102 BEDSIDE DRAIN BTL W/WO TUBE PRXOVR DEF         NA NA NA S
A5102 BEDSIDE DRAIN BTL W/WO TUBE MAXFEE DEF         21.39 4/1/2001 12/31/2299 S
A5105 URINARY SUSPENSORY PRXOVR DEF         NA NA NA S
A5105 URINARY SUSPENSORY MAXFEE DEF         40.32 7/1/2002 12/31/2299 S
A5112 URINARY LEG BAG PRXOVR DEF         NA NA NA S
A5112 URINARY LEG BAG MAXFEE DEF         31.16 7/1/2002 12/31/2299 S
A5113 LATEX LEG STRAP PRXOVR DEF         NA NA NA S
A5113 LATEX LEG STRAP MAXFEE DEF         1.30 11/15/1993 12/31/2299 S
A5114 FOAM/FABRIC LEG STRAP PRXOVR DEF         NA NA NA S
A5114 FOAM/FABRIC LEG STRAP MAXFEE DEF         7.59 1/1/2024 12/31/2299 S
A5119 SKIN BARRIER WIPES BOX PR 50 PRXOVR DEF         NA NA NA S
A5119 SKIN BARRIER WIPES BOX PR 50 MAXFEE DEF         NA     S
A5120 SKIN BARRIER; WIPE OR SWAB PRXOVR DEF         NA NA NA S
A5120 SKIN BARRIER; WIPE OR SWAB MAXFEE DEF         0.20 1/1/2024 12/31/2299 S
A5121 SOLID SKIN BARRIER 6X6 PRXOVR DEF         NA NA NA S
A5121 SOLID SKIN BARRIER 6X6 MAXFEE DEF         7.43 1/1/2024 12/31/2299 S
A5122 SOLID SKIN BARRIER 8X8 PRXOVR DEF         NA NA NA S
A5122 SOLID SKIN BARRIER 8X8 MAXFEE DEF         12.26 4/1/2001 12/31/2299 S
A5126 DISK/FOAM PAD +OR- ADHESIVE PRXOVR DEF         NA NA NA S
A5126 DISK/FOAM PAD +OR- ADHESIVE MAXFEE DEF         1.11 7/1/2002 12/31/2299 S
A5131 APPLIANCE CLEANER PRXOVR DEF         NA NA NA S
A5131 APPLIANCE CLEANER MAXFEE DEF         13.44 1/1/2024 12/31/2299 S
A5200 PERCUTANEOUS CATHETER ANCHOR PRXOVR DEF         NA NA NA E
A5200 PERCUTANEOUS CATHETER ANCHOR MANUAL DEF         NA NA NA E
A6000 WOUND WARMING WOUND COVER PRXOVR DEF         NA NA NA E
A6000 WOUND WARMING WOUND COVER MANUAL DEF         NA NA NA E
A6010 COLLAGEN BASED WOUND FILLER PRXOVR DEF         NA NA NA S
A6010 COLLAGEN BASED WOUND FILLER MAXFEE DEF         30.96 9/1/2005 12/31/2299 S
A6011 COLLAGEN GEL/PASTE WOUND FIL PRXOVR DEF         NA NA NA S
A6011 COLLAGEN GEL/PASTE WOUND FIL MAXFEE DEF         1.82 1/1/2005 12/31/2299 S
A6021 COLLAGEN DRESSING <=16 SQ IN PRXOVR DEF         NA NA NA Y
A6021 COLLAGEN DRESSING <=16 SQ IN MAXFEE DEF         25.23 1/1/2024 12/31/2299 Y
A6022 COLLAGEN DRSG>16<=48 SQ IN PRXOVR DEF         NA NA NA Y
A6022 COLLAGEN DRSG>16<=48 SQ IN MAXFEE DEF         18.91 4/1/2006 12/31/2299 Y
A6023 COLLAGEN DRESSING >48 SQ IN PRXOVR DEF         NA NA NA Y
A6023 COLLAGEN DRESSING >48 SQ IN MAXFEE DEF         171.27 4/1/2006 12/31/2299 Y
A6025 SILICONE GEL SHEET; EACH PRXOVR DEF         NA NA NA E
A6025 SILICONE GEL SHEET; EACH MANUAL DEF         NA NA NA E
A6154 WOUND POUCH EACH PRXOVR DEF         NA NA NA S
A6154 WOUND POUCH EACH MAXFEE DEF         11.40 1/1/1997 12/31/2299 S
A6196 ALGINATE DRESSING <=16 SQ IN PRXOVR DEF         NA NA NA S
A6196 ALGINATE DRESSING <=16 SQ IN MAXFEE DEF         9 1/1/2024 12/31/2299 S
A6197 ALGINATE DRSG >16 <=48 SQ IN PRXOVR DEF         NA NA NA S
A6197 ALGINATE DRSG >16 <=48 SQ IN MAXFEE DEF         18.75 1/1/2024 12/31/2299 S
A6198 ALGINATE DRESSING > 48 SQ IN PRXOVR DEF         NA NA NA S
A6198 ALGINATE DRESSING > 48 SQ IN MAXFEE DEF         31.40 7/26/2007 12/31/2299 S
A6199 ALGINATE DRSG WOUND FILLER PRXOVR DEF         NA NA NA S
A6199 ALGINATE DRSG WOUND FILLER MAXFEE DEF         5.29 9/1/2005 12/31/2299 S
A6200 COMPOS DRSG <=16 NO BORDER PRXOVR DEF         NA NA NA Y
A6200 COMPOS DRSG <=16 NO BORDER MAXFEE DEF         0 12/7/2010 12/31/2299 Y
A6201 COMPOS DRSG >16<=48 NO BDR PRXOVR DEF         NA NA NA Y
A6201 COMPOS DRSG >16<=48 NO BDR MAXFEE DEF         0 12/7/2010 12/31/2299 Y
A6202 COMPOS DRSG >48 NO BORDER PRXOVR DEF         NA NA NA Y
A6202 COMPOS DRSG >48 NO BORDER MAXFEE DEF         0 12/7/2010 12/31/2299 Y
A6203 COMPOSITE DRSG <= 16 SQ IN PRXOVR DEF         NA NA NA S
A6203 COMPOSITE DRSG <= 16 SQ IN MAXFEE DEF         3.02 1/1/1997 12/31/2299 S
A6204 COMPOSITE DRSG >16<=48 SQ IN PRXOVR DEF         NA NA NA S
A6204 COMPOSITE DRSG >16<=48 SQ IN MAXFEE DEF         4.50 1/1/1997 12/31/2299 S
A6205 COMPOSITE DRSG > 48 SQ IN PRXOVR DEF         NA NA NA Y
A6205 COMPOSITE DRSG > 48 SQ IN MAXFEE DEF         5 7/1/2021 12/31/2299 Y
A6206 CONTACT LAYER <= 16 SQ IN PRXOVR DEF         NA NA NA Y
A6206 CONTACT LAYER <= 16 SQ IN MAXFEE DEF         6.25 7/1/2021 12/31/2299 Y
A6207 CONTACT LAYER >16<= 48 SQ IN PRXOVR DEF         NA NA NA S
A6207 CONTACT LAYER >16<= 48 SQ IN MAXFEE DEF         5.30 1/1/1997 12/31/2299 S
A6208 CONTACT LAYER > 48 SQ IN PRXOVR DEF         NA NA NA Y
A6208 CONTACT LAYER > 48 SQ IN MAXFEE DEF         11.98 4/1/2006 12/31/2299 Y
A6209 FOAM DRSG <=16 SQ IN W/O BDR PRXOVR DEF         NA NA NA Y S
A6209 FOAM DRSG <=16 SQ IN W/O BDR MAXFEE DEF         7.46 1/1/2024 12/31/2299 Y S
A6209 FOAM DRSG <=16 SQ IN W/O BDR MAXFEE UC1         14.90 7/1/2021 12/31/2299 Y S
A6210 FOAM DRG >16<=48 SQ IN W/O B PRXOVR DEF         NA NA NA Y S
A6210 FOAM DRG >16<=48 SQ IN W/O B MAXFEE DEF         19.88 1/1/2024 12/31/2299 Y S
A6210 FOAM DRG >16<=48 SQ IN W/O B MAXFEE UC1         20.85 7/1/2021 12/31/2299 Y S
A6211 FOAM DRG > 48 SQ IN W/O BRDR PRXOVR DEF         NA NA NA S
A6211 FOAM DRG > 48 SQ IN W/O BRDR MAXFEE DEF         29.30 1/1/2024 12/31/2299 S
A6212 FOAM DRG <=16 SQ IN W/BORDER PRXOVR DEF         NA NA NA S
A6212 FOAM DRG <=16 SQ IN W/BORDER MAXFEE DEF         10.50 1/1/2024 12/31/2299 S
A6213 FOAM DRG >16<=48 SQ IN W/BDR PRXOVR DEF         NA NA NA Y
A6213 FOAM DRG >16<=48 SQ IN W/BDR MAXFEE DEF         12.54 4/1/2006 12/31/2299 Y
A6214 FOAM DRG > 48 SQ IN W/BORDER PRXOVR DEF         NA NA NA S
A6214 FOAM DRG > 48 SQ IN W/BORDER MAXFEE DEF         7.45 1/1/1997 12/31/2299 S
A6215 FOAM DRESSING WOUND FILLER PRXOVR DEF         NA NA NA S
A6215 FOAM DRESSING WOUND FILLER MAXFEE DEF         1.23 6/28/2006 12/31/2299 S
A6216 NON-STERILE GAUZE<=16 SQ IN PRXOVR DEF         NA NA NA S
A6216 NON-STERILE GAUZE<=16 SQ IN MAXFEE DEF         0.04 7/1/2018 12/31/2299 S
A6217 NON-STERILE GAUZE>16<=48 SQ PRXOVR DEF         NA NA NA S
A6217 NON-STERILE GAUZE>16<=48 SQ MAXFEE DEF         0.64 6/28/2006 12/31/2299 S
A6218 NON-STERILE GAUZE > 48 SQ IN PRXOVR DEF         NA NA NA S
A6218 NON-STERILE GAUZE > 48 SQ IN MAXFEE DEF         1.27 6/28/2006 12/31/2299 S
A6219 GAUZE <= 16 SQ IN W/BORDER PRXOVR DEF         NA NA NA S
A6219 GAUZE <= 16 SQ IN W/BORDER MAXFEE DEF         0.95 6/28/2006 12/31/2299 S
A6220 GAUZE >16 <=48 SQ IN W/BORDR PRXOVR DEF         NA NA NA S
A6220 GAUZE >16 <=48 SQ IN W/BORDR MAXFEE DEF         2.58 6/28/2006 12/31/2299 S
A6221 GAUZE > 48 SQ IN W/BORDER PRXOVR DEF         NA NA NA S
A6221 GAUZE > 48 SQ IN W/BORDER MAXFEE DEF         0.52 6/28/2006 12/31/2299 S
A6222 GAUZE <=16 IN NO W/SAL W/O B PRXOVR DEF         NA NA NA S
A6222 GAUZE <=16 IN NO W/SAL W/O B MAXFEE DEF         1.82 1/1/2024 12/31/2299 S
A6223 GAUZE >16<=48 NO W/SAL W/O B PRXOVR DEF         NA NA NA S
A6223 GAUZE >16<=48 NO W/SAL W/O B MAXFEE DEF         1.75 1/1/1997 12/31/2299 S
A6224 GAUZE > 48 IN NO W/SAL W/O B PRXOVR DEF         NA NA NA S
A6224 GAUZE > 48 IN NO W/SAL W/O B MAXFEE DEF         2.60 1/1/1997 12/31/2299 S
A6228 GAUZE <= 16 SQ IN WATER/SAL PRXOVR DEF         NA NA NA E
A6228 GAUZE <= 16 SQ IN WATER/SAL MANUAL DEF         NA NA NA E
A6229 GAUZE >16<=48 SQ IN WATR/SAL PRXOVR DEF         NA NA NA E
A6229 GAUZE >16<=48 SQ IN WATR/SAL MANUAL DEF         NA NA NA E
A6230 GAUZE > 48 SQ IN WATER/SALNE PRXOVR DEF         NA NA NA E
A6230 GAUZE > 48 SQ IN WATER/SALNE MANUAL DEF         NA NA NA E
A6231 HYDROGEL DSG<=16 SQ IN PRXOVR DEF         NA NA NA S
A6231 HYDROGEL DSG<=16 SQ IN MAXFEE DEF         1.65 1/1/2001 12/31/2299 S
A6232 HYDROGEL DSG>16<=48 SQ IN PRXOVR DEF         NA NA NA S
A6232 HYDROGEL DSG>16<=48 SQ IN MAXFEE DEF         1.75 1/1/2001 12/31/2299 S
A6233 HYDROGEL DRESSING >48 SQ IN PRXOVR DEF         NA NA NA S
A6233 HYDROGEL DRESSING >48 SQ IN MAXFEE DEF         2.60 1/1/2001 12/31/2299 S
A6234 HYDROCOLLD DRG <=16 W/O BDR PRXOVR DEF         NA NA NA S
A6234 HYDROCOLLD DRG <=16 W/O BDR MAXFEE DEF         4.80 1/1/1997 12/31/2299 S
A6235 HYDROCOLLD DRG >16<=48 W/O B PRXOVR DEF         NA NA NA S
A6235 HYDROCOLLD DRG >16<=48 W/O B MAXFEE DEF         12.15 8/1/1997 12/31/2299 S
A6236 HYDROCOLLD DRG > 48 IN W/O B PRXOVR DEF         NA NA NA S
A6236 HYDROCOLLD DRG > 48 IN W/O B MAXFEE DEF         19.65 8/1/1997 12/31/2299 S
A6237 HYDROCOLLD DRG <=16 IN W/BDR PRXOVR DEF         NA NA NA S
A6237 HYDROCOLLD DRG <=16 IN W/BDR MAXFEE DEF         5.80 1/1/1997 12/31/2299 S
A6238 HYDROCOLLD DRG >16<=48 W/BDR PRXOVR DEF         NA NA NA S
A6238 HYDROCOLLD DRG >16<=48 W/BDR MAXFEE DEF         16.75 8/1/1997 12/31/2299 S
A6239 HYDROCOLLD DRG > 48 IN W/BDR PRXOVR DEF         NA NA NA Y
A6239 HYDROCOLLD DRG > 48 IN W/BDR MAXFEE DEF         16.75 7/1/2021 12/31/2299 Y
A6240 HYDROCOLLD DRG FILLER PASTE PRXOVR DEF         NA NA NA N
A6240 HYDROCOLLD DRG FILLER PASTE MAXFEE DEF         5 7/26/2007 12/31/2299 N
A6241 HYDROCOLLOID DRG FILLER DRY PRXOVR DEF         NA NA NA S
A6241 HYDROCOLLOID DRG FILLER DRY MAXFEE DEF         2.57 9/1/2005 12/31/2299 S
A6242 HYDROGEL DRG <=16 IN W/O BDR PRXOVR DEF         NA NA NA S
A6242 HYDROGEL DRG <=16 IN W/O BDR MAXFEE DEF         4.80 1/1/1997 12/31/2299 S
A6243 HYDROGEL DRG >16<=48 W/O BDR PRXOVR DEF         NA NA NA S
A6243 HYDROGEL DRG >16<=48 W/O BDR MAXFEE DEF         8.75 8/1/1997 12/31/2299 S
A6244 HYDROGEL DRG >48 IN W/O BDR PRXOVR DEF         NA NA NA S
A6244 HYDROGEL DRG >48 IN W/O BDR MAXFEE DEF         28.30 1/1/1999 12/31/2299 S
A6245 HYDROGEL DRG <= 16 IN W/BDR PRXOVR DEF         NA NA NA S
A6245 HYDROGEL DRG <= 16 IN W/BDR MAXFEE DEF         5.90 1/1/1997 12/31/2299 S
A6246 HYDROGEL DRG >16<=48 IN W/B PRXOVR DEF         NA NA NA S
A6246 HYDROGEL DRG >16<=48 IN W/B MAXFEE DEF         7.15 1/1/1997 12/31/2299 S
A6247 HYDROGEL DRG > 48 SQ IN W/B PRXOVR DEF         NA NA NA S
A6247 HYDROGEL DRG > 48 SQ IN W/B MAXFEE DEF         17.15 8/1/1997 12/31/2299 S
A6248 HYDROGEL DRSG GEL FILLER PRXOVR DEF         NA NA NA N
A6248 HYDROGEL DRSG GEL FILLER MAXFEE DEF         5.76 7/26/2007 12/31/2299 N
A6250 SKIN SEAL PROTECT MOISTURIZR PRXOVR DEF         NA NA NA E
A6250 SKIN SEAL PROTECT MOISTURIZR MANUAL DEF         NA NA NA E
A6251 ABSORPT DRG <=16 SQ IN W/O B PRXOVR DEF         NA NA NA S
A6251 ABSORPT DRG <=16 SQ IN W/O B MAXFEE DEF         0.90 1/1/1997 12/31/2299 S
A6252 ABSORPT DRG >16 <=48 W/O BDR PRXOVR DEF         NA NA NA S
A6252 ABSORPT DRG >16 <=48 W/O BDR MAXFEE DEF         3.53 1/1/2024 12/31/2299 S
A6253 ABSORPT DRG > 48 SQ IN W/O B PRXOVR DEF         NA NA NA S
A6253 ABSORPT DRG > 48 SQ IN W/O B MAXFEE DEF         4.83 1/1/2024 12/31/2299 S
A6254 ABSORPT DRG <=16 SQ IN W/BDR PRXOVR DEF         NA NA NA S
A6254 ABSORPT DRG <=16 SQ IN W/BDR MAXFEE DEF         0.90 1/1/1997 12/31/2299 S
A6255 ABSORPT DRG >16<=48 IN W/BDR PRXOVR DEF         NA NA NA S
A6255 ABSORPT DRG >16<=48 IN W/BDR MAXFEE DEF         2.20 1/1/1997 12/31/2299 S
A6256 ABSORPT DRG > 48 SQ IN W/BDR PRXOVR DEF         NA NA NA Y
A6256 ABSORPT DRG > 48 SQ IN W/BDR MAXFEE DEF         2.20 7/1/2021 12/31/2299 Y
A6257 TRANSPARENT FILM <= 16 SQ IN PRXOVR DEF         NA NA NA S
A6257 TRANSPARENT FILM <= 16 SQ IN MAXFEE DEF         1.10 1/1/1997 12/31/2299 S
A6258 TRANSPARENT FILM >16<=48 IN PRXOVR DEF         NA NA NA S
A6258 TRANSPARENT FILM >16<=48 IN MAXFEE DEF         3.10 1/1/1997 12/31/2299 S
A6259 TRANSPARENT FILM > 48 SQ IN PRXOVR DEF         NA NA NA S
A6259 TRANSPARENT FILM > 48 SQ IN MAXFEE DEF         7.90 1/1/1997 12/31/2299 S
A6260 WOUND CLEANSER ANY TYPE/SIZE PRXOVR DEF         NA NA NA E
A6260 WOUND CLEANSER ANY TYPE/SIZE MANUAL DEF         NA NA NA E
A6261 WOUND FILLER GEL/PASTE /OZ PRXOVR DEF         NA NA NA S
A6261 WOUND FILLER GEL/PASTE /OZ MAXFEE DEF         100 1/1/1997 12/31/2299 S
A6262 WOUND FILLER DRY FORM / GRAM PRXOVR DEF         NA NA NA S
A6262 WOUND FILLER DRY FORM / GRAM MAXFEE DEF         100 1/1/1997 12/31/2299 S
A6264 NON-STERILE NO ELASTIC GAUZE PRXOVR DEF         NA NA NA S
A6264 NON-STERILE NO ELASTIC GAUZE MAXFEE DEF         NA     S
A6265 TAPE PER 18 SQ INCHES PRXOVR DEF         NA NA NA S
A6265 TAPE PER 18 SQ INCHES MAXFEE DEF         NA     S
A6266 IMPREG GAUZE NO H20/SAL/YARD PRXOVR DEF         NA NA NA S
A6266 IMPREG GAUZE NO H20/SAL/YARD MAXFEE DEF         1.75 8/1/1997 12/31/2299 S
A6402 STERILE GAUZE <= 16 SQ IN PRXOVR DEF         NA NA NA S
A6402 STERILE GAUZE <= 16 SQ IN MAXFEE DEF         0.12 4/1/2006 12/31/2299 S
A6403 STERILE GAUZE>16 <= 48 SQ IN PRXOVR DEF         NA NA NA S
A6403 STERILE GAUZE>16 <= 48 SQ IN MAXFEE DEF         0.43 4/1/2006 12/31/2299 S
A6404 STERILE GAUZE > 48 SQ IN PRXOVR DEF         NA NA NA S
A6404 STERILE GAUZE > 48 SQ IN MAXFEE DEF         0.61 4/1/2006 12/31/2299 S
A6405 STERILE ELASTIC GAUZE /YD PRXOVR DEF         NA NA NA S
A6405 STERILE ELASTIC GAUZE /YD MAXFEE DEF         NA     S
A6406 STERILE NON-ELASTIC GAUZE/YD PRXOVR DEF         NA NA NA S
A6406 STERILE NON-ELASTIC GAUZE/YD MAXFEE DEF         NA     S
A6407 PACKING STRIPS; NON-IMPREG PRXOVR DEF         NA NA NA E
A6407 PACKING STRIPS; NON-IMPREG MANUAL DEF         NA NA NA E
A6410 STERILE EYE PAD PRXOVR DEF         NA NA NA E
A6410 STERILE EYE PAD MANUAL DEF         NA NA NA E
A6411 NON-STERILE EYE PAD PRXOVR DEF         NA NA NA E
A6411 NON-STERILE EYE PAD MANUAL DEF         NA NA NA E
A6412 OCCLUSIVE EYE PATCH PRXOVR DEF         NA NA NA E
A6412 OCCLUSIVE EYE PATCH MANUAL DEF         NA NA NA E
A6441 PAD BAND W>=3 <5/YD PRXOVR DEF         NA NA NA S
A6441 PAD BAND W>=3 <5/YD MAXFEE DEF         0.54 1/1/2005 12/31/2299 S
A6442 CONFORM BAND N/S W<3/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6442,CONFORM BAND N/S W<3/YD MAXFEE DEF         0.14 1/1/2005 12/31/2299 S
A6443 CONFORM BAND N/S W>=3<5/YD PRXOVR DEF         NA NA NA S
A6443 CONFORM BAND N/S W>=3<5/YD MAXFEE DEF         0.23 1/1/2005 12/31/2299 S
A6444 CONFORM BAND N/S W>=5/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6444,CONFORM BAND N/S W>=5/YD MAXFEE DEF         0.45 1/1/2005 12/31/2299 S
A6445 CONFORM BAND S W <3/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6445,CONFORM BAND S W <3/YD MAXFEE DEF         0.26 1/1/2005 12/31/2299 S
A6446 CONFORM BAND S W>=3 <5/YD PRXOVR DEF         NA NA NA S
A6446 CONFORM BAND S W>=3 <5/YD MAXFEE DEF         0.33 1/1/2005 12/31/2299 S
A6447 CONFORM BAND S W >=5/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6447,CONFORM BAND S W >=5/YD MAXFEE DEF         0.54 1/1/2005 12/31/2299 S
A6448 LT COMPRES BAND <3/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6448,LT COMPRES BAND <3/YD MAXFEE DEF         1.04 10/1/2004 12/31/2299 S
A6449 LT COMPRES BAND >=3 <5/YD PRXOVR DEF         NA NA NA S
A6449 LT COMPRES BAND >=3 <5/YD MAXFEE DEF         1.05 10/1/2004 12/31/2299 S
A6450 LT COMPRES BAND >=5/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6450,LT COMPRES BAND >=5/YD MAXFEE DEF         1.60 1/1/2005 12/31/2299 S
A6451 MOD COMPRES BAND W>=3<5/YD PRXOVR DEF         NA NA NA S
A6451 MOD COMPRES BAND W>=3<5/YD MAXFEE DEF         3.19 1/1/2005 12/31/2299 S
A6452 HIGH COMPRES BAND W>=3<5YD PRXOVR DEF         NA NA NA S
A6452 HIGH COMPRES BAND W>=3<5YD MAXFEE DEF         5.32 10/1/2004 12/31/2299 S
A6453 SELF-ADHER BAND W <3/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6453,SELF-ADHER BAND W <3/YD MAXFEE DEF         0.55 10/1/2004 12/31/2299 S
A6454 SELF-ADHER BAND W>=3 <5/YD PRXOVR DEF         NA NA NA S
A6454 SELF-ADHER BAND W>=3 <5/YD MAXFEE DEF         0.69 10/1/2004 12/31/2299 S
A6455 SELF-ADHER BAND >=5/YD,PRXOVR,DEF,,,,,NA,NA,NA,S, =A6455,SELF-ADHER BAND >=5/YD MAXFEE DEF         1.25 10/1/2004 12/31/2299 S
A6457 TUBULAR DRESSING PRXOVR DEF         NA NA NA E
A6457 TUBULAR DRESSING MANUAL DEF         NA NA NA E
A6460 SYNTHETIC DRSG <= 16 SQ IN PRXOVR DEF         NA NA NA S
A6460 SYNTHETIC DRSG <= 16 SQ IN MAXFEE DEF         9.75 7/1/2021 12/31/2299 S
A6461 SYNTHETIC DRSG >16<=48 SQ IN PRXOVR DEF         NA NA NA S
A6461 SYNTHETIC DRSG >16<=48 SQ IN MAXFEE DEF         9.75 7/1/2021 12/31/2299 S
A6501 COMPRES BURNGARMENT BODYSUIT PRXOVR DEF         NA NA NA Y
A6501 COMPRES BURNGARMENT BODYSUIT PADOLR DEF         NA NA NA Y
A6502 COMPRES BURNGARMENT CHINSTRP PRXOVR DEF         NA NA NA Y
A6502 COMPRES BURNGARMENT CHINSTRP PADOLR DEF         NA NA NA Y
A6503 COMPRES BURNGARMENT FACEHOOD PRXOVR DEF         NA NA NA Y
A6503 COMPRES BURNGARMENT FACEHOOD PADOLR DEF         NA NA NA Y
A6504 CMPRSBURNGARMENT GLOVE-WRIST PRXOVR DEF         NA NA NA Y
A6504 CMPRSBURNGARMENT GLOVE-WRIST PADOLR DEF         NA NA NA Y
A6505 CMPRSBURNGARMENT GLOVE-ELBOW PRXOVR DEF         NA NA NA Y
A6505 CMPRSBURNGARMENT GLOVE-ELBOW PADOLR DEF         NA NA NA Y
A6506 CMPRSBURNGRMNT GLOVE-AXILLA PRXOVR DEF         NA NA NA Y
A6506 CMPRSBURNGRMNT GLOVE-AXILLA PADOLR DEF         NA NA NA Y
A6507 CMPRS BURNGARMENT FOOT-KNEE PRXOVR DEF         NA NA NA Y
A6507 CMPRS BURNGARMENT FOOT-KNEE PADOLR DEF         NA NA NA Y
A6508 CMPRS BURNGARMENT FOOT-THIGH PRXOVR DEF         NA NA NA Y
A6508 CMPRS BURNGARMENT FOOT-THIGH PADOLR DEF         NA NA NA Y
A6509 COMPRES BURN GARMENT JACKET PRXOVR DEF         NA NA NA Y
A6509 COMPRES BURN GARMENT JACKET PADOLR DEF         NA NA NA Y
A6510 COMPRES BURN GARMENT LEOTARD PRXOVR DEF         NA NA NA Y
A6510 COMPRES BURN GARMENT LEOTARD PADOLR DEF         NA NA NA Y
A6511 COMPRES BURN GARMENT PANTY PRXOVR DEF         NA NA NA Y
A6511 COMPRES BURN GARMENT PANTY PADOLR DEF         NA NA NA Y
A6512 COMPRES BURN GARMENT; NOC PRXOVR DEF         NA NA NA Y
A6512 COMPRES BURN GARMENT; NOC PADOLR DEF         NA NA NA Y
A6513 COMPRESS BURN MASK FACE/NECK PRXOVR DEF         NA NA NA E
A6513 COMPRESS BURN MASK FACE/NECK MANUAL DEF         NA NA NA E
A6520 G COM GARMNT GLOVE NGHTTIME PRXOVR DEF         NA NA NA Y
A6520 G COM GARMNT GLOVE NGHTTIME MANUAL DEF         NA NA NA Y
A6521 G COM GARMNT GLOVE NGHT CUST PRXOVR DEF         NA NA NA Y
A6521 G COM GARMNT GLOVE NGHT CUST MANUAL DEF         NA NA NA Y
A6522 G COM GARMENT ARM NIGHTTIME PRXOVR DEF         NA NA NA Y
A6522 G COM GARMENT ARM NIGHTTIME MANUAL DEF         NA NA NA Y
A6523 G COM GARMENT ARM NGHT CUSTM PRXOVR DEF         NA NA NA Y
A6523 G COM GARMENT ARM NGHT CUSTM MANUAL DEF         NA NA NA Y
A6524 G COM GARMNT LWR LEG/FT NGHT PRXOVR DEF         NA NA NA Y
A6524 G COM GARMNT LWR LEG/FT NGHT MANUAL DEF         NA NA NA Y
A6525 G COM GARM LWRLEG/FT NGT CUS PRXOVR DEF         NA NA NA Y
A6525 G COM GARM LWRLEG/FT NGT CUS MANUAL DEF         NA NA NA Y
A6526 G COM GARMT FULL LEG/FT NGHT PRXOVR DEF         NA NA NA Y
A6526 G COM GARMT FULL LEG/FT NGHT MANUAL DEF         NA NA NA Y
A6527 G GARMT FULL LEG/FT NGHT CUS PRXOVR DEF         NA NA NA Y
A6527 G GARMT FULL LEG/FT NGHT CUS MANUAL DEF         NA NA NA Y
A6528 G COM GARMENT BRA NIGHTTIME PRXOVR DEF         NA NA NA Y
A6528 G COM GARMENT BRA NIGHTTIME MANUAL DEF         NA NA NA Y
A6529 G COM GARMT BRA NIGHT CUSTM PRXOVR DEF         NA NA NA Y
A6529 G COM GARMT BRA NIGHT CUSTM MANUAL DEF         NA NA NA Y
A6530 COMPRESSION STOCKING BK18-30 PRXOVR DEF         NA NA NA Y
A6530 COMPRESSION STOCKING BK18-30 MAXFEE DEF         21.64 7/26/2007 12/31/2299 Y
A6531 COMPRESS STKING BK30-40 SURG PRXOVR DEF         NA NA NA Y
A6531 COMPRESS STKING BK30-40 SURG MAXFEE DEF         26.06 7/26/2007 12/31/2299 Y
A6532 COMPRESS STKING BK40-50 SURG PRXOVR DEF         NA NA NA Y
A6532 COMPRESS STKING BK40-50 SURG MAXFEE DEF         30.48 7/26/2007 12/31/2299 Y
A6533 GC STOCKING THIGHLNGTH 18-30 PRXOVR DEF         NA NA NA Y
A6533 GC STOCKING THIGHLNGTH 18-30 MAXFEE DEF         24.64 7/26/2007 12/31/2299 Y
A6534 GC STOCKING THIGHLNGTH 30-40 PRXOVR DEF         NA NA NA Y
A6534 GC STOCKING THIGHLNGTH 30-40 MAXFEE DEF         29.06 7/26/2007 12/31/2299 Y
A6535 GC STOCKING THIGHLNGTH 40+ PRXOVR DEF         NA NA NA Y
A6535 GC STOCKING THIGHLNGTH 40+ MAXFEE DEF         33.48 7/26/2007 12/31/2299 Y
A6536 GC STOCKING FULL LNGTH 18-30 PRXOVR DEF         NA NA NA Y
A6536 GC STOCKING FULL LNGTH 18-30 MAXFEE DEF         43.27 1/1/2006 12/31/2299 Y
A6537 GC STOCKING FULL LNGTH 30-40 PRXOVR DEF         NA NA NA Y
A6537 GC STOCKING FULL LNGTH 30-40 MAXFEE DEF         52.12 7/26/2007 12/31/2299 Y
A6538 GC STOCKING FULL LNGTH 40+ PRXOVR DEF         NA NA NA Y
A6538 GC STOCKING FULL LNGTH 40+ MAXFEE DEF         60.96 1/1/2006 12/31/2299 Y
A6539 GC STOCKING WAISTLNGTH 18-30 PRXOVR DEF         NA NA NA Y
A6539 GC STOCKING WAISTLNGTH 18-30 MAXFEE DEF         50 7/26/2007 12/31/2299 Y
A6540 GC STOCKING WAISTLNGTH 30-40 PRXOVR DEF         NA NA NA Y
A6540 GC STOCKING WAISTLNGTH 30-40 MAXFEE DEF         62.50 7/26/2007 12/31/2299 Y
A6541 GC STOCKING WAISTLNGTH 40+ PRXOVR DEF         NA NA NA Y
A6541 GC STOCKING WAISTLNGTH 40+ MAXFEE DEF         75 7/26/2007 12/31/2299 Y
A6542 GC STOCKING CUSTOM MADE PRXOVR DEF         NA NA NA Y
A6542 GC STOCKING CUSTOM MADE PADOLR DEF         NA NA NA Y
A6544 GC STOCKING GARTER BELT PRXOVR DEF         NA NA NA E
A6544 GC STOCKING GARTER BELT MANUAL DEF         NA NA NA E
A6545 GRAD COM NON-ELASTIC BK SURG PRXOVR DEF         NA NA NA E
A6545 GRAD COM NON-ELASTIC BK SURG MANUAL DEF         NA NA NA E
A6549 G COMPRESSION GARMENT PRXOVR DEF         NA NA NA Y
A6549 G COMPRESSION GARMENT PADOLR DEF         NA NA NA Y
A6550 NEG PRES WOUND THER DRSG SET PRXOVR DEF         NA NA NA E
A6550 NEG PRES WOUND THER DRSG SET MANUAL DEF         NA NA NA E
A6552 GRAD COM STOCKING BK 30-40 PRXOVR DEF         NA NA NA Y
A6552 GRAD COM STOCKING BK 30-40 MANUAL DEF         NA NA NA Y
A6553 G COM STCKING BK 30-40 CUSTM PRXOVR DEF         NA NA NA Y
A6553 G COM STCKING BK 30-40 CUSTM MANUAL DEF         NA NA NA Y
A6554 GRAD COM STOCKING BK 40+ PRXOVR DEF         NA NA NA Y
A6554 GRAD COM STOCKING BK 40+ MANUAL DEF         NA NA NA Y
A6555 G COM STCKING BK 40+ CUSTM PRXOVR DEF         NA NA NA Y
A6555 G COM STCKING BK 40+ CUSTM MANUAL DEF         NA NA NA Y
A6556 G COM STCKING THGH18-30 CUST PRXOVR DEF         NA NA NA Y
A6556 G COM STCKING THGH18-30 CUST MANUAL DEF         NA NA NA Y
A6557 G COM STCKING THGH30-40 CUST PRXOVR DEF         NA NA NA Y
A6557 G COM STCKING THGH30-40 CUST MANUAL DEF         NA NA NA Y
A6558 G COM STCKING THGH 40+ CUST PRXOVR DEF         NA NA NA Y
A6558 G COM STCKING THGH 40+ CUST MANUAL DEF         NA NA NA Y
A6559 G STCKNG FULL/CHAP18-30 CUST PRXOVR DEF         NA NA NA Y
A6559 G STCKNG FULL/CHAP18-30 CUST MANUAL DEF         NA NA NA Y
A6560 G STCKNG FULL/CHAP30-40 CUST PRXOVR DEF         NA NA NA Y
A6560 G STCKNG FULL/CHAP30-40 CUST MANUAL DEF         NA NA NA Y
A6561 G STOCKNG FULL/CHAP 40+ CUST PRXOVR DEF         NA NA NA Y
A6561 G STOCKNG FULL/CHAP 40+ CUST MANUAL DEF         NA NA NA Y
A6562 G COM STCKNG WAIST18-30 CUST PRXOVR DEF         NA NA NA Y
A6562 G COM STCKNG WAIST18-30 CUST MANUAL DEF         NA NA NA Y
A6563 G COM STCKNG WAIST30-40 CUST PRXOVR DEF         NA NA NA Y
A6563 G COM STCKNG WAIST30-40 CUST MANUAL DEF         NA NA NA Y
A6564 G COM STCKNG WAIST 40+ CUST PRXOVR DEF         NA NA NA Y
A6564 G COM STCKNG WAIST 40+ CUST MANUAL DEF         NA NA NA Y
A6565 GRAD COMP GAUNTLET CUSTOM PRXOVR DEF         NA NA NA Y
A6565 GRAD COMP GAUNTLET CUSTOM MANUAL DEF         NA NA NA Y
A6566 GRAD COM GARMENT NECK/HEAD PRXOVR DEF         NA NA NA Y
A6566 GRAD COM GARMENT NECK/HEAD MANUAL DEF         NA NA NA Y
A6567 G COM GARMENT NECK/HEAD CUST PRXOVR DEF         NA NA NA Y
A6567 G COM GARMENT NECK/HEAD CUST MANUAL DEF         NA NA NA Y
A6568 G COM GARMENT TORSO/SHLDR PRXOVR DEF         NA NA NA Y
A6568 G COM GARMENT TORSO/SHLDR MANUAL DEF         NA NA NA Y
A6569 G COM GARMNT TORSO/SHDR CUST PRXOVR DEF         NA NA NA Y
A6569 G COM GARMNT TORSO/SHDR CUST MANUAL DEF         NA NA NA Y
A6570 GRAD COM GARMENT GENITAL PRXOVR DEF         NA NA NA Y
A6570 GRAD COM GARMENT GENITAL MANUAL DEF         NA NA NA Y
A6571 G COM GARMENT GENITAL CUSTM PRXOVR DEF         NA NA NA Y
A6571 G COM GARMENT GENITAL CUSTM MANUAL DEF         NA NA NA Y
A6572 GRAD COM GARMENT TOE CAPS PRXOVR DEF         NA NA NA Y
A6572 GRAD COM GARMENT TOE CAPS MANUAL DEF         NA NA NA Y
A6573 GRAD COM GARMNT TOE CAP CUST PRXOVR DEF         NA NA NA Y
A6573 GRAD COM GARMNT TOE CAP CUST MANUAL DEF         NA NA NA Y
A6574 CUSTOM GRADIENT SLEEV/GLOV PRXOVR DEF         NA NA NA Y
A6574 CUSTOM GRADIENT SLEEV/GLOV MANUAL DEF         NA NA NA Y
A6575 GRADIENT COMP SLEEV/GLOV PRXOVR DEF         NA NA NA Y
A6575 GRADIENT COMP SLEEV/GLOV MANUAL DEF         NA NA NA Y
A6576 CUSTOM GRAD COM SLEEVE MED PRXOVR DEF         NA NA NA Y
A6576 CUSTOM GRAD COM SLEEVE MED MANUAL DEF         NA NA NA Y
A6577 CUSTOM GRAD CM SLEEVE HEAVY PRXOVR DEF         NA NA NA Y
A6577 CUSTOM GRAD CM SLEEVE HEAVY MANUAL DEF         NA NA NA Y
A6578 GRADIENT COMP SLEEVE PRXOVR DEF         NA NA NA Y
A6578 GRADIENT COMP SLEEVE MANUAL DEF         NA NA NA Y
A6579 CUSTOM GRAD COM GLOVE MED PRXOVR DEF         NA NA NA Y
A6579 CUSTOM GRAD COM GLOVE MED MANUAL DEF         NA NA NA Y
A6580 CUSTOM GRAD COM GLOVE HEAVY PRXOVR DEF         NA NA NA Y
A6580 CUSTOM GRAD COM GLOVE HEAVY MANUAL DEF         NA NA NA Y
A6581 GRADIENT COMP GLOVE PRXOVR DEF         NA NA NA Y
A6581 GRADIENT COMP GLOVE MANUAL DEF         NA NA NA Y
A6582 GRADIENT COMP GAUNTLET PRXOVR DEF         NA NA NA Y
A6582 GRADIENT COMP GAUNTLET MANUAL DEF         NA NA NA Y
A6583 GRAD COM WRAP W STRAPS BK PRXOVR DEF         NA NA NA Y
A6583 GRAD COM WRAP W STRAPS BK MANUAL DEF         NA NA NA Y
A6584 GRAD COM WRAP W STRAPS PRXOVR DEF         NA NA NA Y
A6584 GRAD COM WRAP W STRAPS MANUAL DEF         NA NA NA Y
A6585 GRAD COM WRAP W STRAPS AK PRXOVR DEF         NA NA NA Y
A6585 GRAD COM WRAP W STRAPS AK MANUAL DEF         NA NA NA Y
A6586 GRAD COM WRAP W STRAPS LEG PRXOVR DEF         NA NA NA Y
A6586 GRAD COM WRAP W STRAPS LEG MANUAL DEF         NA NA NA Y
A6587 GRAD COM WRAP W STRAPS FOOT PRXOVR DEF         NA NA NA Y
A6587 GRAD COM WRAP W STRAPS FOOT MANUAL DEF         NA NA NA Y
A6588 GRAD COM WRAP W STRAPS ARM PRXOVR DEF         NA NA NA Y
A6588 GRAD COM WRAP W STRAPS ARM MANUAL DEF         NA NA NA Y
A6589 GRAD COM WRAP W STRAPS BRA PRXOVR DEF         NA NA NA Y
A6589 GRAD COM WRAP W STRAPS BRA MANUAL DEF         NA NA NA Y
A6590 URINARY CATH DISP SUC PUMP PRXOVR DEF         NA NA NA S
A6590 URINARY CATH DISP SUC PUMP MAXFEE DEF         259.20 4/1/2023 12/31/2299 S
A6591 URINARY CATH SUC PUMP PRXOVR DEF         NA NA NA S
A6591 URINARY CATH SUC PUMP MAXFEE DEF         54.40 4/1/2023 12/31/2299 S
A6593 GRAD COM ACCESSORY GMT_WRAP PRXOVR DEF         NA NA NA Y
A6593 GRAD COM ACCESSORY GMT_WRAP MANUAL DEF         NA NA NA Y
A6594 G COMP BANDGE LINER LWR EXTR PRXOVR DEF         NA NA NA Y
A6594 G COMP BANDGE LINER LWR EXTR MANUAL DEF         NA NA NA Y
A6595 G COMP BANDGE LINER UPR EXTR PRXOVR DEF         NA NA NA Y
A6595 G COMP BANDGE LINER UPR EXTR MANUAL DEF         NA NA NA Y
A6596 G COMP BANDGE CONFORM GAUZE PRXOVR DEF         NA NA NA Y
A6596 G COMP BANDGE CONFORM GAUZE MANUAL DEF         NA NA NA Y
A6597 G COMP BANDAGE LONG STRETCH PRXOVR DEF         NA NA NA Y
A6597 G COMP BANDAGE LONG STRETCH MANUAL DEF         NA NA NA Y
A6598 G COMP BANDAGE MED STRETCH PRXOVR DEF         NA NA NA Y
A6598 G COMP BANDAGE MED STRETCH MANUAL DEF         NA NA NA Y
A6599 G COMP BANDAGE SHORT STRETCH PRXOVR DEF         NA NA NA Y
A6599 G COMP BANDAGE SHORT STRETCH MANUAL DEF         NA NA NA Y
A6600 G COM BANDGE HGH DN FOAM SHT PRXOVR DEF         NA NA NA Y
A6600 G COM BANDGE HGH DN FOAM SHT MANUAL DEF         NA NA NA Y
A6601 G COM BANDGE HGH DN FOAM PAD PRXOVR DEF         NA NA NA Y
A6601 G COM BANDGE HGH DN FOAM PAD MANUAL DEF         NA NA NA Y
A6602 G COM BANDGE HGH DN FOAMROLL PRXOVR DEF         NA NA NA Y
A6602 G COM BANDGE HGH DN FOAMROLL MANUAL DEF         NA NA NA Y
A6603 G COM BANDGE LOW DN FOAMCHNL PRXOVR DEF         NA NA NA Y
A6603 G COM BANDGE LOW DN FOAMCHNL MANUAL DEF         NA NA NA Y
A6604 G COM BANDGE LOW DN FOAM FLT PRXOVR DEF         NA NA NA Y
A6604 G COM BANDGE LOW DN FOAM FLT MANUAL DEF         NA NA NA Y
A6605 G COM BANDAGE PADDED FOAM PRXOVR DEF         NA NA NA Y
A6605 G COM BANDAGE PADDED FOAM MANUAL DEF         NA NA NA Y
A6606 G COM BANDAGE PADDED TEXTILE PRXOVR DEF         NA NA NA Y
A6606 G COM BANDAGE PADDED TEXTILE MANUAL DEF         NA NA NA Y
A6607 G COM BANDAGE TUB PROTCT LYR PRXOVR DEF         NA NA NA Y
A6607 G COM BANDAGE TUB PROTCT LYR MANUAL DEF         NA NA NA Y
A6608 G COM BANDAGE TUB PROTCT PAD PRXOVR DEF         NA NA NA Y
A6608 G COM BANDAGE TUB PROTCT PAD MANUAL DEF         NA NA NA Y
A6609 G COMPRESSION BANDAGING PRXOVR DEF         NA NA NA Y
A6609 G COMPRESSION BANDAGING MANUAL DEF         NA NA NA Y
A6610 G COM STCKING BK 18-30 CUSTM PRXOVR DEF         NA NA NA Y
A6610 G COM STCKING BK 18-30 CUSTM MANUAL DEF         NA NA NA Y
A7000 DISPOSABLE CANISTER FOR PUMP PRXOVR DEF         NA NA NA S
A7000 DISPOSABLE CANISTER FOR PUMP MAXFEE DEF         7.50 1/1/2000 12/31/2299 S
A7001 NONDISPOSABLE PUMP CANISTER PRXOVR DEF         NA NA NA E
A7001 NONDISPOSABLE PUMP CANISTER MANUAL DEF         NA NA NA E
A7002 TUBING USED W SUCTION PUMP PRXOVR DEF         NA NA NA S
A7002 TUBING USED W SUCTION PUMP MAXFEE DEF         3.75 1/1/2000 12/31/2299 S
A7003 NEBULIZER ADMINISTRATION SET PRXOVR DEF         NA NA NA S
A7003 NEBULIZER ADMINISTRATION SET MAXFEE DEF         2.15 1/1/2000 12/31/2299 S
A7004 DISPOSABLE NEBULIZER SML VOL PRXOVR DEF         NA NA NA S
A7004 DISPOSABLE NEBULIZER SML VOL MAXFEE DEF         1.44 10/1/2004 12/31/2299 S
A7005 NONDISPOSABLE NEBULIZER SET PRXOVR DEF         NA NA NA S
A7005 NONDISPOSABLE NEBULIZER SET MAXFEE DEF         20 1/1/2000 12/31/2299 S
A7006 FILTERED NEBULIZER ADMIN SET PRXOVR DEF         NA NA NA S
A7006 FILTERED NEBULIZER ADMIN SET MAXFEE DEF         8 1/1/2000 12/31/2299 S
A7007 LG VOL NEBULIZER DISPOSABLE PRXOVR DEF         NA NA NA S
A7007 LG VOL NEBULIZER DISPOSABLE MAXFEE DEF         4 10/1/2004 12/31/2299 S
A7008 DISPOSABLE NEBULIZER PREFILL PRXOVR DEF         NA NA NA E
A7008 DISPOSABLE NEBULIZER PREFILL MANUAL DEF         NA NA NA E
A7009 NEBULIZER RESERVOIR BOTTLE PRXOVR DEF         NA NA NA E
A7009 NEBULIZER RESERVOIR BOTTLE MANUAL DEF         NA NA NA E
A7010 DISPOSABLE CORRUGATED TUBING PRXOVR DEF         NA NA NA E
A7010 DISPOSABLE CORRUGATED TUBING MANUAL DEF         NA NA NA E
A7012 NEBULIZER WATER COLLEC DEVIC PRXOVR DEF         NA NA NA S
A7012 NEBULIZER WATER COLLEC DEVIC MAXFEE DEF         1.80 1/1/2000 12/31/2299 S
A7013 DISPOSABLE COMPRESSOR FILTER PRXOVR DEF         NA NA NA E
A7013 DISPOSABLE COMPRESSOR FILTER MANUAL DEF         NA NA NA E
A7014 COMPRESSOR NONDISPOS FILTER PRXOVR DEF         NA NA NA E
A7014 COMPRESSOR NONDISPOS FILTER MANUAL DEF         NA NA NA E
A7015 AEROSOL MASK USED W NEBULIZE PRXOVR DEF         NA NA NA S
A7015 AEROSOL MASK USED W NEBULIZE MAXFEE DEF         1.63 7/1/2002 12/31/2299 S
A7016 NEBULIZER DOME & MOUTHPIECE PRXOVR DEF         NA NA NA E
A7016 NEBULIZER DOME & MOUTHPIECE MANUAL DEF         NA NA NA E
A7017 NEBULIZER NOT USED W OXYGEN PRXOVR DEF         NA NA NA E
A7017 NEBULIZER NOT USED W OXYGEN MANUAL DEF         NA NA NA E
A7018 WATER DISTILLED W/NEBULIZER PRXOVR DEF         NA NA NA S
A7018 WATER DISTILLED W/NEBULIZER MAXFEE DEF         0.28 1/1/2001 12/31/2299 S
A7023 MECH ALLERGEN PARTI BARRIER PRXOVR DEF         NA NA NA Y
A7023 MECH ALLERGEN PARTI BARRIER MANUAL DEF         NA NA NA Y
A7030 CPAP FULL FACE MASK PRXOVR DEF         NA NA NA S
A7030 CPAP FULL FACE MASK MAXFEE DEF         113.18 4/20/2006 12/31/2299 S
A7031 REPLACEMENT FACEMASK INTERFA PRXOVR DEF         NA NA NA N
A7031 REPLACEMENT FACEMASK INTERFA MAXFEE DEF         51.12 2/1/2016 12/31/2299 N
A7032 REPLACEMENT NASAL CUSHION PRXOVR DEF         NA NA NA S
A7032 REPLACEMENT NASAL CUSHION MAXFEE DEF         21.36 10/1/2004 12/31/2299 S
A7033 REPLACEMENT NASAL PILLOWS PRXOVR DEF         NA NA NA S
A7033 REPLACEMENT NASAL PILLOWS MAXFEE DEF         21.36 10/1/2004 12/31/2299 S
A7034 NASAL APPLICATION DEVICE PRXOVR DEF         NA NA NA S
A7034 NASAL APPLICATION DEVICE MAXFEE DEF         66.71 10/1/2004 12/31/2299 S
A7035 POS AIRWAY PRESS HEADGEAR PRXOVR DEF         NA NA NA S
A7035 POS AIRWAY PRESS HEADGEAR MAXFEE DEF         34.95 4/1/2003 12/31/2299 S
A7036 POS AIRWAY PRESS CHINSTRAP PRXOVR DEF         NA NA NA S
A7036 POS AIRWAY PRESS CHINSTRAP MAXFEE DEF         13.60 4/1/2003 12/31/2299 S
A7037 POS AIRWAY PRESSURE TUBING PRXOVR DEF         NA NA NA S
A7037 POS AIRWAY PRESSURE TUBING MAXFEE DEF         28.75 4/1/2003 12/31/2299 S
A7038 POS AIRWAY PRESSURE FILTER PRXOVR DEF         NA NA NA S
A7038 POS AIRWAY PRESSURE FILTER MAXFEE DEF         3.25 4/1/2003 12/31/2299 S
A7039 FILTER; NON DISPOSABLE W PAP PRXOVR DEF         NA NA NA S
A7039 FILTER; NON DISPOSABLE W PAP MAXFEE DEF         12.30 4/1/2003 12/31/2299 S
A7044 PAP ORAL INTERFACE PRXOVR DEF         NA NA NA E
A7044 PAP ORAL INTERFACE MANUAL DEF         NA NA NA E
A7048 VACUUM DRAIN BOTTLE/TUBE KIT PRXOVR DEF         NA NA NA Y
A7048 VACUUM DRAIN BOTTLE/TUBE KIT MAXFEE DEF         37.58 1/1/2015 12/31/2299 Y
A7049 EPAP NASAL VALVE PRXOVR DEF         NA NA NA Y S
A7049 EPAP NASAL VALVE MAXFEE DEF         97.60 4/1/2023 12/31/2299 Y S
A7504 TRACHEOSTOMA HMES FILTER PRXOVR DEF         NA NA NA N
A7504 TRACHEOSTOMA HMES FILTER MAXFEE DEF         0.54 10/1/2004 12/31/2299 N
A7505 HMES OR TRACH VALVE HOUSING PRXOVR DEF         NA NA NA N
A7505 HMES OR TRACH VALVE HOUSING MAXFEE DEF         3.74 10/1/2004 12/31/2299 N
A7506 HMES/TRACHVALVE ADHESIVEDISK PRXOVR DEF         NA NA NA N
A7506 HMES/TRACHVALVE ADHESIVEDISK MAXFEE DEF         0.26 10/1/2004 12/31/2299 N
A7507 INTEGRATED FILTER & HOLDER PRXOVR DEF         NA NA NA N
A7507 INTEGRATED FILTER & HOLDER MAXFEE DEF         1.99 10/1/2004 12/31/2299 N
A7508 HOUSING & INTEGRATED ADHESIV PRXOVR DEF         NA NA NA N
A7508 HOUSING & INTEGRATED ADHESIV MAXFEE DEF         2.30 10/1/2004 12/31/2299 N
A7509 HEAT & MOISTURE EXCHANGE SYS PRXOVR DEF         NA NA NA N
A7509 HEAT & MOISTURE EXCHANGE SYS MAXFEE DEF         1.13 10/1/2004 12/31/2299 N
A7520 TRACH/LARYN TUBE NON-CUFFED PRXOVR DEF         NA NA NA Y S
A7520 TRACH/LARYN TUBE NON-CUFFED MAXFEE UC2         100 7/1/2018 12/31/2299 Y S
A7520 TRACH/LARYN TUBE NON-CUFFED MAXFEE UC3         60 7/1/2018 12/31/2299 Y S
A7520 TRACH/LARYN TUBE NON-CUFFED MAXFEE DEF         47.48 10/1/2004 12/31/2299 Y S
A7520 TRACH/LARYN TUBE NON-CUFFED MAXFEE UC1         389.55 4/1/2016 12/31/2299 Y S
A7521 TRACH/LARYN TUBE CUFFED PRXOVR DEF         NA NA NA Y S
A7521 TRACH/LARYN TUBE CUFFED MAXFEE UC2         220 7/1/2018 12/31/2299 Y S
A7521 TRACH/LARYN TUBE CUFFED MAXFEE UC3         75 7/1/2018 12/31/2299 Y S
A7521 TRACH/LARYN TUBE CUFFED MAXFEE DEF         47.05 10/1/2004 12/31/2299 Y S
A7521 TRACH/LARYN TUBE CUFFED MAXFEE UC1         404.25 4/1/2016 12/31/2299 Y S
A7522 TRACH/LARYN TUBE STAINLESS PRXOVR DEF         NA NA NA S
A7522 TRACH/LARYN TUBE STAINLESS MAXFEE DEF         45.16 10/1/2004 12/31/2299 S
A7523 TRACHEOSTOMY SHOWER PROTECT PRXOVR DEF         NA NA NA E
A7523 TRACHEOSTOMY SHOWER PROTECT MANUAL DEF         NA NA NA E
A7524 TRACHEOSTOMA STENT/STUD/BTTN PRXOVR DEF         NA NA NA E
A7524 TRACHEOSTOMA STENT/STUD/BTTN MANUAL DEF         NA NA NA E
A7525 TRACHEOSTOMY MASK PRXOVR DEF         NA NA NA S
A7525 TRACHEOSTOMY MASK MAXFEE DEF         2.06 1/1/2024 12/31/2299 S
A7526 TRACHEOSTOMY TUBE COLLAR PRXOVR DEF         NA NA NA S
A7526 TRACHEOSTOMY TUBE COLLAR MAXFEE DEF         3.38 1/1/2024 12/31/2299 S
A7527 TRACH/LARYN TUBE PLUG/STOP PRXOVR DEF         NA NA NA E
A7527 TRACH/LARYN TUBE PLUG/STOP MANUAL DEF         NA NA NA E
A8004 REPL SOFT INTERFACE; HELMET PRXOVR DEF         NA NA NA E
A8004 REPL SOFT INTERFACE; HELMET MANUAL DEF         NA NA NA E
A9270 NON-COVERED ITEM OR SERVICE PRXOVR DEF         NA NA NA E
A9270 NON-COVERED ITEM OR SERVICE MANUAL DEF         NA NA NA E
A9272 DISP WOUND SUCT; DRSG/ACCESS PRXOVR DEF         NA NA NA E
A9272 DISP WOUND SUCT; DRSG/ACCESS MANUAL DEF         NA NA NA E
A9273 HOT/COLD BOTLE/CAP/COL/WRAP PRXOVR DEF         NA NA NA N
A9273 HOT/COLD BOTLE/CAP/COL/WRAP MAXFEE DEF         7.50 1/1/2011 12/31/2299 N
A9274 EXT AMB INSULIN DELIVERY SYS PRXOVR DEF         NA NA NA Y
A9274 EXT AMB INSULIN DELIVERY SYS MAXFEE DEF         48.15 1/1/2019 12/31/2299 Y
A9275 DISP HOME GLUCOSE MONITOR PRXOVR DEF         NA NA NA E
A9275 DISP HOME GLUCOSE MONITOR MANUAL DEF         NA NA NA E
A9276 DISPOSABLE SENSOR; CGM SYS PRXOVR DEF         NA NA NA Y
A9276 DISPOSABLE SENSOR; CGM SYS MAXFEE DEF         12.26 7/16/2018 12/31/2299 Y
A9277 EXTERNAL TRANSMITTER; CGM PRXOVR DEF         NA NA NA Y
A9277 EXTERNAL TRANSMITTER; CGM MAXFEE DEF         522.30 7/16/2018 12/31/2299 Y
A9278 EXTERNAL RECEIVER; CGM SYS PRXOVR DEF         NA NA NA Y
A9278 EXTERNAL RECEIVER; CGM SYS MAXFEE DEF         522.30 7/16/2018 12/31/2299 Y
A9279 MONITORING FEATURE/DEVICENOC PRXOVR DEF         NA NA NA E
A9279 MONITORING FEATURE/DEVICENOC MANUAL DEF         NA NA NA E
A9283 FOOT PRESS OFF LOAD SUPP DEV PRXOVR DEF         NA NA NA E
A9283 FOOT PRESS OFF LOAD SUPP DEV MANUAL DEF         NA NA NA E
A9284 NON-ELECTRONIC SPIROMETER PRXOVR DEF         NA NA NA E
A9284 NON-ELECTRONIC SPIROMETER MANUAL DEF         NA NA NA E
A9285 INVERSION EVERSION COR DEVIC PRXOVR DEF         NA NA NA E
A9285 INVERSION EVERSION COR DEVIC MANUAL DEF         NA NA NA E
A9286 ANY HYGIENIC ITEM; DEVICE PRXOVR DEF         NA NA NA E
A9286 ANY HYGIENIC ITEM; DEVICE MANUAL DEF         NA NA NA E
A9574 AIR POLY INTRAUTERINE FOAM PRXOVR DEF         NA NA NA S
A9574 AIR POLY INTRAUTERINE FOAM MANUAL DEF         NA NA NA S
A9900 SUPPLY/ACCESSORY/SERVICE PRXOVR DEF         NA NA NA E
A9900 SUPPLY/ACCESSORY/SERVICE MANUAL DEF         NA NA NA E
B4034 ENTER FEED SUPKIT SYR BY DAY PRXOVR DEF         NA NA NA S
B4034 ENTER FEED SUPKIT SYR BY DAY MAXFEE DEF         3.72 1/1/2010 12/31/2299 S
B4035 ENTERAL FEED SUPP PUMP PER D PRXOVR DEF         NA NA NA S
B4035 ENTERAL FEED SUPP PUMP PER D MAXFEE DEF         7.60 1/1/2024 12/31/2299 S
B4036 ENTERAL FEED SUP KIT GRAV BY PRXOVR DEF         NA NA NA S
B4036 ENTERAL FEED SUP KIT GRAV BY MAXFEE DEF         4.85 1/1/2010 12/31/2299 S
B4081 ENTERAL NG TUBING W/ STYLET PRXOVR DEF         NA NA NA S
B4081 ENTERAL NG TUBING W/ STYLET MAXFEE DEF         19.19 1/1/2010 12/31/2299 S
B4082 ENTERAL NG TUBING W/O STYLET PRXOVR DEF         NA NA NA S
B4082 ENTERAL NG TUBING W/O STYLET MAXFEE DEF         14.29 1/1/2010 12/31/2299 S
B4083 ENTERAL STOMACH TUBE LEVINE PRXOVR DEF         NA NA NA S
B4083 ENTERAL STOMACH TUBE LEVINE MAXFEE DEF         2.05 1/1/2010 12/31/2299 S
B4086 GASTROSTOMY/JEJUNOSTOMY TUBE PRXOVR DEF         NA NA NA S
B4086 GASTROSTOMY/JEJUNOSTOMY TUBE MAXFEE DEF         0 1/1/2008 12/31/2299 S
B4087 GASTRO/JEJUNO TUBE; STD PRXOVR DEF         NA NA NA N
B4087 GASTRO/JEJUNO TUBE; STD MAXFEE DEF         29.66 1/1/2010 12/31/2299 N
B4088 GASTRO/JEJUNO TUBE; LOW-PRO PRXOVR DEF         NA NA NA N
B4088 GASTRO/JEJUNO TUBE; LOW-PRO MAXFEE DEF         160 1/1/2024 12/31/2299 N
B4100 FOOD THICKENER ORAL PRXOVR DEF         NA NA NA N
B4100 FOOD THICKENER ORAL MAXFEE DEF         0.75 1/1/2024 12/31/2299 N
B4100 FOOD THICKENER ORAL MAXFEE UC1         1.62 2/1/2018 12/31/2299 N
B4102 EF ADULT FLUIDS AND ELECTRO PRXOVR DEF         NA NA NA E
B4102 EF ADULT FLUIDS AND ELECTRO MAXFEE DEF         0.60 6/1/2014 12/31/2299 E
B4103 EF PED FLUID AND ELECTROLYTE PRXOVR DEF         NA NA NA E
B4103 EF PED FLUID AND ELECTROLYTE MAXFEE DEF         0.60 6/1/2014 12/31/2299 E
B4104 ADDITIVE FOR ENTERAL FORMULA PRXOVR DEF         NA NA NA E
B4104 ADDITIVE FOR ENTERAL FORMULA PADOLR DEF         NA NA NA E
B4105 ENZYME CARTRIDGE ENTERAL NUT PRXOVR DEF         NA NA NA Y
B4105 ENZYME CARTRIDGE ENTERAL NUT PADOLR DEF         NA NA NA Y
B4148 ENTERAL FEED ELASTOMER DAILY PRXOVR DEF         NA NA NA Y
B4148 ENTERAL FEED ELASTOMER DAILY MAXFEE DEF         7 10/1/2023 12/31/2299 Y
B4149 EF BLENDERIZED FOODS PRXOVR DEF         NA NA NA Y
B4149 EF BLENDERIZED FOODS MAXFEE DEF         1.35 1/1/2024 12/31/2299 Y
B4149 EF BLENDERIZED FOODS MAXFEE UC1         2.30 1/1/2024 12/31/2299 Y
B4150 EF COMPLET W/INTACT NUTRIENT PRXOVR DEF         NA NA NA S
B4150 EF COMPLET W/INTACT NUTRIENT MAXFEE DEF         0.70 1/1/2024 12/31/2299 S
B4151 ENTERAL FORMULAE CAT1NATURAL PRXOVR DEF         NA NA NA Y
B4151 ENTERAL FORMULAE CAT1NATURAL MAXFEE DEF         NA     Y
B4152 EF CALORIE DENSE>/=1.5KCAL PRXOVR DEF         NA NA NA S
B4152 EF CALORIE DENSE>/=1.5KCAL MAXFEE DEF         0.57 1/1/2024 12/31/2299 S
B4153 EF HYDROLYZED/AMINO ACIDS PRXOVR DEF         NA NA NA S
B4153 EF HYDROLYZED/AMINO ACIDS MAXFEE DEF         2.70 1/1/2024 12/31/2299 S
B4154 EF SPEC METABOLIC NONINHERIT PRXOVR DEF         NA NA NA Y S
B4154 EF SPEC METABOLIC NONINHERIT MAXFEE DEF         1.05 1/1/2024 12/31/2299 Y S
B4154 EF SPEC METABOLIC NONINHERIT MAXFEE UC1         1.80 1/1/2024 12/31/2299 Y S
B4155 EF INCOMPLETE/MODULAR PRXOVR DEF         NA NA NA Y S
B4155 EF INCOMPLETE/MODULAR MAXFEE DEF         1 1/1/2024 12/31/2299 Y S
B4155 EF INCOMPLETE/MODULAR MAXFEE UC1         20 7/1/2021 12/31/2299 Y S
B4156 ENTERAL FORMULAE CATEGORY VI PRXOVR DEF         NA NA NA Y
B4156 ENTERAL FORMULAE CATEGORY VI MAXFEE DEF         NA     Y
B4157 EF SPECIAL METABOLIC INHERIT PRXOVR DEF         NA NA NA Y
B4157 EF SPECIAL METABOLIC INHERIT PADOLR DEF         NA NA NA Y
B4158 EF PED COMPLETE INTACT NUT PRXOVR DEF         NA NA NA Y
B4158 EF PED COMPLETE INTACT NUT PADOLR DEF         NA NA NA Y
B4159 EF PED COMPLETE SOY BASED PRXOVR DEF         NA NA NA Y
B4159 EF PED COMPLETE SOY BASED PADOLR DEF         NA NA NA Y
B4160 EF PED CALORIC DENSE>/=0.7KC PRXOVR DEF         NA NA NA Y
B4160 EF PED CALORIC DENSE>/=0.7KC PADOLR DEF         NA NA NA Y
B4161 EF PED HYDROLYZED/AMINO ACID PRXOVR DEF         NA NA NA Y
B4161 EF PED HYDROLYZED/AMINO ACID PADOLR DEF         NA NA NA Y
B4162 EF PED SPECMETABOLIC INHERIT PRXOVR DEF         NA NA NA Y
B4162 EF PED SPECMETABOLIC INHERIT PADOLR DEF         NA NA NA Y
B4164 PARENTERAL 50% DEXTROSE SOLU PRXOVR DEF         NA NA NA E
B4164 PARENTERAL 50% DEXTROSE SOLU MANUAL DEF         NA NA NA E
B4168 PARENTERAL SOL AMINO ACID 3. PRXOVR DEF         NA NA NA E
B4168 PARENTERAL SOL AMINO ACID 3. MANUAL DEF         NA NA NA E
B4172 PARENTERAL SOL AMINO ACID 5. PRXOVR DEF         NA NA NA E
B4172 PARENTERAL SOL AMINO ACID 5. MANUAL DEF         NA NA NA E
B4176 PARENTERAL SOL AMINO ACID 7- PRXOVR DEF         NA NA NA E
B4176 PARENTERAL SOL AMINO ACID 7- MANUAL DEF         NA NA NA E
B4178 PARENTERAL SOL AMINO ACID > PRXOVR DEF         NA NA NA E
B4178 PARENTERAL SOL AMINO ACID > MANUAL DEF         NA NA NA E
B4180 PARENTERAL SOL CARB > 50% PRXOVR DEF         NA NA NA E
B4180 PARENTERAL SOL CARB > 50% MANUAL DEF         NA NA NA E
B4185 PN SOLN NOS 10 GRAMS LIPIDS PRXOVR DEF         NA NA NA E
B4185 PN SOLN NOS 10 GRAMS LIPIDS MANUAL DEF         NA NA NA E
B4187 OMEGAVEN; 10 GRAMS LIPIDS PRXOVR DEF         NA NA NA E
B4187 OMEGAVEN; 10 GRAMS LIPIDS MANUAL DEF         NA NA NA E
B4189 PARENTERAL SOL AMINO ACID & PRXOVR DEF         NA NA NA E
B4189 PARENTERAL SOL AMINO ACID & MANUAL DEF         NA NA NA E
B4193 PARENTERAL SOL 52-73 GM PROT PRXOVR DEF         NA NA NA E
B4193 PARENTERAL SOL 52-73 GM PROT MANUAL DEF         NA NA NA E
B4197 PARENTERAL SOL 74-100 GM PRO PRXOVR DEF         NA NA NA E
B4197 PARENTERAL SOL 74-100 GM PRO MANUAL DEF         NA NA NA E
B4199 PARENTERAL SOL > 100GM PROTE PRXOVR DEF         NA NA NA E
B4199 PARENTERAL SOL > 100GM PROTE MANUAL DEF         NA NA NA E
B4216 PARENTERAL NUTRITION ADDITIV PRXOVR DEF         NA NA NA E
B4216 PARENTERAL NUTRITION ADDITIV MANUAL DEF         NA NA NA E
B4220 PARENTERAL SUPPLY KIT PREMIX PRXOVR DEF         NA NA NA S
B4220 PARENTERAL SUPPLY KIT PREMIX MAXFEE DEF         4.53 1/1/2010 12/31/2299 S
B4222 PARENTERAL SUPPLY KIT HOMEMI PRXOVR DEF         NA NA NA N
B4222 PARENTERAL SUPPLY KIT HOMEMI MAXFEE DEF         6.95 1/1/2010 12/31/2299 N
B4224 PARENTERAL ADMINISTRATION KI PRXOVR DEF         NA NA NA S
B4224 PARENTERAL ADMINISTRATION KI MAXFEE DEF         14.55 11/29/2010 12/31/2299 S
B5000 PARENTERAL SOL RENAL-AMIROSY PRXOVR DEF         NA NA NA E
B5000 PARENTERAL SOL RENAL-AMIROSY MANUAL DEF         NA NA NA E
B5100 PARENTERAL SOLUTION HEPATIC PRXOVR DEF         NA NA NA E
B5100 PARENTERAL SOLUTION HEPATIC MANUAL DEF         NA NA NA E
B5200 PARENTERAL SOL HEPATIC FREAM PRXOVR DEF         NA NA NA E
B5200 PARENTERAL SOL HEPATIC FREAM MANUAL DEF         NA NA NA E
B9998 ENTERAL SUPP NOT OTHERWISE C PRXOVR DEF         NA NA NA Y S
B9998 ENTERAL SUPP NOT OTHERWISE C PADOLR DEF         NA NA NA Y S
B9998 ENTERAL SUPP NOT OTHERWISE C MAXFEE UC2         10 7/1/2021 12/31/2299 Y S
B9998 ENTERAL SUPP NOT OTHERWISE C MAXFEE UC1         17.50 1/1/2024 12/31/2299 Y S
B9999 PARENTERAL SUPP NOT OTHRWS C PRXOVR DEF         NA NA NA Y
B9999 PARENTERAL SUPP NOT OTHRWS C PADOLR DEF         NA NA NA Y
E0100 CANE ADJUST/FIXED WITH TIP PRXOVR DEF         NA NA NA N
E0100 CANE ADJUST/FIXED WITH TIP MAXFEE DEF         10.19 5/1/1990 12/31/2299 N
E0105 CANE ADJUST/FIXED QUAD/3 PRO PRXOVR DEF         NA NA NA N
E0105 CANE ADJUST/FIXED QUAD/3 PRO MAXFEE DEF         39.28 4/1/2006 12/31/2299 N
E0110 CRUTCH FOREARM PAIR PRXOVR DEF         NA NA NA N
E0110 CRUTCH FOREARM PAIR MAXFEE DEF         50 1/1/1992 12/31/2299 N
E0111 CRUTCH FOREARM EACH PRXOVR DEF         NA NA NA S
E0111 CRUTCH FOREARM EACH MAXFEE DEF         25 1/1/1992 12/31/2299 S
E0112 CRUTCH UNDERARM PAIR WOOD PRXOVR DEF         NA NA NA S
E0112 CRUTCH UNDERARM PAIR WOOD MAXFEE DEF         19.25 5/1/1990 12/31/2299 S
E0113 CRUTCH UNDERARM EACH WOOD PRXOVR DEF         NA NA NA S
E0113 CRUTCH UNDERARM EACH WOOD MAXFEE DEF         10.30 4/1/2006 12/31/2299 S
E0114 CRUTCH UNDERARM PAIR NO WOOD PRXOVR DEF         NA NA NA S
E0114 CRUTCH UNDERARM PAIR NO WOOD MAXFEE DEF         23.85 4/1/2006 12/31/2299 S
E0116 CRUTCH UNDERARM EACH NO WOOD PRXOVR DEF         NA NA NA S
E0116 CRUTCH UNDERARM EACH NO WOOD MAXFEE DEF         11.95 4/1/2006 12/31/2299 S
E0117 UNDERARM SPRINGASSIST CRUTCH PRXOVR DEF         NA NA NA E
E0117 UNDERARM SPRINGASSIST CRUTCH MANUAL DEF         NA NA NA E
E0118 CRUTCH SUBSTITUTE PRXOVR DEF         NA NA NA E
E0118 CRUTCH SUBSTITUTE MANUAL DEF         NA NA NA E
E0130 WALKER RIGID ADJUST/FIXED HT PRXOVR DEF         NA NA NA S
E0130 WALKER RIGID ADJUST/FIXED HT MAXFEE DEF         35 5/1/1990 12/31/2299 S
E0135 WALKER FOLDING ADJUST/FIXED PRXOVR DEF         NA NA NA N
E0135 WALKER FOLDING ADJUST/FIXED MAXFEE DEF         47 2/17/1991 12/31/2299 N
E0140 WALKER W TRUNK SUPPORT PRXOVR DEF         NA NA NA N
E0140 WALKER W TRUNK SUPPORT MAXFEE DEF         200 4/1/2006 12/31/2299 N
E0141 RIGID WHEELED WALKER ADJ/FIX PRXOVR DEF         NA NA NA S
E0141 RIGID WHEELED WALKER ADJ/FIX MAXFEE DEF         58 4/1/2006 12/31/2299 S
E0142 WALKER RIGID WHEELED WITH SE PRXOVR DEF         NA NA NA N
E0142 WALKER RIGID WHEELED WITH SE MAXFEE DEF         0 9/1/2005 12/31/2299 N
E0143 WALKER FOLDING WHEELED W/O S PRXOVR DEF         NA NA NA N
E0143 WALKER FOLDING WHEELED W/O S MAXFEE DEF         52.80 7/16/2018 12/31/2299 N
E0144 ENCLOSED WALKER W REAR SEAT PRXOVR DEF         NA NA NA N
E0144 ENCLOSED WALKER W REAR SEAT MAXFEE DEF         150 4/1/2006 12/31/2299 N
E0146 FOLDING WALKER WHEELS W SEAT PRXOVR DEF         NA NA NA N
E0146 FOLDING WALKER WHEELS W SEAT MAXFEE DEF         0 12/1/2005 12/31/2299 N
E0147 WALKER VARIABLE WHEEL RESIST PRXOVR DEF         NA NA NA N
E0147 WALKER VARIABLE WHEEL RESIST MAXFEE DEF         150 4/1/2006 12/31/2299 N
E0148 HEAVYDUTY WALKER NO WHEELS PRXOVR DEF         NA NA NA S
E0148 HEAVYDUTY WALKER NO WHEELS MAXFEE DEF         109.07 4/1/2006 12/31/2299 S
E0149 HEAVY DUTY WHEELED WALKER PRXOVR DEF         NA NA NA N
E0149 HEAVY DUTY WHEELED WALKER MAXFEE DEF         135 4/1/2006 12/31/2299 N
E0152 WALKER; BATTERY POWER WHEELS PRXOVR DEF         NA NA NA Y
E0152 WALKER; BATTERY POWER WHEELS PADOLR DEF         NA NA NA Y
E0153 FOREARM CRUTCH PLATFORM ATTA PRXOVR DEF         NA NA NA E
E0153 FOREARM CRUTCH PLATFORM ATTA MANUAL DEF         NA NA NA E
E0154 WALKER PLATFORM ATTACHMENT PRXOVR DEF         NA NA NA N
E0154 WALKER PLATFORM ATTACHMENT MAXFEE DEF         51.44 1/1/1999 12/31/2299 N
E0155 WALKER WHEEL ATTACHMENT;PAIR PRXOVR DEF         NA NA NA N
E0155 WALKER WHEEL ATTACHMENT;PAIR MAXFEE DEF         16.25 5/1/1990 12/31/2299 N
E0156 WALKER SEAT ATTACHMENT PRXOVR DEF         NA NA NA N
E0156 WALKER SEAT ATTACHMENT MAXFEE DEF         15 5/1/1990 12/31/2299 N
E0157 WALKER CRUTCH ATTACHMENT PRXOVR DEF         NA NA NA S
E0157 WALKER CRUTCH ATTACHMENT MAXFEE DEF         62.50 5/1/1990 12/31/2299 S
E0158 WALKER LEG EXTENDERS SET OF4 PRXOVR DEF         NA NA NA S
E0158 WALKER LEG EXTENDERS SET OF4 MAXFEE DEF         12.64 5/1/1990 12/31/2299 S
E0159 BRAKE FOR WHEELED WALKER PRXOVR DEF         NA NA NA S
E0159 BRAKE FOR WHEELED WALKER MAXFEE DEF         15 10/1/2004 12/31/2299 S
E0160 SITZ TYPE BATH OR EQUIPMENT PRXOVR DEF         NA NA NA E
E0160 SITZ TYPE BATH OR EQUIPMENT MANUAL DEF         NA NA NA E
E0161 SITZ BATH/EQUIPMENT W/FAUCET PRXOVR DEF         NA NA NA E
E0161 SITZ BATH/EQUIPMENT W/FAUCET MANUAL DEF         NA NA NA E
E0162 SITZ BATH CHAIR PRXOVR DEF         NA NA NA E
E0162 SITZ BATH CHAIR MANUAL DEF         NA NA NA E
E0163 COMMODE CHAIR WITH FIXED ARM PRXOVR DEF         NA NA NA N
E0163 COMMODE CHAIR WITH FIXED ARM MAXFEE DEF         52.80 4/1/2006 12/31/2299 N
E0164 COMMODE CHAIR MOBILE FIXED A PRXOVR DEF         NA NA NA S
E0164 COMMODE CHAIR MOBILE FIXED A MAXFEE DEF         0 1/1/2007 12/31/2299 S
E0165 COMMODE CHAIR WITH DETACHARM PRXOVR DEF         NA NA NA N
E0165 COMMODE CHAIR WITH DETACHARM MAXFEE DEF         104 4/1/2006 12/31/2299 N
E0166 COMMODE CHAIR MOBILE DETACH PRXOVR DEF         NA NA NA S
E0166 COMMODE CHAIR MOBILE DETACH MAXFEE DEF         0 1/1/2007 12/31/2299 S
E0167 COMMODE CHAIR PAIL OR PAN PRXOVR DEF         NA NA NA S
E0167 COMMODE CHAIR PAIL OR PAN MAXFEE DEF         5.25 5/1/1990 12/31/2299 S
E0168 HEAVYDUTY/WIDE COMMODE CHAIR PRXOVR DEF         NA NA NA N
E0168 HEAVYDUTY/WIDE COMMODE CHAIR MAXFEE DEF         129.56 4/1/2006 12/31/2299 N
E0170 COMMODE CHAIR ELECTRIC PRXOVR DEF         NA NA NA E
E0170 COMMODE CHAIR ELECTRIC MANUAL DEF         NA NA NA E
E0171 COMMODE CHAIR NON-ELECTRIC PRXOVR DEF         NA NA NA E
E0171 COMMODE CHAIR NON-ELECTRIC MANUAL DEF         NA NA NA E
E0172 SEAT LIFT MECHANISM TOILET PRXOVR DEF         NA NA NA E
E0172 SEAT LIFT MECHANISM TOILET MANUAL DEF         NA NA NA E
E0175 COMMODE CHAIR FOOT REST PRXOVR DEF         NA NA NA E
E0175 COMMODE CHAIR FOOT REST MANUAL DEF         NA NA NA E
E0176 AIR PRESSRE PAD/CUSHION NONP PRXOVR DEF         NA NA NA N
E0176 AIR PRESSRE PAD/CUSHION NONP MAXFEE DEF         NA     N
E0177 WATER PRESS PAD/CUSHION NONP PRXOVR DEF         NA NA NA N
E0177 WATER PRESS PAD/CUSHION NONP MAXFEE DEF         NA     N
E0180 PRESS PAD ALTERNATING W PUMP PRXOVR DEF         NA NA NA S
E0180 PRESS PAD ALTERNATING W PUMP MAXFEE DEF         0 1/1/2007 12/31/2299 S
E0181 PRESS PAD ALTERNATING W/ PUM PRXOVR DEF         NA NA NA N
E0181 PRESS PAD ALTERNATING W/ PUM MAXFEE DEF         148 4/1/2006 12/31/2299 N
E0182 REPLACE PUMP; ALT PRESS PAD PRXOVR DEF         NA NA NA S
E0182 REPLACE PUMP; ALT PRESS PAD MAXFEE DEF         105 11/1/1992 12/31/2299 S
E0183 PRESS UNDERLAY ALTER W/PUMP PRXOVR DEF         NA NA NA N
E0183 PRESS UNDERLAY ALTER W/PUMP MAXFEE DEF         148 10/1/2022 12/31/2299 N
E0184 DRY PRESSURE MATTRESS PRXOVR DEF         NA NA NA N
E0184 DRY PRESSURE MATTRESS MAXFEE DEF         150 7/1/2018 12/31/2299 N
E0185 GEL PRESSURE MATTRESS PAD PRXOVR DEF         NA NA NA N
E0185 GEL PRESSURE MATTRESS PAD MAXFEE DEF         102 8/1/1998 12/31/2299 N
E0186 AIR PRESSURE MATTRESS PRXOVR DEF         NA NA NA Y
E0186 AIR PRESSURE MATTRESS MAXFEE DEF         219.74 4/1/2006 12/31/2299 Y
E0187 WATER PRESSURE MATTRESS PRXOVR DEF         NA NA NA S
E0187 WATER PRESSURE MATTRESS MAXFEE DEF         231 12/15/2002 12/31/2299 S
E0188 SYNTHETIC SHEEPSKIN PAD PRXOVR DEF         NA NA NA S
E0188 SYNTHETIC SHEEPSKIN PAD MAXFEE DEF         5 5/1/1990 12/31/2299 S
E0189 LAMBSWOOL SHEEPSKIN PAD PRXOVR DEF         NA NA NA S
E0189 LAMBSWOOL SHEEPSKIN PAD MAXFEE DEF         43.95 7/1/2002 12/31/2299 S
E0190 POSITIONING CUSHION PRXOVR DEF         NA NA NA N
E0190 POSITIONING CUSHION MAXFEE DEF         100 4/1/2009 12/31/2299 N
E0191 PROTECTOR HEEL OR ELBOW PRXOVR DEF         NA NA NA S
E0191 PROTECTOR HEEL OR ELBOW MAXFEE DEF         9 4/1/2001 12/31/2299 S
E0192 PAD WHEELCHR LOW PRESS/POSIT PRXOVR DEF         NA NA NA S
E0192 PAD WHEELCHR LOW PRESS/POSIT MAXFEE DEF         NA     S
E0193 POWERED AIR FLOTATION BED PRXOVR DEF         NA NA NA N
E0193 POWERED AIR FLOTATION BED MAXFEE DEF         32.50 1/1/1992 12/31/2299 N
E0194 AIR FLUIDIZED BED PRXOVR DEF         NA NA NA Y
E0194 AIR FLUIDIZED BED MAXFEE DEF         95 1/1/2024 12/31/2299 Y
E0196 GEL PRESSURE MATTRESS PRXOVR DEF         NA NA NA N
E0196 GEL PRESSURE MATTRESS MAXFEE DEF         351.69 4/1/2006 12/31/2299 N
E0197 AIR PRESSURE PAD FOR MATTRES PRXOVR DEF         NA NA NA N
E0197 AIR PRESSURE PAD FOR MATTRES MAXFEE DEF         199.42 4/1/2006 12/31/2299 N
E0198 WATER PRESSURE PAD FOR MATTR PRXOVR DEF         NA NA NA Y
E0198 WATER PRESSURE PAD FOR MATTR MAXFEE DEF         177.26 7/26/2007 12/31/2299 Y
E0199 DRY PRESSURE PAD FOR MATTRES PRXOVR DEF         NA NA NA N
E0199 DRY PRESSURE PAD FOR MATTRES MAXFEE DEF         20 5/25/1991 12/31/2299 N
E0200 HEAT LAMP WITHOUT STAND PRXOVR DEF         NA NA NA E
E0200 HEAT LAMP WITHOUT STAND MANUAL DEF         NA NA NA E
E0203 THERAPEUTIC LIGHTBOX TABLETP PRXOVR DEF         NA NA NA E
E0203 THERAPEUTIC LIGHTBOX TABLETP MANUAL DEF         NA NA NA E
E0205 HEAT LAMP WITH STAND PRXOVR DEF         NA NA NA E
E0205 HEAT LAMP WITH STAND MANUAL DEF         NA NA NA E
E0210 ELECTRIC HEAT PAD STANDARD PRXOVR DEF         NA NA NA S
E0210 ELECTRIC HEAT PAD STANDARD MAXFEE DEF         15.09 5/1/1990 12/31/2299 S
E0215 ELECTRIC HEAT PAD MOIST PRXOVR DEF         NA NA NA S
E0215 ELECTRIC HEAT PAD MOIST MAXFEE DEF         25 5/1/1990 12/31/2299 S
E0217 WATER CIRC HEAT PAD W PUMP PRXOVR DEF         NA NA NA E
E0217 WATER CIRC HEAT PAD W PUMP MANUAL DEF         NA NA NA E
E0218 FLUID CIRC COLD PAD W PUMP PRXOVR DEF         NA NA NA E
E0218 FLUID CIRC COLD PAD W PUMP MANUAL DEF         NA NA NA E
E0220 HOT WATER BOTTLE PRXOVR DEF         NA NA NA S
E0220 HOT WATER BOTTLE MAXFEE DEF         NA     S
E0221 INFRARED HEATING PAD SYSTEM PRXOVR DEF         NA NA NA E
E0221 INFRARED HEATING PAD SYSTEM MANUAL DEF         NA NA NA E
E0225 HYDROCOLLATOR UNIT PRXOVR DEF         NA NA NA E
E0225 HYDROCOLLATOR UNIT MANUAL DEF         NA NA NA E
E0230 ICE CAP OR COLLAR PRXOVR DEF         NA NA NA S
E0230 ICE CAP OR COLLAR MAXFEE DEF         NA     S
E0231 WOUND WARMING DEVICE PRXOVR DEF         NA NA NA E
E0231 WOUND WARMING DEVICE MANUAL DEF         NA NA NA E
E0232 WARMING CARD FOR NWT PRXOVR DEF         NA NA NA E
E0232 WARMING CARD FOR NWT MANUAL DEF         NA NA NA E
E0235 PARAFFIN BATH UNIT PORTABLE PRXOVR DEF         NA NA NA S
E0235 PARAFFIN BATH UNIT PORTABLE MAXFEE DEF         133 4/1/2006 12/31/2299 S
E0236 PUMP FOR WATER CIRCULATING P PRXOVR DEF         NA NA NA E
E0236 PUMP FOR WATER CIRCULATING P MANUAL DEF         NA NA NA E
E0238 HEAT PAD NON-ELECTRIC MOIST PRXOVR DEF         NA NA NA S
E0238 HEAT PAD NON-ELECTRIC MOIST MAXFEE DEF         NA     S
E0240 BATH/SHOWER CHAIR MAXFEE UC5         2420 7/1/2021 12/31/2299 Y N
E0240 BATH/SHOWER CHAIR PRXOVR DEF         NA NA NA Y N
E0240 BATH/SHOWER CHAIR MAXFEE UC2         755 7/1/2021 12/31/2299 Y N
E0240 BATH/SHOWER CHAIR MAXFEE UC3         500 7/1/2021 12/31/2299 Y N
E0240 BATH/SHOWER CHAIR MAXFEE DEF         35 7/1/2021 12/31/2299 Y N
E0240 BATH/SHOWER CHAIR MAXFEE UC1         53 7/1/2021 12/31/2299 Y N
E0240 BATH/SHOWER CHAIR MAXFEE UC4         1250 7/1/2021 12/31/2299 Y N
E0241 BATH TUB WALL RAIL PRXOVR DEF         NA NA NA N
E0241 BATH TUB WALL RAIL MAXFEE DEF         24 1/1/1997 12/31/2299 N
E0242 BATH TUB RAIL FLOOR PRXOVR DEF         NA NA NA E
E0242 BATH TUB RAIL FLOOR MANUAL DEF         NA NA NA E
E0243 TOILET RAIL PRXOVR DEF         NA NA NA N
E0243 TOILET RAIL MAXFEE DEF         40 4/1/1999 12/31/2299 N
E0244 TOILET SEAT RAISED PRXOVR DEF         NA NA NA N
E0244 TOILET SEAT RAISED MAXFEE DEF         49.25 4/1/1999 12/31/2299 N
E0245 TUB STOOL OR BENCH PRXOVR DEF         NA NA NA N
E0245 TUB STOOL OR BENCH MAXFEE DEF         30 7/1/2021 12/31/2299 N
E0246 TRANSFER TUB RAIL ATTACHMENT PRXOVR DEF         NA NA NA S
E0246 TRANSFER TUB RAIL ATTACHMENT MAXFEE DEF         57.90 4/1/2006 12/31/2299 S
E0247 TRANS BENCH W/WO COMM OPEN PRXOVR DEF         NA NA NA Y N
E0247 TRANS BENCH W/WO COMM OPEN MAXFEE UC2         3300 7/1/2021 12/31/2299 Y N
E0247 TRANS BENCH W/WO COMM OPEN MAXFEE DEF         60 7/1/2021 12/31/2299 Y N
E0247 TRANS BENCH W/WO COMM OPEN MAXFEE UC1         100 7/1/2021 12/31/2299 Y N
E0248 HDTRANS BENCH W/WO COMM OPEN PRXOVR DEF         NA NA NA N
E0248 HDTRANS BENCH W/WO COMM OPEN MAXFEE DEF         100 7/1/2021 12/31/2299 N
E0249 PAD WATER CIRCULATING HEAT U PRXOVR DEF         NA NA NA E
E0249 PAD WATER CIRCULATING HEAT U MANUAL DEF         NA NA NA E
E0255 HOSPITAL BED VAR HT W/ MATTR PRXOVR DEF         NA NA NA Y
E0255 HOSPITAL BED VAR HT W/ MATTR MAXFEE DEF         677 5/25/1991 12/31/2299 Y
E0256 HOSPITAL BED VAR HT W/O MATT PRXOVR DEF         NA NA NA N
E0256 HOSPITAL BED VAR HT W/O MATT MAXFEE DEF         580 5/25/1991 12/31/2299 N
E0260 HOSP BED SEMI-ELECTR W/ MATT PRXOVR DEF         NA NA NA Y
E0260 HOSP BED SEMI-ELECTR W/ MATT MAXFEE DEF         989 7/16/2018 12/31/2299 Y
E0261 HOSP BED SEMI-ELECTR W/O MAT PRXOVR DEF         NA NA NA Y
E0261 HOSP BED SEMI-ELECTR W/O MAT MAXFEE DEF         892 5/25/1991 12/31/2299 Y
E0270 HOSPITAL BED INSTITUTIONAL T PRXOVR DEF         NA NA NA E
E0270 HOSPITAL BED INSTITUTIONAL T MANUAL DEF         NA NA NA E
E0271 MATTRESS INNERSPRING PRXOVR DEF         NA NA NA N
E0271 MATTRESS INNERSPRING MAXFEE DEF         97 5/1/1990 12/31/2299 N
E0272 MATTRESS FOAM RUBBER PRXOVR DEF         NA NA NA N
E0272 MATTRESS FOAM RUBBER MAXFEE DEF         92 5/1/1990 12/31/2299 N
E0273 BED BOARD PRXOVR DEF         NA NA NA E
E0273 BED BOARD MANUAL DEF         NA NA NA E
E0274 OVER-BED TABLE PRXOVR DEF         NA NA NA E
E0274 OVER-BED TABLE MANUAL DEF         NA NA NA E
E0275 BED PAN STANDARD PRXOVR DEF         NA NA NA S
E0275 BED PAN STANDARD MAXFEE DEF         4 5/1/1990 12/31/2299 S
E0276 BED PAN FRACTURE PRXOVR DEF         NA NA NA S
E0276 BED PAN FRACTURE MAXFEE DEF         3 5/1/1990 12/31/2299 S
E0277 POWERED PRES-REDU AIR MATTRS PRXOVR DEF         NA NA NA Y
E0277 POWERED PRES-REDU AIR MATTRS MAXFEE DEF         3046.08 7/16/2018 12/31/2299 Y
E0292 HOSP BED VAR HT NO SR W/MATT PRXOVR DEF         NA NA NA Y
E0292 HOSP BED VAR HT NO SR W/MATT MAXFEE DEF         567 5/25/1991 12/31/2299 Y
E0293 HOSP BED VAR HT NO SR NO MAT PRXOVR DEF         NA NA NA Y
E0293 HOSP BED VAR HT NO SR NO MAT MAXFEE DEF         470 5/25/1991 12/31/2299 Y
E0294 HOSP BED SEMI-ELECT W/ MATTR PRXOVR DEF         NA NA NA Y
E0294 HOSP BED SEMI-ELECT W/ MATTR MAXFEE DEF         703.20 7/16/2018 12/31/2299 Y
E0295 HOSP BED SEMI-ELECT W/O MATT PRXOVR DEF         NA NA NA Y
E0295 HOSP BED SEMI-ELECT W/O MATT MAXFEE DEF         625.60 7/16/2018 12/31/2299 Y
E0300 ENCLOSED PED CRIB HOSP GRADE PRXOVR DEF         NA NA NA E
E0300 ENCLOSED PED CRIB HOSP GRADE MANUAL DEF         NA NA NA E
E0301 HD HOSP BED; 350-600 LBS PRXOVR DEF         NA NA NA Y
E0301 HD HOSP BED; 350-600 LBS MAXFEE DEF         1677.44 7/16/2018 12/31/2299 Y
E0302 EX HD HOSP BED > 600 LBS PRXOVR DEF         NA NA NA Y
E0302 EX HD HOSP BED > 600 LBS MAXFEE DEF         4578.80 7/16/2018 12/31/2299 Y
E0303 HOSP BED HVY DTY XTRA WIDE PRXOVR DEF         NA NA NA Y
E0303 HOSP BED HVY DTY XTRA WIDE MAXFEE DEF         1945.44 7/16/2018 12/31/2299 Y
E0304 HOSP BED XTRA HVY DTY X WIDE PRXOVR DEF         NA NA NA Y
E0304 HOSP BED XTRA HVY DTY X WIDE MAXFEE DEF         4932.32 7/16/2018 12/31/2299 Y
E0305 RAILS BED SIDE HALF LENGTH PRXOVR DEF         NA NA NA N
E0305 RAILS BED SIDE HALF LENGTH MAXFEE DEF         185.01 1/1/2010 12/31/2299 N
E0310 RAILS BED SIDE FULL LENGTH PRXOVR DEF         NA NA NA N
E0310 RAILS BED SIDE FULL LENGTH MAXFEE DEF         143.74 4/1/2009 12/31/2299 N
E0316 BED SAFETY ENCLOSURE PRXOVR DEF         NA NA NA Y
E0316 BED SAFETY ENCLOSURE MANUAL DEF         NA NA NA Y
E0325 URINAL MALE JUG-TYPE PRXOVR DEF         NA NA NA S
E0325 URINAL MALE JUG-TYPE MAXFEE DEF         7.93 1/1/2024 12/31/2299 S
E0326 URINAL FEMALE JUG-TYPE PRXOVR DEF         NA NA NA S
E0326 URINAL FEMALE JUG-TYPE MAXFEE DEF         3.50 5/1/1990 12/31/2299 S
E0328 PED HOSPITAL BED; MANUAL PRXOVR DEF         NA NA NA Y
E0328 PED HOSPITAL BED; MANUAL MAXFEE DEF         5560 9/1/2013 12/31/2299 Y
E0329 PED HOSPITAL BED SEMI/ELECT PRXOVR DEF         NA NA NA Y
E0329 PED HOSPITAL BED SEMI/ELECT MAXFEE DEF         6000 9/1/2013 12/31/2299 Y
E0350 CONTROL UNIT BOWEL SYSTEM PRXOVR DEF         NA NA NA Y
E0350 CONTROL UNIT BOWEL SYSTEM MANUAL DEF         NA NA NA Y
E0352 DISPOSABLE PACK W/BOWEL SYST PRXOVR DEF         NA NA NA E
E0352 DISPOSABLE PACK W/BOWEL SYST MANUAL DEF         NA NA NA E
E0370 AIR ELEVATOR FOR HEEL PRXOVR DEF         NA NA NA E
E0370 AIR ELEVATOR FOR HEEL MANUAL DEF         NA NA NA E
E0371 NONPOWER MATTRESS OVERLAY PRXOVR DEF         NA NA NA Y
E0371 NONPOWER MATTRESS OVERLAY MAXFEE DEF         4644.81 4/1/2006 12/31/2299 Y
E0372 POWERED AIR MATTRESS OVERLAY PRXOVR DEF         NA NA NA Y
E0372 POWERED AIR MATTRESS OVERLAY MAXFEE DEF         5838.28 4/1/2006 12/31/2299 Y
E0373 NONPOWERED PRESSURE MATTRESS PRXOVR DEF         NA NA NA Y
E0373 NONPOWERED PRESSURE MATTRESS MAXFEE DEF         5321.02 7/16/2018 12/31/2299 Y
E0445 OXIMETER NON-INVASIVE PRXOVR DEF         NA NA NA Y
E0445 OXIMETER NON-INVASIVE MAXFEE DEF         2250 2/26/2010 12/31/2299 Y
E0454 PRESSURE VENTILATOR PRXOVR DEF         NA NA NA Y
E0454 PRESSURE VENTILATOR MAXFEE DEF         NA     Y
E0455 OXYGEN TENT EXCL CROUP/PED T PRXOVR DEF         NA NA NA N
E0455 OXYGEN TENT EXCL CROUP/PED T MAXFEE DEF         8 5/1/1990 12/31/2299 N
E0457 CHEST SHELL PRXOVR DEF         NA NA NA S
E0457 CHEST SHELL MAXFEE DEF         450 8/1/1998 12/31/2299 S
E0459 CHEST WRAP PRXOVR DEF         NA NA NA S
E0459 CHEST WRAP MAXFEE DEF         352 8/1/1998 12/31/2299 S
E0462 ROCKING BED W/ OR W/O SIDE R PRXOVR DEF         NA NA NA E
E0462 ROCKING BED W/ OR W/O SIDE R MANUAL DEF         NA NA NA E
E0480 PERCUSSOR ELECT/PNEUM HOME M PRXOVR DEF         NA NA NA N
E0480 PERCUSSOR ELECT/PNEUM HOME M MAXFEE DEF         321 4/1/2006 12/31/2299 N
E0481 INTRPULMNRY PERCUSS VENT SYS PRXOVR DEF         NA NA NA N
E0481 INTRPULMNRY PERCUSS VENT SYS MAXFEE DEF         7500 1/1/2024 12/31/2299 N
E0482 COUGH STIMULATING DEVICE PRXOVR DEF         NA NA NA Y
E0482 COUGH STIMULATING DEVICE MAXFEE DEF         4022.80 1/1/2024 12/31/2299 Y
E0483 HI FREQ CHEST WALL OSCIL SYS PRXOVR DEF         NA NA NA N
E0483 HI FREQ CHEST WALL OSCIL SYS MAXFEE DEF         12190 10/1/2004 12/31/2299 N
E0484 NON-ELEC OSCILLATORY PEP DVC PRXOVR DEF         NA NA NA N
E0484 NON-ELEC OSCILLATORY PEP DVC MAXFEE DEF         27.70 9/1/2005 12/31/2299 N
E0485 ORAL DEVICE/APPLIANCE PREFAB PRXOVR DEF         NA NA NA E
E0485 ORAL DEVICE/APPLIANCE PREFAB MANUAL DEF         NA NA NA E
E0487 ELECTRONIC SPIROMETER PRXOVR DEF         NA NA NA E
E0487 ELECTRONIC SPIROMETER MANUAL DEF         NA NA NA E
E0492 CONTROL UNIT NM STIM W PHONE PRXOVR DEF         NA NA NA Y N
E0492 CONTROL UNIT NM STIM W PHONE MANUAL DEF         NA NA NA Y N
E0493 ORAL DV/APP NEUROMUS MOUTHPI PRXOVR DEF         NA NA NA Y N
E0493 ORAL DV/APP NEUROMUS MOUTHPI MANUAL DEF         NA NA NA Y N
E0500 IPPB ALL TYPES PRXOVR DEF         NA NA NA N
E0500 IPPB ALL TYPES MAXFEE DEF         65 4/1/1992 12/31/2299 N
E0530 ELECTRONIC POSA TREATMENT PRXOVR DEF         NA NA NA Y N
E0530 ELECTRONIC POSA TREATMENT MANUAL DEF         NA NA NA Y N
E0550 HUMIDIF EXTENS SUPPLE W IPPB PRXOVR DEF         NA NA NA E
E0550 HUMIDIF EXTENS SUPPLE W IPPB MANUAL DEF         NA NA NA E
E0555 HUMIDIFIER FOR USE W/ REGULA PRXOVR DEF         NA NA NA E
E0555 HUMIDIFIER FOR USE W/ REGULA MANUAL DEF         NA NA NA E
E0560 HUMIDIFIER SUPPLEMENTAL W/ I PRXOVR DEF         NA NA NA E
E0560 HUMIDIFIER SUPPLEMENTAL W/ I MANUAL DEF         NA NA NA E
E0561 HUMIDIFIER NONHEATED W PAP PRXOVR DEF         NA NA NA N
E0561 HUMIDIFIER NONHEATED W PAP MAXFEE DEF         92 4/1/2009 12/31/2299 N
E0562 HUMIDIFIER HEATED USED W PAP PRXOVR DEF         NA NA NA Y
E0562 HUMIDIFIER HEATED USED W PAP MAXFEE DEF         225.92 10/1/2004 12/31/2299 Y
E0565 COMPRESSOR AIR POWER SOURCE PRXOVR DEF         NA NA NA Y
E0565 COMPRESSOR AIR POWER SOURCE MAXFEE DEF         525 4/1/1996 12/31/2299 Y
E0570 NEBULIZER WITH COMPRESSION PRXOVR DEF         NA NA NA N
E0570 NEBULIZER WITH COMPRESSION MAXFEE DEF         133 4/1/2006 12/31/2299 N
E0572 AEROSOL COMPRESSOR ADJUST PR PRXOVR DEF         NA NA NA E
E0572 AEROSOL COMPRESSOR ADJUST PR MANUAL DEF         NA NA NA E
E0574 ULTRASONIC GENERATOR W SVNEB PRXOVR DEF         NA NA NA E
E0574 ULTRASONIC GENERATOR W SVNEB MANUAL DEF         NA NA NA E
E0575 NEBULIZER ULTRASONIC PRXOVR DEF         NA NA NA S
E0575 NEBULIZER ULTRASONIC MAXFEE DEF         430 4/1/2006 12/31/2299 S
E0580 NEBULIZER FOR USE W/ REGULAT PRXOVR DEF         NA NA NA S
E0580 NEBULIZER FOR USE W/ REGULAT MAXFEE DEF         115 4/1/2006 12/31/2299 S
E0585 NEBULIZER W/ COMPRESSOR & HE PRXOVR DEF         NA NA NA E
E0585 NEBULIZER W/ COMPRESSOR & HE MANUAL DEF         NA NA NA E
E0601 CONT AIRWAY PRESSURE DEVICE PRXOVR DEF         NA NA NA Y
E0601 CONT AIRWAY PRESSURE DEVICE MAXFEE DEF         775 4/1/1992 12/31/2299 Y
E0602 MANUAL BREAST PUMP PRXOVR DEF         NA NA NA N
E0602 MANUAL BREAST PUMP MAXFEE DEF         15 10/1/2004 12/31/2299 N
E0603 ELECTRIC BREAST PUMP PRXOVR DEF         NA NA NA S
E0603 ELECTRIC BREAST PUMP MAXFEE DEF         202.50 7/26/2007 12/31/2299 S
E0604 HOSP GRADE ELEC BREAST PUMP PRXOVR DEF         NA NA NA N
E0604 HOSP GRADE ELEC BREAST PUMP MAXFEE DEF         2.25 1/1/2002 12/31/2299 N
E0605 VAPORIZER ROOM TYPE PRXOVR DEF         NA NA NA S
E0605 VAPORIZER ROOM TYPE MAXFEE DEF         20 5/1/1990 12/31/2299 S
E0606 DRAINAGE BOARD POSTURAL PRXOVR DEF         NA NA NA E
E0606 DRAINAGE BOARD POSTURAL MANUAL DEF         NA NA NA E
E0607 BLOOD GLUCOSE MONITOR HOME PRXOVR DEF         NA NA NA E
E0607 BLOOD GLUCOSE MONITOR HOME MANUAL DEF         NA NA NA E
E0610 PACEMAKER MONITR AUDIBLE/VIS PRXOVR DEF         NA NA NA E
E0610 PACEMAKER MONITR AUDIBLE/VIS MANUAL DEF         NA NA NA E
E0615 PACEMAKER MONITR DIGITAL/VIS PRXOVR DEF         NA NA NA E
E0615 PACEMAKER MONITR DIGITAL/VIS MANUAL DEF         NA NA NA E
E0616 CARDIAC EVENT RECORDER PRXOVR DEF         NA NA NA E
E0616 CARDIAC EVENT RECORDER MANUAL DEF         NA NA NA E
E0617 AUTOMATIC EXT DEFIBRILLATOR PRXOVR DEF         NA NA NA E
E0617 AUTOMATIC EXT DEFIBRILLATOR MANUAL DEF         NA NA NA E
E0621 PATIENT LIFT SLING OR SEAT PRXOVR DEF         NA NA NA N
E0621 PATIENT LIFT SLING OR SEAT MAXFEE DEF         89.70 1/1/1999 12/31/2299 N
E0627 SEAT LIFT MECH; ELECTRIC ANY PRXOVR DEF         NA NA NA E
E0627 SEAT LIFT MECH; ELECTRIC ANY MANUAL DEF         NA NA NA E
E0629 SEAT LIFT MECH; NON-ELECTRIC PRXOVR DEF         NA NA NA E
E0629 SEAT LIFT MECH; NON-ELECTRIC MANUAL DEF         NA NA NA E
E0635 PATIENT LIFT ELECTRIC PRXOVR DEF         NA NA NA E
E0635 PATIENT LIFT ELECTRIC MANUAL DEF         NA NA NA E
E0636 PT SUPPORT & POSITIONING SYS PRXOVR DEF         NA NA NA E
E0636 PT SUPPORT & POSITIONING SYS MANUAL DEF         NA NA NA E
E0637 COMBINATION SIT TO STAND SYS PADOLR DEF         NA NA NA Y
E0637 COMBINATION SIT TO STAND SYS PADOLR UC1         NA NA NA Y
E0637 COMBINATION SIT TO STAND SYS PADOLR UC4         NA NA NA Y
E0637 COMBINATION SIT TO STAND SYS PADOLR UC2         NA NA NA Y
E0637 COMBINATION SIT TO STAND SYS PADOLR UC3         NA NA NA Y
E0639 MOVEABLE PATIENT LIFT SYSTEM PRXOVR DEF         NA NA NA E
E0639 MOVEABLE PATIENT LIFT SYSTEM MANUAL DEF         NA NA NA E
E0640 FIXED PATIENT LIFT SYSTEM PRXOVR DEF         NA NA NA E
E0640 FIXED PATIENT LIFT SYSTEM MANUAL DEF         NA NA NA E
E0641 MULTI-POSITION STND FRAM SYS PRXOVR DEF         NA NA NA Y
E0641 MULTI-POSITION STND FRAM SYS PADOLR DEF         NA NA NA Y
E0641 MULTI-POSITION STND FRAM SYS PADOLR UC1         NA NA NA Y
E0641 MULTI-POSITION STND FRAM SYS PADOLR UC4         NA NA NA Y
E0641 MULTI-POSITION STND FRAM SYS PADOLR UC2         NA NA NA Y
E0641 MULTI-POSITION STND FRAM SYS PADOLR UC3         NA NA NA Y
E0642 DYNAMIC STANDING FRAME PRXOVR DEF         NA NA NA E
E0642 DYNAMIC STANDING FRAME PADOLR DEF         NA NA NA E
E0650 PNEUMA COMPRESOR NON-SEGMENT PRXOVR DEF         NA NA NA N
E0650 PNEUMA COMPRESOR NON-SEGMENT MAXFEE DEF         510 1/1/1994 12/31/2299 N
E0651 PNEUM COMPRESSOR SEGMENTAL PRXOVR DEF         NA NA NA E
E0651 PNEUM COMPRESSOR SEGMENTAL MAXFEE DEF         790.72 1/1/2024 12/31/2299 E
E0652 PNEUM COMPRES W/CAL PRESSURE PRXOVR DEF         NA NA NA E
E0652 PNEUM COMPRES W/CAL PRESSURE MAXFEE DEF         5046 1/1/2024 12/31/2299 E
E0655 PNEUMATIC APPLIANCE HALF ARM PRXOVR DEF         NA NA NA Y
E0655 PNEUMATIC APPLIANCE HALF ARM MAXFEE DEF         77.50 1/1/1994 12/31/2299 Y
E0656 SEGMENTAL PNEUMATIC TRUNK PRXOVR DEF         NA NA NA E
E0656 SEGMENTAL PNEUMATIC TRUNK MANUAL DEF         NA NA NA E
E0657 SEGMENTAL PNEUMATIC CHEST PRXOVR DEF         NA NA NA E
E0657 SEGMENTAL PNEUMATIC CHEST MANUAL DEF         NA NA NA E
E0660 PNEUMATIC APPLIANCE FULL LEG PRXOVR DEF         NA NA NA N
E0660 PNEUMATIC APPLIANCE FULL LEG MAXFEE DEF         135.12 7/1/2002 12/31/2299 N
E0665 PNEUMATIC APPLIANCE FULL ARM PRXOVR DEF         NA NA NA Y
E0665 PNEUMATIC APPLIANCE FULL ARM MAXFEE DEF         101.50 1/1/1994 12/31/2299 Y
E0666 PNEUMATIC APPLIANCE HALF LEG PRXOVR DEF         NA NA NA N
E0666 PNEUMATIC APPLIANCE HALF LEG MAXFEE DEF         95 1/1/1994 12/31/2299 N
E0667 SEG PNEUMATIC APPL FULL LEG PRXOVR DEF         NA NA NA N
E0667 SEG PNEUMATIC APPL FULL LEG MAXFEE DEF         202.43 1/1/2024 12/31/2299 N
E0668 SEG PNEUMATIC APPL FULL ARM PRXOVR DEF         NA NA NA N
E0668 SEG PNEUMATIC APPL FULL ARM MAXFEE DEF         208.15 1/1/2024 12/31/2299 N
E0669 SEG PNEUMATIC APPLI HALF LEG PRXOVR DEF         NA NA NA N
E0669 SEG PNEUMATIC APPLI HALF LEG MAXFEE DEF         NA     N
E0670 SEG PNEUM INT LEGS/TRUNK PRXOVR DEF         NA NA NA E
E0670 SEG PNEUM INT LEGS/TRUNK MANUAL DEF         NA NA NA E
E0671 PRESSURE PNEUM APPL FULL LEG PRXOVR DEF         NA NA NA E
E0671 PRESSURE PNEUM APPL FULL LEG MANUAL DEF         NA NA NA E
E0672 PRESSURE PNEUM APPL FULL ARM PRXOVR DEF         NA NA NA E
E0672 PRESSURE PNEUM APPL FULL ARM MANUAL DEF         NA NA NA E
E0673 PRESSURE PNEUM APPL HALF LEG PRXOVR DEF         NA NA NA E
E0673 PRESSURE PNEUM APPL HALF LEG MANUAL DEF         NA NA NA E
E0675 PNEUMATIC COMPRESSION DEVICE PRXOVR DEF         NA NA NA E
E0675 PNEUMATIC COMPRESSION DEVICE MANUAL DEF         NA NA NA E
E0676 INTER LIMB COMPRESS DEV NOS PRXOVR DEF         NA NA NA E
E0676 INTER LIMB COMPRESS DEV NOS MANUAL DEF         NA NA NA E
E0677 NON PNEUM SEQ COMP TRUNK PRXOVR DEF         NA NA NA N
E0677 NON PNEUM SEQ COMP TRUNK MAXFEE DEF         520 4/1/2023 12/31/2299 N
E0678 NON PNEUM SEQ COMP FULL LEG PRXOVR DEF         NA NA NA N
E0678 NON PNEUM SEQ COMP FULL LEG MAXFEE DEF         318 1/1/2024 12/31/2299 N
E0679 NON PNEUM SEQ COMP HALF LEG PRXOVR DEF         NA NA NA N
E0679 NON PNEUM SEQ COMP HALF LEG MAXFEE DEF         178 1/1/2024 12/31/2299 N
E0680 NON PNEUM COMP CONTROL CAL PRXOVR DEF         NA NA NA N
E0680 NON PNEUM COMP CONTROL CAL MAXFEE DEF         5046 1/1/2024 12/31/2299 N
E0681 NON PNEU COMP CONTROL W/O CA PRXOVR DEF         NA NA NA N
E0681 NON PNEU COMP CONTROL W/O CA MAXFEE DEF         850 1/1/2024 12/31/2299 N
E0682 NON PNEUM COMPRESS FULL ARM PRXOVR DEF         NA NA NA N
E0682 NON PNEUM COMPRESS FULL ARM MAXFEE DEF         410 1/1/2024 12/31/2299 N
E0691 UVL PNL 2 SQ FT OR LESS PRXOVR DEF         NA NA NA Y
E0691 UVL PNL 2 SQ FT OR LESS MAXFEE DEF         809.08 7/1/2019 12/31/2299 Y
E0692 UVL SYS PANEL 4 FT PRXOVR DEF         NA NA NA Y
E0692 UVL SYS PANEL 4 FT MAXFEE DEF         1015.99 7/1/2019 12/31/2299 Y
E0693 UVL SYS PANEL 6 FT PRXOVR DEF         NA NA NA Y
E0693 UVL SYS PANEL 6 FT MAXFEE DEF         1252.42 7/1/2019 12/31/2299 Y
E0694 UVL MD CABINET SYS 6 FT PRXOVR DEF         NA NA NA Y
E0694 UVL MD CABINET SYS 6 FT MAXFEE DEF         3986.35 7/1/2019 12/31/2299 Y
E0700 SAFETY EQUIPMENT PRXOVR DEF         NA NA NA S
E0700 SAFETY EQUIPMENT MAXFEE DEF         10.82 5/1/1990 12/31/2299 S
E0705 TRANSFER DEVICE PRXOVR DEF         NA NA NA N
E0705 TRANSFER DEVICE MAXFEE DEF         46.62 5/26/2006 12/31/2299 N
E0710 RESTRAINTS ANY TYPE PRXOVR DEF         NA NA NA E
E0710 RESTRAINTS ANY TYPE MANUAL DEF         NA NA NA E
E0711 UE ENCLOSURE RESTR ROM PRXOVR DEF         NA NA NA N
E0711 UE ENCLOSURE RESTR ROM MAXFEE DEF         0 4/1/2023 12/31/2299 N
E0731 CONDUCTIVE GARMENT FOR TENS/ PRXOVR DEF         NA NA NA E
E0731 CONDUCTIVE GARMENT FOR TENS/ MANUAL DEF         NA NA NA E
E0732 CES SYSTEM PRXOVR DEF         NA NA NA Y N
E0732 CES SYSTEM MANUAL DEF         NA NA NA Y N
E0733 TRANS ELEC NERV FOR TRIGEMIN PRXOVR DEF         NA NA NA Y N
E0733 TRANS ELEC NERV FOR TRIGEMIN MANUAL DEF         NA NA NA Y N
E0734 EXT UP LIMB TREMOR STIM WRIS PRXOVR DEF         NA NA NA Y N
E0734 EXT UP LIMB TREMOR STIM WRIS MANUAL DEF         NA NA NA Y N
E0735 NON-INVASIVE VAGUS NERV STIM PRXOVR DEF         NA NA NA Y N
E0735 NON-INVASIVE VAGUS NERV STIM MANUAL DEF         NA NA NA Y N
E0740 NON-IMPLANT PELV FLR E-STIM PRXOVR DEF         NA NA NA E
E0740 NON-IMPLANT PELV FLR E-STIM MANUAL DEF         NA NA NA E
E0744 NEUROMUSCULAR STIM FOR SCOLI PRXOVR DEF         NA NA NA Y N
E0744 NEUROMUSCULAR STIM FOR SCOLI MANUAL DEF         NA NA NA Y N
E0745 NEUROMUSCULAR STIM FOR SHOCK PRXOVR DEF         NA NA NA E
E0745 NEUROMUSCULAR STIM FOR SHOCK MANUAL DEF         NA NA NA E
E0755 ELECTRONIC SALIVARY REFLEX S PRXOVR DEF         NA NA NA E
E0755 ELECTRONIC SALIVARY REFLEX S MANUAL DEF         NA NA NA E
E0761 NONTHERM ELECTROMGNTC DEVICE PRXOVR DEF         NA NA NA E
E0761 NONTHERM ELECTROMGNTC DEVICE MANUAL DEF         NA NA NA E
E0762 TRANS ELEC JT STIM DEV SYS PRXOVR DEF         NA NA NA E
E0762 TRANS ELEC JT STIM DEV SYS MANUAL DEF         NA NA NA E
E0764 FUNCTIONAL NEUROMUSCULARSTIM PRXOVR DEF         NA NA NA E
E0764 FUNCTIONAL NEUROMUSCULARSTIM MANUAL DEF         NA NA NA E
E0765 NERVE STIMULATOR FOR TX N&V PRXOVR DEF         NA NA NA E
E0765 NERVE STIMULATOR FOR TX N&V MANUAL DEF         NA NA NA E
E0766 ELEC STIM CANCER TREATMENT PRXOVR DEF         NA NA NA E
E0766 ELEC STIM CANCER TREATMENT MANUAL DEF         NA NA NA E
E0769 ELECTRIC WOUND TREATMENT DEV PRXOVR DEF         NA NA NA E
E0769 ELECTRIC WOUND TREATMENT DEV MANUAL DEF         NA NA NA E
E0776 IV POLE PRXOVR DEF         NA NA NA N
E0776 IV POLE MAXFEE DEF         75 4/1/2006 12/31/2299 N
E0779 AMB INFUSION PUMP MECHANICAL PRXOVR DEF         NA NA NA E
E0779 AMB INFUSION PUMP MECHANICAL MANUAL DEF         NA NA NA E
E0780 MECH AMB INFUSION PUMP <8HRS PRXOVR DEF         NA NA NA E
E0780 MECH AMB INFUSION PUMP <8HRS MANUAL DEF         NA NA NA E
E0782 NON-PROGRAMBLE INFUSION PUMP PRXOVR DEF         NA NA NA E
E0782 NON-PROGRAMBLE INFUSION PUMP MANUAL DEF         NA NA NA E
E0783 PROGRAMMABLE INFUSION PUMP PRXOVR DEF         NA NA NA E
E0783 PROGRAMMABLE INFUSION PUMP MANUAL DEF         NA NA NA E
E0785 REPLACEMENT IMPL PUMP CATHET PRXOVR DEF         NA NA NA E
E0785 REPLACEMENT IMPL PUMP CATHET MAXFEE DEF         NA     E
E0786 IMPLANTABLE PUMP REPLACEMENT PRXOVR DEF         NA NA NA E
E0786 IMPLANTABLE PUMP REPLACEMENT MANUAL DEF         NA NA NA E
E0830 AMBULATORY TRACTION DEVICE PRXOVR DEF         NA NA NA E
E0830 AMBULATORY TRACTION DEVICE MANUAL DEF         NA NA NA E
E0840 TRACT FRAME ATTACH HEADBOARD PRXOVR DEF         NA NA NA N
E0840 TRACT FRAME ATTACH HEADBOARD MAXFEE DEF         58.62 7/26/2007 12/31/2299 N
E0849 CERVICAL PNEUM TRAC EQUIP PRXOVR DEF         NA NA NA E
E0849 CERVICAL PNEUM TRAC EQUIP MANUAL DEF         NA NA NA E
E0850 TRACTION STAND FREE STANDING PRXOVR DEF         NA NA NA N
E0850 TRACTION STAND FREE STANDING MAXFEE DEF         84.05 7/26/2007 12/31/2299 N
E0855 CERVICAL TRACTION EQUIPMENT PRXOVR DEF         NA NA NA E
E0855 CERVICAL TRACTION EQUIPMENT MANUAL DEF         NA NA NA E
E0856 CERVIC COLLAR W AIR BLADDERS PRXOVR DEF         NA NA NA E
E0856 CERVIC COLLAR W AIR BLADDERS MAXFEE DEF         0 1/1/2008 12/31/2299 E
E0860 TRACT EQUIP CERVICAL TRACT PRXOVR DEF         NA NA NA N
E0860 TRACT EQUIP CERVICAL TRACT MAXFEE DEF         30.82 7/26/2007 12/31/2299 N
E0870 TRACT FRAME ATTACH FOOTBOARD PRXOVR DEF         NA NA NA N
E0870 TRACT FRAME ATTACH FOOTBOARD MAXFEE DEF         93.05 7/26/2007 12/31/2299 N
E0880 TRAC STAND FREE STAND EXTREM PRXOVR DEF         NA NA NA N
E0880 TRAC STAND FREE STAND EXTREM MAXFEE DEF         100.43 7/26/2007 12/31/2299 N
E0890 TRACTION FRAME ATTACH PELVIC PRXOVR DEF         NA NA NA N
E0890 TRACTION FRAME ATTACH PELVIC MAXFEE DEF         96.33 7/26/2007 12/31/2299 N
E0900 TRAC STAND FREE STAND PELVIC PRXOVR DEF         NA NA NA N
E0900 TRAC STAND FREE STAND PELVIC MAXFEE DEF         102.50 7/26/2007 12/31/2299 N
E0910 TRAPEZE BAR ATTACHED TO BED PRXOVR DEF         NA NA NA N
E0910 TRAPEZE BAR ATTACHED TO BED MAXFEE DEF         208 7/26/2007 12/31/2299 N
E0911 HD TRAPEZE BAR ATTACH TO BED PRXOVR DEF         NA NA NA E
E0911 HD TRAPEZE BAR ATTACH TO BED MANUAL DEF         NA NA NA E
E0912 HD TRAPEZE BAR FREE STANDING PRXOVR DEF         NA NA NA N
E0912 HD TRAPEZE BAR FREE STANDING MAXFEE DEF         1190.49 7/26/2007 12/31/2299 N
E0920 FRACTURE FRAME ATTACHED TO B PRXOVR DEF         NA NA NA N
E0920 FRACTURE FRAME ATTACHED TO B MAXFEE DEF         479.86 7/26/2007 12/31/2299 N
E0930 FRACTURE FRAME FREE STANDING PRXOVR DEF         NA NA NA N
E0930 FRACTURE FRAME FREE STANDING MAXFEE DEF         475.17 7/26/2007 12/31/2299 N
E0936 CPM DEVICE; OTHER THAN KNEE PRXOVR DEF         NA NA NA E
E0936 CPM DEVICE; OTHER THAN KNEE MANUAL DEF         NA NA NA E
E0940 TRAPEZE BAR FREE STANDING PRXOVR DEF         NA NA NA N
E0940 TRAPEZE BAR FREE STANDING MAXFEE DEF         361.61 7/26/2007 12/31/2299 N
E0941 GRAVITY ASSISTED TRACTION DE PRXOVR DEF         NA NA NA S
E0941 GRAVITY ASSISTED TRACTION DE MAXFEE DEF         451.46 7/26/2007 12/31/2299 S
E0942 CERVICAL HEAD HARNESS/HALTER PRXOVR DEF         NA NA NA N
E0942 CERVICAL HEAD HARNESS/HALTER MAXFEE DEF         15.88 7/26/2007 12/31/2299 N
E0944 PELVIC BELT/HARNESS/BOOT PRXOVR DEF         NA NA NA N
E0944 PELVIC BELT/HARNESS/BOOT MAXFEE DEF         36.70 7/26/2007 12/31/2299 N
E0945 BELT/HARNESS EXTREMITY PRXOVR DEF         NA NA NA S
E0945 BELT/HARNESS EXTREMITY MAXFEE DEF         35.46 7/26/2007 12/31/2299 S
E0946 FRACTURE FRAME DUAL W CROSS PRXOVR DEF         NA NA NA Y
E0946 FRACTURE FRAME DUAL W CROSS MAXFEE DEF         615.26 7/26/2007 12/31/2299 Y
E0947 FRACTURE FRAME ATTACHMNTS PE PRXOVR DEF         NA NA NA Y
E0947 FRACTURE FRAME ATTACHMNTS PE MAXFEE DEF         485.17 7/26/2007 12/31/2299 Y
E0948 FRACTURE FRAME ATTACHMNTS CE PRXOVR DEF         NA NA NA Y
E0948 FRACTURE FRAME ATTACHMNTS CE MAXFEE DEF         469.27 7/26/2007 12/31/2299 Y
E0950 TRAY PRXOVR DEF         NA NA NA Y
E0950 TRAY MAXFEE DEF         101.50 1/1/2024 12/31/2299 Y
E0951 LOOP HEEL PRXOVR DEF         NA NA NA N
E0951 LOOP HEEL MAXFEE DEF         20 1/1/2024 12/31/2299 N
E0952 TOE LOOP/HOLDER; EACH PRXOVR DEF         NA NA NA N
E0952 TOE LOOP/HOLDER; EACH MAXFEE DEF         15.98 1/1/2017 12/31/2299 N
E0953 W/C LATERAL THIGH/KNEE SUP PRXOVR DEF         NA NA NA Y
E0953 W/C LATERAL THIGH/KNEE SUP MAXFEE DEF         500 7/1/2021 12/31/2299 Y
E0954 FOOT BOX; ANY TYPE EACH FOOT PRXOVR DEF         NA NA NA Y
E0954 FOOT BOX; ANY TYPE EACH FOOT MAXFEE DEF         150 1/1/2024 12/31/2299 Y
E0954 FOOT BOX; ANY TYPE EACH FOOT MAXFEE UC1         NA     Y
E0955 CUSHIONED HEADREST PRXOVR DEF         NA NA NA Y
E0955 CUSHIONED HEADREST MAXFEE DEF         250 1/1/2024 12/31/2299 Y
E0956 W/C LATERAL TRUNK/HIP SUPPOR PRXOVR DEF         NA NA NA S
E0956 W/C LATERAL TRUNK/HIP SUPPOR MAXFEE DEF         98.49 1/1/2017 12/31/2299 S
E0957 W/C MEDIAL THIGH SUPPORT PRXOVR DEF         NA NA NA S
E0957 W/C MEDIAL THIGH SUPPORT MAXFEE DEF         137.79 1/1/2017 12/31/2299 S
E0958 WHLCHR ATT- CONV 1 ARM DRIVE PRXOVR DEF         NA NA NA Y
E0958 WHLCHR ATT- CONV 1 ARM DRIVE MAXFEE DEF         420 1/1/2024 12/31/2299 Y
E0959 AMPUTEE ADAPTER PRXOVR DEF         NA NA NA N
E0959 AMPUTEE ADAPTER MAXFEE DEF         37.54 1/1/2017 12/31/2299 N
E0960 W/C SHOULDER HARNESS/STRAPS PRXOVR DEF         NA NA NA N
E0960 W/C SHOULDER HARNESS/STRAPS MAXFEE DEF         100 1/1/2024 12/31/2299 N
E0961 WHEELCHAIR BRAKE EXTENSION PRXOVR DEF         NA NA NA Y
E0961 WHEELCHAIR BRAKE EXTENSION MAXFEE DEF         25.26 1/1/2017 12/31/2299 Y
E0962 WHEELCHAIR 1 INCH CUSHION PRXOVR DEF         NA NA NA S
E0962 WHEELCHAIR 1 INCH CUSHION MAXFEE DEF         NA     S
E0963 WHEELCHAIR 2 INCH CUSHION PRXOVR DEF         NA NA NA S
E0963 WHEELCHAIR 2 INCH CUSHION MAXFEE DEF         NA     S
E0964 WHEELCHAIR 3 INCH CUSHION PRXOVR DEF         NA NA NA S
E0964 WHEELCHAIR 3 INCH CUSHION MAXFEE DEF         NA     S
E0965 WHEELCHAIR 4 INCH CUSHION PRXOVR DEF         NA NA NA S
E0965 WHEELCHAIR 4 INCH CUSHION MAXFEE DEF         NA     S
E0966 WHEELCHAIR HEAD REST EXTENSI PRXOVR DEF         NA NA NA Y
E0966 WHEELCHAIR HEAD REST EXTENSI MAXFEE DEF         64.69 1/1/2017 12/31/2299 Y
E0967 MAN WC RIM/PROJECTION REP EA PRXOVR DEF         NA NA NA N
E0967 MAN WC RIM/PROJECTION REP EA MAXFEE DEF         65.61 1/1/2017 12/31/2299 N
E0968 WHEELCHAIR COMMODE SEAT PRXOVR DEF         NA NA NA N
E0968 WHEELCHAIR COMMODE SEAT MAXFEE DEF         150 7/1/2021 12/31/2299 N
E0969 WHEELCHAIR NARROWING DEVICE PRXOVR DEF         NA NA NA S
E0969 WHEELCHAIR NARROWING DEVICE MAXFEE DEF         133 1/1/2017 12/31/2299 S
E0970 WHEELCHAIR NO. 2 FOOTPLATES PRXOVR DEF         NA NA NA Y
E0970 WHEELCHAIR NO. 2 FOOTPLATES MAXFEE DEF         45 7/1/2021 12/31/2299 Y
E0971 WHEELCHAIR ANTI-TIPPING DEVI PRXOVR DEF         NA NA NA Y
E0971 WHEELCHAIR ANTI-TIPPING DEVI MAXFEE DEF         50 1/1/2024 12/31/2299 Y
E0972 TRANSFER BOARD OR DEVICE PRXOVR DEF         NA NA NA S
E0972 TRANSFER BOARD OR DEVICE MAXFEE DEF         NA     S
E0973 W/CH ACCESS DET ADJ ARMREST PRXOVR DEF         NA NA NA Y
E0973 W/CH ACCESS DET ADJ ARMREST MAXFEE DEF         97.62 1/1/2017 12/31/2299 Y
E0974 W/CH ACCESS ANTI-ROLLBACK PRXOVR DEF         NA NA NA N
E0974 W/CH ACCESS ANTI-ROLLBACK MAXFEE DEF         78.33 1/1/2017 12/31/2299 N
E0978 W/C ACC;SAF BELT PELV STRAP PRXOVR DEF         NA NA NA S
E0978 W/C ACC;SAF BELT PELV STRAP MAXFEE DEF         44.04 1/1/2024 12/31/2299 S
E0980 WHEELCHAIR SAFETY VEST PRXOVR DEF         NA NA NA N
E0980 WHEELCHAIR SAFETY VEST MAXFEE DEF         31.92 1/1/2017 12/31/2299 N
E0981 SEAT UPHOLSTERY; REPLACEMENT PRXOVR DEF         NA NA NA N
E0981 SEAT UPHOLSTERY; REPLACEMENT MAXFEE DEF         40.04 1/1/2017 12/31/2299 N
E0982 BACK UPHOLSTERY; REPLACEMENT PRXOVR DEF         NA NA NA Y
E0982 BACK UPHOLSTERY; REPLACEMENT MAXFEE DEF         33.02 1/1/2017 12/31/2299 Y
E0983 ADD PWR JOYSTICK PRXOVR DEF         NA NA NA Y
E0983 ADD PWR JOYSTICK MAXFEE DEF         4500 7/1/2021 12/31/2299 Y
E0984 ADD PWR TILLER PRXOVR DEF         NA NA NA Y
E0984 ADD PWR TILLER MAXFEE DEF         1420.73 1/1/2017 12/31/2299 Y
E0986 MAN W/C PUSH-RIM POWR SYSTEM PRXOVR DEF         NA NA NA Y
E0986 MAN W/C PUSH-RIM POWR SYSTEM MAXFEE DEF         4851.75 1/1/2024 12/31/2299 Y
E0988 LEVER-ACTIVATED WHEEL DRIVE PRXOVR DEF         NA NA NA Y
E0988 LEVER-ACTIVATED WHEEL DRIVE MAXFEE DEF         2850 7/1/2021 12/31/2299 Y
E0990 WHEELCHAIR ELEVATING LEG RES PRXOVR DEF         NA NA NA Y
E0990 WHEELCHAIR ELEVATING LEG RES MAXFEE DEF         99.72 1/1/2017 12/31/2299 Y
E0992 WHEELCHAIR SOLID SEAT INSERT PRXOVR DEF         NA NA NA N
E0992 WHEELCHAIR SOLID SEAT INSERT MAXFEE DEF         95.06 1/1/2017 12/31/2299 N
E0994 WHEELCHAIR ARM REST PRXOVR DEF         NA NA NA Y
E0994 WHEELCHAIR ARM REST MAXFEE DEF         17.60 1/1/2017 12/31/2299 Y
E0995 WC CALF REST; PAD REPLACEMNT PRXOVR DEF         NA NA NA Y
E0995 WC CALF REST; PAD REPLACEMNT MAXFEE DEF         25.82 1/1/2017 12/31/2299 Y
E1009 ADD MECH LEG ELEVATION PRXOVR DEF         NA NA NA Y
E1009 ADD MECH LEG ELEVATION MAXFEE DEF         2090 7/1/2021 12/31/2299 Y
E1011 PED WC MODIFY WIDTH ADJUSTM PRXOVR DEF         NA NA NA Y
E1011 PED WC MODIFY WIDTH ADJUSTM MAXFEE DEF         180 7/1/2021 12/31/2299 Y
E1012 CTR MOUNT PWR ELEV LEG REST PRXOVR DEF         NA NA NA Y
E1012 CTR MOUNT PWR ELEV LEG REST MAXFEE DEF         2200 7/1/2021 12/31/2299 Y
E1013 INT SEAT SYS CONTOUR PED W/C PRXOVR DEF         NA NA NA Y
E1013 INT SEAT SYS CONTOUR PED W/C MAXFEE DEF         NA     Y
E1014 RECLINING BACK ADD PED W/C PRXOVR DEF         NA NA NA N
E1014 RECLINING BACK ADD PED W/C MAXFEE DEF         319.44 1/1/2017 12/31/2299 N
E1015 SHOCK ABSORBER FOR MAN W/C PRXOVR DEF         NA NA NA N
E1015 SHOCK ABSORBER FOR MAN W/C MAXFEE DEF         114.59 1/1/2017 12/31/2299 N
E1016 SHOCK ABSORBER FOR POWER W/C PRXOVR DEF         NA NA NA N
E1016 SHOCK ABSORBER FOR POWER W/C MAXFEE DEF         131.18 1/1/2017 12/31/2299 N
E1017 HD SHCK ABSRBR FOR HD MAN WC PRXOVR DEF         NA NA NA N
E1017 HD SHCK ABSRBR FOR HD MAN WC MAXFEE DEF         115 7/1/2021 12/31/2299 N
E1018 HD SHCK ABSRBER FOR HD POWWC PRXOVR DEF         NA NA NA Y
E1018 HD SHCK ABSRBER FOR HD POWWC MAXFEE DEF         185 7/1/2021 12/31/2299 Y
E1020 RESIDUAL LIMB SUPPORT SYSTEM PRXOVR DEF         NA NA NA N
E1020 RESIDUAL LIMB SUPPORT SYSTEM MAXFEE DEF         243.15 1/1/2017 12/31/2299 N
E1028 W/C MANUAL SWINGAWAY PRXOVR DEF         NA NA NA Y
E1028 W/C MANUAL SWINGAWAY MAXFEE DEF         225 1/1/2024 12/31/2299 Y
E1029 W/C VENT TRAY FIXED PRXOVR DEF         NA NA NA N
E1029 W/C VENT TRAY FIXED MAXFEE DEF         278.65 1/1/2017 12/31/2299 N
E1030 W/C VENT TRAY GIMBALED PRXOVR DEF         NA NA NA N
E1030 W/C VENT TRAY GIMBALED MAXFEE DEF         878.64 1/1/2017 12/31/2299 N
E1031 ROLLABOUT CHAIR WITH CASTERS PRXOVR DEF         NA NA NA N
E1031 ROLLABOUT CHAIR WITH CASTERS MAXFEE DEF         504.63 1/1/2017 12/31/2299 N
E1035 PATIENT TRANSFER SYSTEM <300 PRXOVR DEF         NA NA NA Y
E1035 PATIENT TRANSFER SYSTEM <300 MAXFEE DEF         6125.67 1/1/2017 12/31/2299 Y
E1036 PATIENT TRANSFER SYSTEM >300 PRXOVR DEF         NA NA NA Y
E1036 PATIENT TRANSFER SYSTEM >300 MAXFEE DEF         8587.53 1/1/2017 12/31/2299 Y
E1037 TRANSPORT CHAIR; PED SIZE PRXOVR DEF         NA NA NA S
E1037 TRANSPORT CHAIR; PED SIZE MAXFEE DEF         1083.69 1/1/2017 12/31/2299 S
E1038 TRANSPORT CHAIR PT WT<=300LB PRXOVR DEF         NA NA NA N
E1038 TRANSPORT CHAIR PT WT<=300LB MAXFEE DEF         180.09 1/1/2017 12/31/2299 N
E1039 TRANSPORT CHAIR PT WT >300LB PRXOVR DEF         NA NA NA N
E1039 TRANSPORT CHAIR PT WT >300LB MAXFEE DEF         341.55 1/1/2017 12/31/2299 N
E1050 WHELCHR FXD FULL LENGTH ARMS PRXOVR DEF         NA NA NA Y
E1050 WHELCHR FXD FULL LENGTH ARMS MAXFEE DEF         1017.27 1/1/2017 12/31/2299 Y
E1060 WHEELCHAIR DETACHABLE ARMS PRXOVR DEF         NA NA NA Y
E1060 WHEELCHAIR DETACHABLE ARMS MAXFEE DEF         1259.28 1/1/2017 12/31/2299 Y
E1070 WHEELCHAIR DETACHABLE FOOT R PRXOVR DEF         NA NA NA Y
E1070 WHEELCHAIR DETACHABLE FOOT R MAXFEE DEF         930.06 1/1/2017 12/31/2299 Y
E1083 HEMI-WHEELCHAIR FIXED ARMS PRXOVR DEF         NA NA NA N
E1083 HEMI-WHEELCHAIR FIXED ARMS MAXFEE DEF         786.60 1/1/2017 12/31/2299 N
E1084 HEMI-WHEELCHAIR DETACHABLE A PRXOVR DEF         NA NA NA N
E1084 HEMI-WHEELCHAIR DETACHABLE A MAXFEE DEF         980.01 1/1/2017 12/31/2299 N
E1085 HEMI-WHEELCHAIR FIXED ARMS PRXOVR DEF         NA NA NA N
E1085 HEMI-WHEELCHAIR FIXED ARMS MAXFEE DEF         715.32 1/1/2017 12/31/2299 N
E1086 HEMI-WHEELCHAIR DETACHABLE A PRXOVR DEF         NA NA NA N
E1086 HEMI-WHEELCHAIR DETACHABLE A MAXFEE DEF         908.73 1/1/2017 12/31/2299 N
E1087 WHEELCHAIR LIGHTWT FIXED ARM PRXOVR DEF         NA NA NA Y
E1087 WHEELCHAIR LIGHTWT FIXED ARM MAXFEE DEF         1229.22 1/1/2017 12/31/2299 Y
E1088 WHEELCHAIR LIGHTWEIGHT DET A PRXOVR DEF         NA NA NA Y
E1088 WHEELCHAIR LIGHTWEIGHT DET A MAXFEE DEF         1346.31 1/1/2017 12/31/2299 Y
E1089 WHEELCHAIR LIGHTWT FIXED ARM PRXOVR DEF         NA NA NA Y
E1089 WHEELCHAIR LIGHTWT FIXED ARM MAXFEE DEF         1157.94 1/1/2017 12/31/2299 Y
E1090 WHEELCHAIR LIGHTWEIGHT DET A PRXOVR DEF         NA NA NA Y
E1090 WHEELCHAIR LIGHTWEIGHT DET A MAXFEE DEF         1275.03 1/1/2017 12/31/2299 Y
E1092 WHEELCHAIR WIDE W/ LEG RESTS PRXOVR DEF         NA NA NA Y
E1092 WHEELCHAIR WIDE W/ LEG RESTS MAXFEE DEF         1117.62 1/1/2017 12/31/2299 Y
E1093 WHEELCHAIR WIDE W/ FOOT REST PRXOVR DEF         NA NA NA Y
E1093 WHEELCHAIR WIDE W/ FOOT REST MAXFEE DEF         994.59 1/1/2017 12/31/2299 Y
E1100 WHCHR S-RECL FXD ARM LEG RES PRXOVR DEF         NA NA NA Y
E1100 WHCHR S-RECL FXD ARM LEG RES MAXFEE DEF         881.37 1/1/2017 12/31/2299 Y
E1110 WHEELCHAIR SEMI-RECL DETACH PRXOVR DEF         NA NA NA Y
E1110 WHEELCHAIR SEMI-RECL DETACH MAXFEE DEF         895.32 1/1/2017 12/31/2299 Y
E1130 WHLCHR STAND FXD ARM FT REST PRXOVR DEF         NA NA NA N
E1130 WHLCHR STAND FXD ARM FT REST MAXFEE DEF         553.14 1/1/2017 12/31/2299 N
E1140 WHEELCHAIR STANDARD DETACH A PRXOVR DEF         NA NA NA N
E1140 WHEELCHAIR STANDARD DETACH A MAXFEE DEF         743.58 1/1/2017 12/31/2299 N
E1150 WHEELCHAIR STANDARD W/ LEG R PRXOVR DEF         NA NA NA N
E1150 WHEELCHAIR STANDARD W/ LEG R MAXFEE DEF         814.86 1/1/2017 12/31/2299 N
E1160 WHEELCHAIR FIXED ARMS PRXOVR DEF         NA NA NA N
E1160 WHEELCHAIR FIXED ARMS MAXFEE DEF         624.42 1/1/2017 12/31/2299 N
E1161 MANUAL ADULT WC W TILTINSPAC PRXOVR DEF         NA NA NA Y
E1161 MANUAL ADULT WC W TILTINSPAC MAXFEE DEF         2500 1/1/2024 12/31/2299 Y
E1170 WHLCHR AMPU FXD ARM LEG REST PRXOVR DEF         NA NA NA N
E1170 WHLCHR AMPU FXD ARM LEG REST MAXFEE DEF         758.52 1/1/2017 12/31/2299 N
E1171 WHEELCHAIR AMPUTEE W/O LEG R PRXOVR DEF         NA NA NA N
E1171 WHEELCHAIR AMPUTEE W/O LEG R MAXFEE DEF         680.58 1/1/2017 12/31/2299 N
E1172 WHEELCHAIR AMPUTEE DETACH AR PRXOVR DEF         NA NA NA N
E1172 WHEELCHAIR AMPUTEE DETACH AR MAXFEE DEF         831.78 1/1/2017 12/31/2299 N
E1180 WHEELCHAIR AMPUTEE W/ FOOT R PRXOVR DEF         NA NA NA N
E1180 WHEELCHAIR AMPUTEE W/ FOOT R MAXFEE DEF         893.52 1/1/2017 12/31/2299 N
E1190 WHEELCHAIR AMPUTEE W/ LEG RE PRXOVR DEF         NA NA NA N
E1190 WHEELCHAIR AMPUTEE W/ LEG RE MAXFEE DEF         1027.62 1/1/2017 12/31/2299 N
E1195 WHEELCHAIR AMPUTEE HEAVY DUT PRXOVR DEF         NA NA NA Y
E1195 WHEELCHAIR AMPUTEE HEAVY DUT MAXFEE DEF         1066.68 1/1/2017 12/31/2299 Y
E1200 WHEELCHAIR AMPUTEE FIXED ARM PRXOVR DEF         NA NA NA N
E1200 WHEELCHAIR AMPUTEE FIXED ARM MAXFEE DEF         738.81 1/1/2017 12/31/2299 N
E1220 WHLCHR SPECIAL SIZE/CONSTRC PRXOVR DEF         NA NA NA Y
E1220 WHLCHR SPECIAL SIZE/CONSTRC MAXFEE DEF         1900 7/1/2021 12/31/2299 Y
E1221 WHEELCHAIR SPEC SIZE W FOOT PRXOVR DEF         NA NA NA N
E1221 WHEELCHAIR SPEC SIZE W FOOT MAXFEE DEF         474.66 1/1/2017 12/31/2299 N
E1222 WHEELCHAIR SPEC SIZE W/ LEG PRXOVR DEF         NA NA NA N
E1222 WHEELCHAIR SPEC SIZE W/ LEG MAXFEE DEF         635.67 1/1/2017 12/31/2299 N
E1223 WHEELCHAIR SPEC SIZE W FOOT PRXOVR DEF         NA NA NA N
E1223 WHEELCHAIR SPEC SIZE W FOOT MAXFEE DEF         739.35 1/1/2017 12/31/2299 N
E1224 WHEELCHAIR SPEC SIZE W/ LEG PRXOVR DEF         NA NA NA N
E1224 WHEELCHAIR SPEC SIZE W/ LEG MAXFEE DEF         810.63 1/1/2017 12/31/2299 N
E1225 MANUAL SEMI-RECLINING BACK PRXOVR DEF         NA NA NA Y
E1225 MANUAL SEMI-RECLINING BACK MAXFEE DEF         280 1/1/2017 12/31/2299 Y
E1226 MANUAL FULLY RECLINING BACK PRXOVR DEF         NA NA NA Y
E1226 MANUAL FULLY RECLINING BACK MAXFEE DEF         463.32 1/1/2017 12/31/2299 Y
E1227 WHEELCHAIR SPEC SZ SPEC HT A PRXOVR DEF         NA NA NA N
E1227 WHEELCHAIR SPEC SZ SPEC HT A MAXFEE DEF         235.63 1/1/2017 12/31/2299 N
E1228 WHEELCHAIR SPEC SZ SPEC HT B PRXOVR DEF         NA NA NA Y
E1228 WHEELCHAIR SPEC SZ SPEC HT B PADOLR DEF         NA NA NA Y
E1229 PEDIATRIC WHEELCHAIR NOS PRXOVR DEF         NA NA NA Y
E1229 PEDIATRIC WHEELCHAIR NOS MAXFEE DEF         1750 7/1/2021 12/31/2299 Y
E1230 POWER OPERATED VEHICLE PRXOVR DEF         NA NA NA Y
E1230 POWER OPERATED VEHICLE MAXFEE DEF         2212.79 1/1/2017 12/31/2299 Y
E1231 RIGID PED W/C TILT-IN-SPACE PRXOVR DEF         NA NA NA Y
E1231 RIGID PED W/C TILT-IN-SPACE MAXFEE DEF         2513.37 1/1/2024 12/31/2299 Y
E1232 FOLDING PED WC TILT-IN-SPACE PRXOVR DEF         NA NA NA Y
E1232 FOLDING PED WC TILT-IN-SPACE MAXFEE DEF         2300 1/1/2024 12/31/2299 Y
E1233 RIG PED WC TLTNSPC W/O SEAT PRXOVR DEF         NA NA NA Y
E1233 RIG PED WC TLTNSPC W/O SEAT MAXFEE DEF         2213.37 1/1/2017 12/31/2299 Y
E1234 FLD PED WC TLTNSPC W/O SEAT PRXOVR DEF         NA NA NA Y
E1234 FLD PED WC TLTNSPC W/O SEAT MAXFEE DEF         2000 1/1/2024 12/31/2299 Y
E1235 RIGID PED WC ADJUSTABLE PRXOVR DEF         NA NA NA Y S
E1235 RIGID PED WC ADJUSTABLE MAXFEE DEF         1855.62 1/1/2017 12/31/2299 Y S
E1236 FOLDING PED WC ADJUSTABLE PRXOVR DEF         NA NA NA Y S
E1236 FOLDING PED WC ADJUSTABLE MAXFEE DEF         1875 1/1/2024 12/31/2299 Y S
E1237 RGD PED WC ADJSTABL W/O SEAT PRXOVR DEF         NA NA NA Y S
E1237 RGD PED WC ADJSTABL W/O SEAT MAXFEE DEF         1651.32 1/1/2017 12/31/2299 Y S
E1238 FLD PED WC ADJSTABL W/O SEAT PRXOVR DEF         NA NA NA Y S
E1238 FLD PED WC ADJSTABL W/O SEAT MAXFEE DEF         1637.01 1/1/2017 12/31/2299 Y S
E1239 PED POWER WHEELCHAIR NOS PRXOVR DEF         NA NA NA Y
E1239 PED POWER WHEELCHAIR NOS MAXFEE DEF         2200 7/1/2021 12/31/2299 Y
E1240 WHCHR LITWT DET ARM LEG REST PRXOVR DEF         NA NA NA N
E1240 WHCHR LITWT DET ARM LEG REST MAXFEE DEF         1029.15 1/1/2017 12/31/2299 N
E1250 WHEELCHAIR LIGHTWT FIXED ARM PRXOVR DEF         NA NA NA Y
E1250 WHEELCHAIR LIGHTWT FIXED ARM MAXFEE DEF         717.30 1/1/2017 12/31/2299 Y
E1260 WHEELCHAIR LIGHTWT FOOT REST PRXOVR DEF         NA NA NA Y
E1260 WHEELCHAIR LIGHTWT FOOT REST MAXFEE DEF         957.87 1/1/2017 12/31/2299 Y
E1270 WHEELCHAIR LIGHTWEIGHT LEG R PRXOVR DEF         NA NA NA Y
E1270 WHEELCHAIR LIGHTWEIGHT LEG R MAXFEE DEF         788.58 1/1/2017 12/31/2299 Y
E1280 WHCHR H-DUTY DET ARM LEG RES PRXOVR DEF         NA NA NA Y
E1280 WHCHR H-DUTY DET ARM LEG RES MAXFEE DEF         1199.79 1/1/2017 12/31/2299 Y
E1285 WHEELCHAIR HEAVY DUTY FIXED PRXOVR DEF         NA NA NA N
E1285 WHEELCHAIR HEAVY DUTY FIXED MAXFEE DEF         1051.02 1/1/2017 12/31/2299 N
E1290 WHEELCHAIR HVY DUTY DETACH A PRXOVR DEF         NA NA NA N
E1290 WHEELCHAIR HVY DUTY DETACH A MAXFEE DEF         1128.51 1/1/2017 12/31/2299 N
E1295 WHEELCHAIR HEAVY DUTY FIXED PRXOVR DEF         NA NA NA Y
E1295 WHEELCHAIR HEAVY DUTY FIXED MAXFEE DEF         1122.30 1/1/2017 12/31/2299 Y
E1296 WHEELCHAIR SPECIAL SEAT HEIG PRXOVR DEF         NA NA NA N
E1296 WHEELCHAIR SPECIAL SEAT HEIG MAXFEE DEF         417.47 1/1/2017 12/31/2299 N
E1297 WHEELCHAIR SPECIAL SEAT DEPT PRXOVR DEF         NA NA NA Y
E1297 WHEELCHAIR SPECIAL SEAT DEPT MAXFEE DEF         88.82 1/1/2017 12/31/2299 Y
E1298 WHEELCHAIR SPEC SEAT DEPTH/W PRXOVR DEF         NA NA NA Y
E1298 WHEELCHAIR SPEC SEAT DEPTH/W MAXFEE DEF         359.73 1/1/2017 12/31/2299 Y
E1300 WHIRLPOOL PORTABLE PRXOVR DEF         NA NA NA S
E1300 WHIRLPOOL PORTABLE MAXFEE DEF         170 4/1/2006 12/31/2299 S
E1301 WHIRLPOOL TUB WALKIN PORTABL PRXOVR DEF         NA NA NA Y N
E1301 WHIRLPOOL TUB WALKIN PORTABL MANUAL DEF         NA NA NA Y N
E1310 WHIRLPOOL NON-PORTABLE PRXOVR DEF         NA NA NA E
E1310 WHIRLPOOL NON-PORTABLE MANUAL DEF         NA NA NA E
E1351 MAJOR REPAIR LTCF PRXOVR DEF         NA NA NA Y
E1351 MAJOR REPAIR LTCF PADOLR DEF         NA NA NA Y
E1352 O2 FLOW REG POS INSPIR PRESS PRXOVR DEF         NA NA NA E
E1352 O2 FLOW REG POS INSPIR PRESS MANUAL DEF         NA NA NA E
E1353 OXYGEN SUPPLIES REGULATOR PRXOVR DEF         NA NA NA E
E1353 OXYGEN SUPPLIES REGULATOR MANUAL DEF         NA NA NA E
E1354 WHEELED CART; PORT CYL/CONC PRXOVR DEF         NA NA NA E
E1354 WHEELED CART; PORT CYL/CONC MANUAL DEF         NA NA NA E
E1355 OXYGEN SUPPLIES STAND/RACK PRXOVR DEF         NA NA NA E
E1355 OXYGEN SUPPLIES STAND/RACK MANUAL DEF         NA NA NA E
E1356 BATT PACK/CART; PORT CONC PRXOVR DEF         NA NA NA E
E1356 BATT PACK/CART; PORT CONC MANUAL DEF         NA NA NA E
E1357 BATTERY CHARGER; PORT CONC PRXOVR DEF         NA NA NA E
E1357 BATTERY CHARGER; PORT CONC MANUAL DEF         NA NA NA E
E1358 DC POWER ADAPTER; PORT CONC PRXOVR DEF         NA NA NA E
E1358 DC POWER ADAPTER; PORT CONC MANUAL DEF         NA NA NA E
E1372 OXY SUPPL HEATER FOR NEBULIZ PRXOVR DEF         NA NA NA E
E1372 OXY SUPPL HEATER FOR NEBULIZ MAXFEE DEF         118 4/1/2006 12/31/2299 E
E1399 DURABLE MEDICAL EQUIPMENT MI PRXOVR DEF         NA NA NA Y S
E1399 DURABLE MEDICAL EQUIPMENT MI PADOLR DEF         NA NA NA Y S
E1399 DURABLE MEDICAL EQUIPMENT MI REPAIR DEF         NA NA NA Y S
E1405 O2/WATER VAPOR ENRICH W/HEAT PRXOVR DEF         NA NA NA E
E1405 O2/WATER VAPOR ENRICH W/HEAT MANUAL DEF         NA NA NA E
E1406 O2/WATER VAPOR ENRICH W/O HE PRXOVR DEF         NA NA NA E
E1406 O2/WATER VAPOR ENRICH W/O HE MANUAL DEF         NA NA NA E
E1500 CENTRIFUGE PRXOVR DEF         NA NA NA E
E1500 CENTRIFUGE MANUAL DEF         NA NA NA E
E1520 HEPARIN INFUSION PUMP PRXOVR DEF         NA NA NA E
E1520 HEPARIN INFUSION PUMP MANUAL DEF         NA NA NA E
E1530 REPLACEMENT AIR BUBBLE DETEC PRXOVR DEF         NA NA NA E
E1530 REPLACEMENT AIR BUBBLE DETEC MANUAL DEF         NA NA NA E
E1540 REPLACEMENT PRESSURE ALARM PRXOVR DEF         NA NA NA E
E1540 REPLACEMENT PRESSURE ALARM MANUAL DEF         NA NA NA E
E1550 BATH CONDUCTIVITY METER PRXOVR DEF         NA NA NA E
E1550 BATH CONDUCTIVITY METER MAXFEE DEF         0 9/1/2005 12/31/2299 E
E1550 BATH CONDUCTIVITY METER MANUAL DEF         NA NA NA E
E1560 REPLACE BLOOD LEAK DETECTOR PRXOVR DEF         NA NA NA E
E1560 REPLACE BLOOD LEAK DETECTOR MANUAL DEF         NA NA NA E
E1570 ADJUSTABLE CHAIR FOR ESRD PT PRXOVR DEF         NA NA NA E
E1570 ADJUSTABLE CHAIR FOR ESRD PT MANUAL DEF         NA NA NA E
E1575 TRANSDUCER PROTECT/FLD BAR PRXOVR DEF         NA NA NA E
E1575 TRANSDUCER PROTECT/FLD BAR MANUAL DEF         NA NA NA E
E1580 UNIPUNCTURE CONTROL SYSTEM PRXOVR DEF         NA NA NA E
E1580 UNIPUNCTURE CONTROL SYSTEM MANUAL DEF         NA NA NA E
E1610 REVERSE OSMOSIS H2O PURI SYS PRXOVR DEF         NA NA NA E
E1610 REVERSE OSMOSIS H2O PURI SYS MANUAL DEF         NA NA NA E
E1615 DEIONIZER H2O PURI SYSTEM PRXOVR DEF         NA NA NA E
E1615 DEIONIZER H2O PURI SYSTEM MANUAL DEF         NA NA NA E
E1620 REPLACEMENT BLOOD PUMP PRXOVR DEF         NA NA NA E
E1620 REPLACEMENT BLOOD PUMP MANUAL DEF         NA NA NA E
E1625 WATER SOFTENING SYSTEM PRXOVR DEF         NA NA NA E
E1625 WATER SOFTENING SYSTEM MANUAL DEF         NA NA NA E
E1630 RECIPROCATING PERITONEAL DIA PRXOVR DEF         NA NA NA E
E1630 RECIPROCATING PERITONEAL DIA MANUAL DEF         NA NA NA E
E1634 PERITONEAL DIALYSIS CLAMP PRXOVR DEF         NA NA NA E
E1634 PERITONEAL DIALYSIS CLAMP MANUAL DEF         NA NA NA E
E1636 SORBENT CARTRIDGES PER 10 PRXOVR DEF         NA NA NA E
E1636 SORBENT CARTRIDGES PER 10 MANUAL DEF         NA NA NA E
E1637 HEMOSTATS FOR DIALYSIS; EACH PRXOVR DEF         NA NA NA E
E1637 HEMOSTATS FOR DIALYSIS; EACH MANUAL DEF         NA NA NA E
E1639 SCALE; EACH PRXOVR DEF         NA NA NA E
E1639 SCALE; EACH MANUAL DEF         NA NA NA E
E1699 DIALYSIS EQUIPMENT NOC PRXOVR DEF         NA NA NA E
E1699 DIALYSIS EQUIPMENT NOC MANUAL DEF         NA NA NA E
E1700 JAW MOTION REHAB SYSTEM PRXOVR DEF         NA NA NA E
E1700 JAW MOTION REHAB SYSTEM MANUAL DEF         NA NA NA E
E1701 REPL CUSHIONS FOR JAW MOTION PRXOVR DEF         NA NA NA E
E1701 REPL CUSHIONS FOR JAW MOTION MANUAL DEF         NA NA NA E
E1702 REPL MEASR SCALES JAW MOTION PRXOVR DEF         NA NA NA E
E1702 REPL MEASR SCALES JAW MOTION MANUAL DEF         NA NA NA E
E1800 ADJUST ELBOW EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1800 ADJUST ELBOW EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1801 SPS ELBOW DEVICE PRXOVR DEF         NA NA NA E
E1801 SPS ELBOW DEVICE MANUAL DEF         NA NA NA E
E1802 ADJST FOREARM PRO/SUP DEVICE PRXOVR DEF         NA NA NA E
E1802 ADJST FOREARM PRO/SUP DEVICE MANUAL DEF         NA NA NA E
E1805 ADJUST WRIST EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1805 ADJUST WRIST EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1806 SPS WRIST DEVICE PRXOVR DEF         NA NA NA E
E1806 SPS WRIST DEVICE MANUAL DEF         NA NA NA E
E1810 ADJUST KNEE EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1810 ADJUST KNEE EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1811 SPS KNEE DEVICE PRXOVR DEF         NA NA NA E
E1811 SPS KNEE DEVICE MANUAL DEF         NA NA NA E
E1812 KNEE EXT/FLEX W ACT RES CTRL PRXOVR DEF         NA NA NA E
E1812 KNEE EXT/FLEX W ACT RES CTRL MANUAL DEF         NA NA NA E
E1815 ADJUST ANKLE EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1815 ADJUST ANKLE EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1816 SPS ANKLE DEVICE PRXOVR DEF         NA NA NA E
E1816 SPS ANKLE DEVICE MANUAL DEF         NA NA NA E
E1818 SPS FOREARM DEVICE PRXOVR DEF         NA NA NA E
E1818 SPS FOREARM DEVICE MANUAL DEF         NA NA NA E
E1820 SOFT INTERFACE MATERIAL PRXOVR DEF         NA NA NA S
E1820 SOFT INTERFACE MATERIAL MAXFEE DEF         65.39 4/1/2006 12/31/2299 S
E1821 REPLACEMENT INTERFACE SPSD PRXOVR DEF         NA NA NA E
E1821 REPLACEMENT INTERFACE SPSD MANUAL DEF         NA NA NA E
E1825 ADJUST FINGER EXT/FLEX DEVC PRXOVR DEF         NA NA NA E
E1825 ADJUST FINGER EXT/FLEX DEVC MANUAL DEF         NA NA NA E
E1830 ADJUST TOE EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1830 ADJUST TOE EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1831 STATIC STR TOE DEV EXT/FLEX PRXOVR DEF         NA NA NA E
E1831 STATIC STR TOE DEV EXT/FLEX MANUAL DEF         NA NA NA E
E1840 ADJ SHOULDER EXT/FLEX DEVICE PRXOVR DEF         NA NA NA E
E1840 ADJ SHOULDER EXT/FLEX DEVICE MANUAL DEF         NA NA NA E
E1841 STATIC STR SHLDR DEV ROM ADJ PRXOVR DEF         NA NA NA E
E1841 STATIC STR SHLDR DEV ROM ADJ MANUAL DEF         NA NA NA E
E2000 GASTRIC SUCTION PUMP HME MDL PRXOVR DEF         NA NA NA E
E2000 GASTRIC SUCTION PUMP HME MDL MANUAL DEF         NA NA NA E
E2001 SUCT PUM EXT MGMT SYS PRXOVR DEF         NA NA NA S N
E2001 SUCT PUM EXT MGMT SYS MAXFEE DEF         299 1/1/2024 12/31/2299 S N
E2100 BLD GLUCOSE MONITOR W VOICE PRXOVR DEF         NA NA NA E
E2100 BLD GLUCOSE MONITOR W VOICE MAXFEE DEF         0 2/1/2010 12/31/2299 E
E2101 BLD GLUCOSE MONITOR W LANCE PRXOVR DEF         NA NA NA E
E2101 BLD GLUCOSE MONITOR W LANCE MAXFEE DEF         0 2/1/2010 12/31/2299 E
E2102 ADJU CGM RECEIVER/MONITOR PRXOVR DEF         NA NA NA S
E2102 ADJU CGM RECEIVER/MONITOR MANUAL DEF         NA NA NA S
E2103 NON-ADJU CGM RECEIVER/MON PRXOVR DEF         NA NA NA Y
E2103 NON-ADJU CGM RECEIVER/MON MAXFEE DEF         210 1/1/2024 12/31/2299 Y
E2104 GLUCOSE MONITOR W CARTRIDGE PRXOVR DEF         NA NA NA N
E2104 GLUCOSE MONITOR W CARTRIDGE MAXFEE DEF         42 4/1/2024 12/31/2299 N
E2120 PULSE GEN SYS TX ENDOLYMP FL PRXOVR DEF         NA NA NA E
E2120 PULSE GEN SYS TX ENDOLYMP FL MAXFEE DEF         0 9/1/2005 12/31/2299 E
E2201 MAN W/CH ACC SEAT W>=20<24 PRXOVR DEF         NA NA NA Y
E2201 MAN W/CH ACC SEAT W>=20<24 MAXFEE DEF         372.72 1/1/2017 12/31/2299 Y
E2202 SEAT WIDTH 24-27 IN PRXOVR DEF         NA NA NA Y
E2202 SEAT WIDTH 24-27 IN MAXFEE DEF         473.47 1/1/2017 12/31/2299 Y
E2203 FRAME DEPTH LESS THAN 22 IN PRXOVR DEF         NA NA NA Y
E2203 FRAME DEPTH LESS THAN 22 IN MAXFEE DEF         478.56 1/1/2017 12/31/2299 Y
E2204 FRAME DEPTH 22 TO 25 IN PRXOVR DEF         NA NA NA Y
E2204 FRAME DEPTH 22 TO 25 IN MAXFEE DEF         812.56 1/1/2017 12/31/2299 Y
E2205 MANUAL WC ACCESSORY; HANDRIM PRXOVR DEF         NA NA NA Y
E2205 MANUAL WC ACCESSORY; HANDRIM MAXFEE DEF         32.63 1/1/2017 12/31/2299 Y
E2206 MAN WC WHL LOCK COMP REPL EA PRXOVR DEF         NA NA NA N
E2206 MAN WC WHL LOCK COMP REPL EA MAXFEE DEF         40.64 1/1/2017 12/31/2299 N
E2207 CRUTCH AND CANE HOLDER PRXOVR DEF         NA NA NA N
E2207 CRUTCH AND CANE HOLDER MAXFEE DEF         43.30 1/1/2017 12/31/2299 N
E2208 CYLINDER TANK CARRIER PRXOVR DEF         NA NA NA Y
E2208 CYLINDER TANK CARRIER MAXFEE DEF         118.67 1/1/2017 12/31/2299 Y
E2209 ARM TROUGH EACH PRXOVR DEF         NA NA NA Y
E2209 ARM TROUGH EACH MAXFEE DEF         107.06 1/1/2017 12/31/2299 Y
E2210 WHEELCHAIR BEARINGS PRXOVR DEF         NA NA NA Y
E2210 WHEELCHAIR BEARINGS MAXFEE DEF         10 1/1/2024 12/31/2299 Y
E2211 PNEUMATIC PROPULSION TIRE PRXOVR DEF         NA NA NA S
E2211 PNEUMATIC PROPULSION TIRE MAXFEE DEF         34.74 1/1/2017 12/31/2299 S
E2212 PNEUMATIC PROP TIRE TUBE PRXOVR DEF         NA NA NA N
E2212 PNEUMATIC PROP TIRE TUBE MAXFEE DEF         5.87 1/1/2017 12/31/2299 N
E2213 PNEUMATIC PROP TIRE INSERT PRXOVR DEF         NA NA NA S
E2213 PNEUMATIC PROP TIRE INSERT MAXFEE DEF         30.38 1/1/2017 12/31/2299 S
E2214 PNEUMATIC CASTER TIRE EACH PRXOVR DEF         NA NA NA N
E2214 PNEUMATIC CASTER TIRE EACH MAXFEE DEF         30.57 1/1/2017 12/31/2299 N
E2215 PNEUMATIC CASTER TIRE TUBE PRXOVR DEF         NA NA NA Y
E2215 PNEUMATIC CASTER TIRE TUBE MAXFEE DEF         9.59 1/1/2017 12/31/2299 Y
E2216 FOAM FILLED PROPULSION TIRE PRXOVR DEF         NA NA NA N
E2216 FOAM FILLED PROPULSION TIRE MAXFEE DEF         35 7/1/2021 12/31/2299 N
E2217 FOAM FILLED CASTER TIRE EACH PRXOVR DEF         NA NA NA N
E2217 FOAM FILLED CASTER TIRE EACH MAXFEE DEF         35 7/1/2021 12/31/2299 N
E2218 FOAM PROPULSION TIRE EACH PRXOVR DEF         NA NA NA N
E2218 FOAM PROPULSION TIRE EACH MAXFEE DEF         40 7/1/2021 12/31/2299 N
E2219 FOAM CASTER TIRE ANY SIZE EA PRXOVR DEF         NA NA NA N
E2219 FOAM CASTER TIRE ANY SIZE EA MAXFEE DEF         38.60 1/1/2017 12/31/2299 N
E2220 SOLID PROPULS TIRE; REPL; EA PRXOVR DEF         NA NA NA N
E2220 SOLID PROPULS TIRE; REPL; EA MAXFEE DEF         24.23 1/1/2017 12/31/2299 N
E2221 SOLID CASTER TIRE REPL; EACH PRXOVR DEF         NA NA NA N
E2221 SOLID CASTER TIRE REPL; EACH MAXFEE DEF         25.52 1/1/2017 12/31/2299 N
E2222 SOLID CASTER INTEG WHL; REPL PRXOVR DEF         NA NA NA N
E2222 SOLID CASTER INTEG WHL; REPL MAXFEE DEF         21.04 1/1/2017 12/31/2299 N
E2224 PROPULSION WHL EXCL TIRE REP PRXOVR DEF         NA NA NA N
E2224 PROPULSION WHL EXCL TIRE REP MAXFEE DEF         83.26 1/1/2017 12/31/2299 N
E2225 CASTER WHEEL EXCLUDES TIRE PRXOVR DEF         NA NA NA Y
E2225 CASTER WHEEL EXCLUDES TIRE MAXFEE DEF         17.39 1/1/2017 12/31/2299 Y
E2226 CASTER FORK REPLACEMENT ONLY PRXOVR DEF         NA NA NA N
E2226 CASTER FORK REPLACEMENT ONLY MAXFEE DEF         37.91 1/1/2017 12/31/2299 N
E2227 GEAR REDUCTION DRIVE WHEEL PRXOVR DEF         NA NA NA Y
E2227 GEAR REDUCTION DRIVE WHEEL MAXFEE DEF         1636.50 1/1/2017 12/31/2299 Y
E2228 MWC ACC; WHEELCHAIR BRAKE PRXOVR DEF         NA NA NA Y
E2228 MWC ACC; WHEELCHAIR BRAKE MAXFEE DEF         935.29 1/1/2017 12/31/2299 Y
E2230 MANUAL STANDING SYSTEM PRXOVR DEF         NA NA NA Y
E2230 MANUAL STANDING SYSTEM MAXFEE DEF         3000 7/1/2021 12/31/2299 Y
E2231 SOLID SEAT SUPPORT BASE PRXOVR DEF         NA NA NA Y
E2231 SOLID SEAT SUPPORT BASE MAXFEE DEF         153.51 1/1/2017 12/31/2299 Y
E2291 PLANAR BACK FOR PED SIZE WC PRXOVR DEF         NA NA NA N
E2291 PLANAR BACK FOR PED SIZE WC MAXFEE DEF         350 7/1/2021 12/31/2299 N
E2292 PLANAR SEAT FOR PED SIZE WC PRXOVR DEF         NA NA NA N
E2292 PLANAR SEAT FOR PED SIZE WC MAXFEE DEF         350 7/1/2021 12/31/2299 N
E2293 CONTOUR BACK FOR PED SIZE WC PRXOVR DEF         NA NA NA N
E2293 CONTOUR BACK FOR PED SIZE WC MAXFEE DEF         500 7/1/2021 12/31/2299 N
E2294 CONTOUR SEAT FOR PED SIZE WC PRXOVR DEF         NA NA NA N
E2294 CONTOUR SEAT FOR PED SIZE WC MAXFEE DEF         500 7/1/2021 12/31/2299 N
E2295 PED DYNAMIC SEATING FRAME PRXOVR DEF         NA NA NA Y
E2295 PED DYNAMIC SEATING FRAME MAXFEE DEF         2150 7/1/2021 12/31/2299 Y
E2320 HAND CHIN CONTROL PRXOVR DEF         NA NA NA Y
E2320 HAND CHIN CONTROL MAXFEE DEF         0 1/1/2007 12/31/2299 Y
E2340 W/C WDTH 20-23 IN SEAT FRAME PRXOVR DEF         NA NA NA S
E2340 W/C WDTH 20-23 IN SEAT FRAME MAXFEE DEF         357.98 1/1/2017 12/31/2299 S
E2341 W/C WDTH 24-27 IN SEAT FRAME PRXOVR DEF         NA NA NA S
E2341 W/C WDTH 24-27 IN SEAT FRAME MAXFEE DEF         537.02 1/1/2017 12/31/2299 S
E2342 W/C DPTH 20-21 IN SEAT FRAME PRXOVR DEF         NA NA NA Y
E2342 W/C DPTH 20-21 IN SEAT FRAME MAXFEE DEF         447.52 1/1/2017 12/31/2299 Y
E2343 W/C DPTH 22-25 IN SEAT FRAME PRXOVR DEF         NA NA NA S
E2343 W/C DPTH 22-25 IN SEAT FRAME MAXFEE DEF         716.03 1/1/2017 12/31/2299 S
E2358 GR 34 NONSEALED LEADACID PRXOVR DEF         NA NA NA Y
E2358 GR 34 NONSEALED LEADACID MAXFEE DEF         150 7/1/2021 12/31/2299 Y
E2359 GR34 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2359 GR34 SEALED LEADACID BATTERY MAXFEE DEF         196.85 1/1/2024 12/31/2299 N
E2360 22NF NONSEALED LEADACID PRXOVR DEF         NA NA NA S
E2360 22NF NONSEALED LEADACID MAXFEE DEF         102.06 1/1/2017 12/31/2299 S
E2361 22NF SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2361 22NF SEALED LEADACID BATTERY MAXFEE DEF         155 1/1/2024 12/31/2299 N
E2362 GR24 NONSEALED LEADACID PRXOVR DEF         NA NA NA N
E2362 GR24 NONSEALED LEADACID MAXFEE DEF         91.89 1/1/2017 12/31/2299 N
E2363 GR24 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2363 GR24 SEALED LEADACID BATTERY MAXFEE DEF         200 1/1/2024 12/31/2299 N
E2364 U1NONSEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2364 U1NONSEALED LEADACID BATTERY MAXFEE DEF         102.06 1/1/2017 12/31/2299 N
E2365 U1 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2365 U1 SEALED LEADACID BATTERY MAXFEE DEF         132.04 1/1/2024 12/31/2299 N
E2366 BATTERY CHARGER; SINGLE MODE PRXOVR DEF         NA NA NA N
E2366 BATTERY CHARGER; SINGLE MODE MAXFEE DEF         223.84 1/1/2017 12/31/2299 N
E2367 BATTERY CHARGER; DUAL MODE PRXOVR DEF         NA NA NA N
E2367 BATTERY CHARGER; DUAL MODE MAXFEE DEF         418.64 1/1/2017 12/31/2299 N
E2371 GR27 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA N
E2371 GR27 SEALED LEADACID BATTERY MAXFEE DEF         150.58 1/1/2017 12/31/2299 N
E2372 GR27 NON-SEALED LEADACID PRXOVR DEF         NA NA NA Y
E2372 GR27 NON-SEALED LEADACID MAXFEE DEF         150 7/1/2021 12/31/2299 Y
E2381 PNEUM DRIVE WHEEL TIRE PRXOVR DEF         NA NA NA N
E2381 PNEUM DRIVE WHEEL TIRE MAXFEE DEF         76.10 1/1/2017 12/31/2299 N
E2382 TUBE; PNEUM WHEEL DRIVE TIRE PRXOVR DEF         NA NA NA N
E2382 TUBE; PNEUM WHEEL DRIVE TIRE MAXFEE DEF         20.75 1/1/2017 12/31/2299 N
E2383 INSERT; PNEUM WHEEL DRIVE PRXOVR DEF         NA NA NA N
E2383 INSERT; PNEUM WHEEL DRIVE MAXFEE DEF         151.71 1/1/2017 12/31/2299 N
E2384 PNEUMATIC CASTER TIRE PRXOVR DEF         NA NA NA N
E2384 PNEUMATIC CASTER TIRE MAXFEE DEF         80.85 1/1/2017 12/31/2299 N
E2385 TUBE; PNEUMATIC CASTER TIRE PRXOVR DEF         NA NA NA N
E2385 TUBE; PNEUMATIC CASTER TIRE MAXFEE DEF         49.46 1/1/2017 12/31/2299 N
E2386 FOAM FILLED DRIVE WHEEL TIRE PRXOVR DEF         NA NA NA N
E2386 FOAM FILLED DRIVE WHEEL TIRE MAXFEE DEF         150.35 1/1/2017 12/31/2299 N
E2387 FOAM FILLED CASTER TIRE PRXOVR DEF         NA NA NA N
E2387 FOAM FILLED CASTER TIRE MAXFEE DEF         64.86 1/1/2017 12/31/2299 N
E2388 FOAM DRIVE WHEEL TIRE PRXOVR DEF         NA NA NA N
E2388 FOAM DRIVE WHEEL TIRE MAXFEE DEF         50.35 1/1/2017 12/31/2299 N
E2389 FOAM CASTER TIRE PRXOVR DEF         NA NA NA N
E2389 FOAM CASTER TIRE MAXFEE DEF         27.34 1/1/2017 12/31/2299 N
E2390 SOLID DRIVE WHEEL TIRE PRXOVR DEF         NA NA NA N
E2390 SOLID DRIVE WHEEL TIRE MAXFEE DEF         42.75 1/1/2017 12/31/2299 N
E2391 SOLID CASTER TIRE PRXOVR DEF         NA NA NA N
E2391 SOLID CASTER TIRE MAXFEE DEF         20.49 1/1/2017 12/31/2299 N
E2392 SOLID CASTER TIRE; INTEGRATE PRXOVR DEF         NA NA NA N
E2392 SOLID CASTER TIRE; INTEGRATE MAXFEE DEF         53.81 1/1/2017 12/31/2299 N
E2394 DRIVE WHEEL EXCLUDES TIRE PRXOVR DEF         NA NA NA N
E2394 DRIVE WHEEL EXCLUDES TIRE MAXFEE DEF         76.67 1/1/2017 12/31/2299 N
E2395 CASTER WHEEL EXCLUDES TIRE PRXOVR DEF         NA NA NA N
E2395 CASTER WHEEL EXCLUDES TIRE MAXFEE DEF         54.49 1/1/2017 12/31/2299 N
E2396 CASTER FORK PRXOVR DEF         NA NA NA N
E2396 CASTER FORK MAXFEE DEF         56.48 1/1/2017 12/31/2299 N
E2397 PWC ACC; LITH-BASED BATTERY PRXOVR DEF         NA NA NA N
E2397 PWC ACC; LITH-BASED BATTERY MAXFEE DEF         413.70 1/1/2017 12/31/2299 N
E2398 WC DYNAMIC POS BACK HARDWARE PRXOVR DEF         NA NA NA Y
E2398 WC DYNAMIC POS BACK HARDWARE MAXFEE DEF         2440 7/1/2021 12/31/2299 Y
E2402 NEG PRESS WOUND THERAPY PUMP PRXOVR DEF         NA NA NA E
E2402 NEG PRESS WOUND THERAPY PUMP MAXFEE DEF         0 9/1/2005 12/31/2299 E
E2601 GEN W/C CUSHION WDTH < 22 IN PRXOVR DEF         NA NA NA N
E2601 GEN W/C CUSHION WDTH < 22 IN MAXFEE DEF         61.10 1/1/2017 12/31/2299 N
E2602 GEN W/C CUSHION WDTH >=22 IN PRXOVR DEF         NA NA NA N
E2602 GEN W/C CUSHION WDTH >=22 IN MAXFEE DEF         119.28 1/1/2017 12/31/2299 N
E2603 SKIN PROTECT WC CUS WD <22IN PRXOVR DEF         NA NA NA N
E2603 SKIN PROTECT WC CUS WD <22IN MAXFEE DEF         151.43 1/1/2017 12/31/2299 N
E2604 SKIN PROTECT WC CUS WD>=22IN PRXOVR DEF         NA NA NA N
E2604 SKIN PROTECT WC CUS WD>=22IN MAXFEE DEF         188.21 1/1/2017 12/31/2299 N
E2605 POSITION WC CUSH WDTH <22 IN PRXOVR DEF         NA NA NA N
E2605 POSITION WC CUSH WDTH <22 IN MAXFEE DEF         268.89 1/1/2017 12/31/2299 N
E2606 POSITION WC CUSH WDTH>=22 IN PRXOVR DEF         NA NA NA N
E2606 POSITION WC CUSH WDTH>=22 IN MAXFEE DEF         419.50 1/1/2017 12/31/2299 N
E2607 SKIN PRO/POS WC CUS WD <22IN PRXOVR DEF         NA NA NA N
E2607 SKIN PRO/POS WC CUS WD <22IN MAXFEE DEF         289.55 1/1/2017 12/31/2299 N
E2608 SKIN PRO/POS WC CUS WD>=22IN PRXOVR DEF         NA NA NA N
E2608 SKIN PRO/POS WC CUS WD>=22IN MAXFEE DEF         347.72 1/1/2017 12/31/2299 N
E2611 GEN USE BACK CUSH WDTH <22IN PRXOVR DEF         NA NA NA Y
E2611 GEN USE BACK CUSH WDTH <22IN MAXFEE DEF         312.01 1/1/2017 12/31/2299 Y
E2612 GEN USE BACK CUSH WDTH>=22IN PRXOVR DEF         NA NA NA N
E2612 GEN USE BACK CUSH WDTH>=22IN MAXFEE DEF         422.11 1/1/2017 12/31/2299 N
E2613 POSITION BACK CUSH WD <22IN PRXOVR DEF         NA NA NA Y
E2613 POSITION BACK CUSH WD <22IN MAXFEE DEF         392.63 1/1/2017 12/31/2299 Y
E2614 POSITION BACK CUSH WD>=22IN PRXOVR DEF         NA NA NA N
E2614 POSITION BACK CUSH WD>=22IN MAXFEE DEF         543.36 1/1/2017 12/31/2299 N
E2615 POS BACK POST/LAT WDTH <22IN PRXOVR DEF         NA NA NA Y
E2615 POS BACK POST/LAT WDTH <22IN MAXFEE DEF         451.86 1/1/2017 12/31/2299 Y
E2616 POS BACK POST/LAT WDTH>=22IN PRXOVR DEF         NA NA NA N
E2616 POS BACK POST/LAT WDTH>=22IN MAXFEE DEF         607.94 1/1/2017 12/31/2299 N
E2618 WC ACC SOLID SEAT SUPP BASE PRXOVR DEF         NA NA NA Y
E2618 WC ACC SOLID SEAT SUPP BASE MAXFEE DEF         0 1/1/2008 12/31/2299 Y
E2619 REPLACE COVER W/C SEAT CUSH PRXOVR DEF         NA NA NA N
E2619 REPLACE COVER W/C SEAT CUSH MAXFEE DEF         51.27 1/1/2017 12/31/2299 N
E2620 WC PLANAR BACK CUSH WD <22IN PRXOVR DEF         NA NA NA Y
E2620 WC PLANAR BACK CUSH WD <22IN MAXFEE DEF         547.13 1/1/2017 12/31/2299 Y
E2621 WC PLANAR BACK CUSH WD>=22IN PRXOVR DEF         NA NA NA N
E2621 WC PLANAR BACK CUSH WD>=22IN MAXFEE DEF         574.16 1/1/2017 12/31/2299 N
E2622 ADJ SKIN PRO W/C CUS WD<22IN PRXOVR DEF         NA NA NA Y
E2622 ADJ SKIN PRO W/C CUS WD<22IN MAXFEE DEF         331.12 1/1/2017 12/31/2299 Y
E2623 ADJ SKIN PRO WC CUS WD>=22IN PRXOVR DEF         NA NA NA N
E2623 ADJ SKIN PRO WC CUS WD>=22IN MAXFEE DEF         421.34 1/1/2017 12/31/2299 N
E2624 ADJ SKIN PRO/POS CUS<22IN PRXOVR DEF         NA NA NA Y
E2624 ADJ SKIN PRO/POS CUS<22IN MAXFEE DEF         333.84 1/1/2017 12/31/2299 Y
E2625 ADJ SKIN PRO/POS WC CUS>=22 PRXOVR DEF         NA NA NA N
E2625 ADJ SKIN PRO/POS WC CUS>=22 MAXFEE DEF         422.62 1/1/2017 12/31/2299 N
E2627 ARM SUPP ATT TO WC RANCHO TY PRXOVR DEF         NA NA NA N
E2627 ARM SUPP ATT TO WC RANCHO TY MAXFEE DEF         841.57 1/1/2017 12/31/2299 N
E2628 MOBILE ARM SUPPORTS RECLININ PRXOVR DEF         NA NA NA N
E2628 MOBILE ARM SUPPORTS RECLININ MAXFEE DEF         633.99 1/1/2017 12/31/2299 N
E2629 FRICTION DAMPENING ARM SUPP PRXOVR DEF         NA NA NA N
E2629 FRICTION DAMPENING ARM SUPP MAXFEE DEF         943.88 1/1/2017 12/31/2299 N
E2630 MONOSUSPENSION ARM/HAND SUPP PRXOVR DEF         NA NA NA N
E2630 MONOSUSPENSION ARM/HAND SUPP MAXFEE DEF         561.04 1/1/2017 12/31/2299 N
E2631 ELEVAT PROXIMAL ARM SUPPORT PRXOVR DEF         NA NA NA N
E2631 ELEVAT PROXIMAL ARM SUPPORT MAXFEE DEF         224.42 1/1/2017 12/31/2299 N
E3000 SPEECH VOLUME MODULATION SYS PRXOVR DEF         NA NA NA Y N
E3000 SPEECH VOLUME MODULATION SYS MAXFEE DEF         2495 1/1/2024 12/31/2299 Y N
K0001 STANDARD WHEELCHAIR PRXOVR DEF         NA NA NA N
K0001 STANDARD WHEELCHAIR MAXFEE DEF         532.08 1/1/2017 12/31/2299 N
K0002 STND HEMI (LOW SEAT) WHLCHR PRXOVR DEF         NA NA NA N
K0002 STND HEMI (LOW SEAT) WHLCHR MAXFEE DEF         817.38 1/1/2017 12/31/2299 N
K0003 LIGHTWEIGHT WHEELCHAIR PRXOVR DEF         NA NA NA Y S
K0003 LIGHTWEIGHT WHEELCHAIR MAXFEE DEF         895.05 1/1/2017 12/31/2299 Y S
K0004 HIGH STRENGTH LTWT WHLCHR PRXOVR DEF         NA NA NA Y
K0004 HIGH STRENGTH LTWT WHLCHR MAXFEE DEF         1134.72 1/1/2017 12/31/2299 Y
K0005 ULTRALIGHTWEIGHT WHEELCHAIR PRXOVR DEF         NA NA NA Y
K0005 ULTRALIGHTWEIGHT WHEELCHAIR MAXFEE DEF         2250 1/1/2024 12/31/2299 Y
K0006 HEAVY DUTY WHEELCHAIR PRXOVR DEF         NA NA NA Y
K0006 HEAVY DUTY WHEELCHAIR MAXFEE DEF         1114.02 1/1/2017 12/31/2299 Y
K0007 EXTRA HEAVY DUTY WHEELCHAIR PRXOVR DEF         NA NA NA Y
K0007 EXTRA HEAVY DUTY WHEELCHAIR MAXFEE DEF         1783.08 1/1/2017 12/31/2299 Y
K0008 CSTM MANUAL WHEELCHAIR/BASE PRXOVR DEF         NA NA NA Y
K0008 CSTM MANUAL WHEELCHAIR/BASE MANUAL DEF         NA NA NA Y
K0009 OTHER MANUAL WHEELCHAIR/BASE PRXOVR DEF         NA NA NA Y
K0009 OTHER MANUAL WHEELCHAIR/BASE MAXFEE DEF         742.77 1/1/2017 12/31/2299 Y
K0013 CUSTOM POWER WHLCHR BASE PRXOVR DEF         NA NA NA S
K0013 CUSTOM POWER WHLCHR BASE MANUAL DEF         NA NA NA S
K0015 DETACH NON-ADJ HT ARMRST REP PRXOVR DEF         NA NA NA N
K0015 DETACH NON-ADJ HT ARMRST REP MAXFEE DEF         181.15 1/1/2017 12/31/2299 N
K0016 DETACH ADJUST ARMRST CMPLETE PRXOVR DEF         NA NA NA Y
K0016 DETACH ADJUST ARMRST CMPLETE MAXFEE DEF         NA     Y
K0017 DETACH ADJUST ARMREST BASE PRXOVR DEF         NA NA NA Y
K0017 DETACH ADJUST ARMREST BASE MAXFEE DEF         51.07 1/1/2017 12/31/2299 Y
K0018 DETACH ADJUST ARMRST UPPER PRXOVR DEF         NA NA NA N
K0018 DETACH ADJUST ARMRST UPPER MAXFEE DEF         28.52 1/1/2017 12/31/2299 N
K0019 ARM PAD REPL; EACH PRXOVR DEF         NA NA NA N
K0019 ARM PAD REPL; EACH MAXFEE DEF         14.30 1/1/2017 12/31/2299 N
K0020 FIXED ADJUST ARMREST PAIR PRXOVR DEF         NA NA NA N
K0020 FIXED ADJUST ARMREST PAIR MAXFEE DEF         46.40 1/1/2017 12/31/2299 N
K0021 ANTI-TIPPING DEVICE EACH PRXOVR DEF         NA NA NA Y
K0021 ANTI-TIPPING DEVICE EACH MAXFEE DEF         NA     Y
K0023 PLANR BACK INSRT FOAM W/STRP PRXOVR DEF         NA NA NA Y
K0023 PLANR BACK INSRT FOAM W/STRP MAXFEE DEF         NA     Y
K0024 PLNR BACK INSRT FOAM W/HRDWR PRXOVR DEF         NA NA NA Y
K0024 PLNR BACK INSRT FOAM W/HRDWR MAXFEE DEF         NA     Y
K0025 HOOK-ON HEADREST EXTENSION PRXOVR DEF         NA NA NA Y
K0025 HOOK-ON HEADREST EXTENSION MAXFEE DEF         NA     Y
K0028 MANUAL FULLY RECLINING BACK PRXOVR DEF         NA NA NA Y
K0028 MANUAL FULLY RECLINING BACK MAXFEE DEF         NA     Y
K0030 SOLID PLNR SEAT SNGL DNSFOAM PRXOVR DEF         NA NA NA Y
K0030 SOLID PLNR SEAT SNGL DNSFOAM MAXFEE DEF         NA     Y
K0031 SAFETY BELT/PELVIC STRAP PRXOVR DEF         NA NA NA Y
K0031 SAFETY BELT/PELVIC STRAP MAXFEE DEF         NA     Y
K0034 HEEL LOOP EACH PRXOVR DEF         NA NA NA S
K0034 HEEL LOOP EACH MAXFEE DEF         NA     S
K0035 HEEL LOOP WITH ANKLE STRAP PRXOVR DEF         NA NA NA S
K0035 HEEL LOOP WITH ANKLE STRAP MAXFEE DEF         NA     S
K0036 TOE LOOP EACH PRXOVR DEF         NA NA NA S
K0036 TOE LOOP EACH MAXFEE DEF         NA     S
K0037 HI MOUNT FLIP-UP FOOTREST EA PRXOVR DEF         NA NA NA N
K0037 HI MOUNT FLIP-UP FOOTREST EA MAXFEE DEF         40.89 1/1/2017 12/31/2299 N
K0038 LEG STRAP EACH PRXOVR DEF         NA NA NA N
K0038 LEG STRAP EACH MAXFEE DEF         24.23 1/1/2017 12/31/2299 N
K0039 LEG STRAP H STYLE EACH PRXOVR DEF         NA NA NA N
K0039 LEG STRAP H STYLE EACH MAXFEE DEF         53.81 1/1/2017 12/31/2299 N
K0040 ADJUSTABLE ANGLE FOOTPLATE PRXOVR DEF         NA NA NA Y
K0040 ADJUSTABLE ANGLE FOOTPLATE MAXFEE DEF         74.58 1/1/2017 12/31/2299 Y
K0041 LARGE SIZE FOOTPLATE EACH PRXOVR DEF         NA NA NA N
K0041 LARGE SIZE FOOTPLATE EACH MAXFEE DEF         52.86 1/1/2017 12/31/2299 N
K0042 STANDARD SIZE FTPLATE REP EA PRXOVR DEF         NA NA NA N
K0042 STANDARD SIZE FTPLATE REP EA MAXFEE DEF         34.61 1/1/2017 12/31/2299 N
K0043 FTRST LOWR EXTEN TUBE REP EA PRXOVR DEF         NA NA NA N
K0043 FTRST LOWR EXTEN TUBE REP EA MAXFEE DEF         19.51 1/1/2017 12/31/2299 N
K0044 FTRST UPR HANGER BRAC REP EA PRXOVR DEF         NA NA NA N
K0044 FTRST UPR HANGER BRAC REP EA MAXFEE DEF         16.61 1/1/2017 12/31/2299 N
K0045 FTRST COMPL ASSEMBLY REPL EA PRXOVR DEF         NA NA NA Y
K0045 FTRST COMPL ASSEMBLY REPL EA MAXFEE DEF         56.57 1/1/2017 12/31/2299 Y
K0046 ELEV LGRST LWR EXTEN REPL EA PRXOVR DEF         NA NA NA Y
K0046 ELEV LGRST LWR EXTEN REPL EA MAXFEE DEF         19.51 1/1/2017 12/31/2299 Y
K0047 ELEV LEGRST UPR HANGR REP EA PRXOVR DEF         NA NA NA Y
K0047 ELEV LEGRST UPR HANGR REP EA MAXFEE DEF         76.40 1/1/2017 12/31/2299 Y
K0050 RATCHET ASSEMBLY REPLACEMENT PRXOVR DEF         NA NA NA Y
K0050 RATCHET ASSEMBLY REPLACEMENT MAXFEE DEF         32.47 1/1/2017 12/31/2299 Y
K0051 CAM REL ASM FT/LEGRST REP EA PRXOVR DEF         NA NA NA N
K0051 CAM REL ASM FT/LEGRST REP EA MAXFEE DEF         52.54 1/1/2017 12/31/2299 N
K0052 SWINGAWAY DETACH FTREST REPL PRXOVR DEF         NA NA NA N
K0052 SWINGAWAY DETACH FTREST REPL MAXFEE DEF         92.34 1/1/2017 12/31/2299 N
K0053 ELEVATE FOOTREST ARTICULATE PRXOVR DEF         NA NA NA N
K0053 ELEVATE FOOTREST ARTICULATE MAXFEE DEF         101.90 1/1/2017 12/31/2299 N
K0054 SEAT WDTH 10-12/15/17/20 WC PRXOVR DEF         NA NA NA Y
K0054 SEAT WDTH 10-12/15/17/20 WC MAXFEE DEF         NA     Y
K0055 SEAT DPTH 15/17/18 LTWT WC PRXOVR DEF         NA NA NA Y
K0055 SEAT DPTH 15/17/18 LTWT WC MAXFEE DEF         NA     Y
K0056 SEAT HT <17 OR >=21 LTWT WC PRXOVR DEF         NA NA NA N
K0056 SEAT HT <17 OR >=21 LTWT WC MAXFEE DEF         95 1/1/2017 12/31/2299 N
K0057 SEAT WDTH 19/20 HVY DTY WC PRXOVR DEF         NA NA NA Y
K0057 SEAT WDTH 19/20 HVY DTY WC MAXFEE DEF         NA     Y
K0058 SEAT DPTH 17/18 POWER WC PRXOVR DEF         NA NA NA Y
K0058 SEAT DPTH 17/18 POWER WC MAXFEE DEF         NA     Y
K0059 PLASTIC COATED HANDRIM EACH PRXOVR DEF         NA NA NA Y
K0059 PLASTIC COATED HANDRIM EACH MAXFEE DEF         NA     Y
K0061 ALUMINUM HANDRIM EACH PRXOVR DEF         NA NA NA Y
K0061 ALUMINUM HANDRIM EACH MAXFEE DEF         NA     Y
K0062 HANDRIM 8-10 VERT/OBLIQ PROJ PRXOVR DEF         NA NA NA Y
K0062 HANDRIM 8-10 VERT/OBLIQ PROJ MAXFEE DEF         NA     Y
K0063 HNDRM 12-16 VERT/OBLIQ PROJ PRXOVR DEF         NA NA NA Y
K0063 HNDRM 12-16 VERT/OBLIQ PROJ MAXFEE DEF         NA     Y
K0064 ZERO PRESSURE TUBE FLAT FREE PRXOVR DEF         NA NA NA Y
K0064 ZERO PRESSURE TUBE FLAT FREE MAXFEE DEF         NA     Y
K0065 SPOKE PROTECTORS PRXOVR DEF         NA NA NA N
K0065 SPOKE PROTECTORS MAXFEE DEF         44.41 1/1/2017 12/31/2299 N
K0067 PNEUMATIC TIRE ANY SIZE EACH PRXOVR DEF         NA NA NA Y
K0067 PNEUMATIC TIRE ANY SIZE EACH MAXFEE DEF         NA     Y
K0069 RR WHL COMPL SOL TIRE REP EA PRXOVR DEF         NA NA NA Y
K0069 RR WHL COMPL SOL TIRE REP EA MAXFEE DEF         99.83 1/1/2017 12/31/2299 Y
K0070 RR WHL COMPL PNE TIRE REP EA PRXOVR DEF         NA NA NA Y
K0070 RR WHL COMPL PNE TIRE REP EA MAXFEE DEF         182.96 1/1/2017 12/31/2299 Y
K0071 FR CSTR COMP PNE TIRE REP EA PRXOVR DEF         NA NA NA N
K0071 FR CSTR COMP PNE TIRE REP EA MAXFEE DEF         109.13 1/1/2017 12/31/2299 N
K0072 FR CSTR SEMI-PNE TIRE REP EA PRXOVR DEF         NA NA NA N
K0072 FR CSTR SEMI-PNE TIRE REP EA MAXFEE DEF         65.70 1/1/2017 12/31/2299 N
K0073 CASTER PIN LOCK EACH PRXOVR DEF         NA NA NA N
K0073 CASTER PIN LOCK EACH MAXFEE DEF         33.43 1/1/2017 12/31/2299 N
K0074 PNEUMATIC CASTER TIRE EACH PRXOVR DEF         NA NA NA Y
K0074 PNEUMATIC CASTER TIRE EACH MAXFEE DEF         NA     Y
K0075 SEMI-PNEUMATIC CASTER TIRE PRXOVR DEF         NA NA NA Y
K0075 SEMI-PNEUMATIC CASTER TIRE MAXFEE DEF         NA     Y
K0077 FR CSTR ASMB SOL TIRE REP EA PRXOVR DEF         NA NA NA N
K0077 FR CSTR ASMB SOL TIRE REP EA MAXFEE DEF         58.80 1/1/2017 12/31/2299 N
K0079 WHEEL LOCK EXTENSION PAIR PRXOVR DEF         NA NA NA Y
K0079 WHEEL LOCK EXTENSION PAIR MAXFEE DEF         NA     Y
K0080 ANTI-ROLLBACK DEVICE PAIR PRXOVR DEF         NA NA NA Y
K0080 ANTI-ROLLBACK DEVICE PAIR MAXFEE DEF         NA     Y
K0082 22 NF NONSEALED LEADACID PRXOVR DEF         NA NA NA S
K0082 22 NF NONSEALED LEADACID MAXFEE DEF         NA     S
K0083 22NF SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA S
K0083 22NF SEALED LEADACID BATTERY MAXFEE DEF         NA     S
K0084 GR24 NONSEALED LEADACID PRXOVR DEF         NA NA NA S
K0084 GR24 NONSEALED LEADACID MAXFEE DEF         NA     S
K0085 GR24 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA S
K0085 GR24 SEALED LEADACID BATTERY MAXFEE DEF         NA     S
K0087 U1 SEALED LEADACID BATTERY PRXOVR DEF         NA NA NA S
K0087 U1 SEALED LEADACID BATTERY MAXFEE DEF         NA     S
K0088 BATTERY CHARGER; SINGLE MODE PRXOVR DEF         NA NA NA S
K0088 BATTERY CHARGER; SINGLE MODE MAXFEE DEF         NA     S
K0089 BATTERY CHARGER; DUAL MODE PRXOVR DEF         NA NA NA S
K0089 BATTERY CHARGER; DUAL MODE MAXFEE DEF         NA     S
K0093 REAR ZERO PRESSURE TIRE TUBE PRXOVR DEF         NA NA NA Y
K0093 REAR ZERO PRESSURE TIRE TUBE MAXFEE DEF         0 1/1/2007 12/31/2299 Y
K0097 WHEEL ZERO PRESURE TIRE TUBE PRXOVR DEF         NA NA NA Y
K0097 WHEEL ZERO PRESURE TIRE TUBE MAXFEE DEF         0 1/1/2007 12/31/2299 Y
K0100 AMPUTEE ADAPTER PAIR PRXOVR DEF         NA NA NA S
K0100 AMPUTEE ADAPTER PAIR MAXFEE DEF         NA     S
K0101 ONE-ARM DRIVE ATTACHMENT PRXOVR DEF         NA NA NA Y
K0101 ONE-ARM DRIVE ATTACHMENT MAXFEE DEF         NA     Y
K0102 CRUTCH AND CANE HOLDER PRXOVR DEF         NA NA NA S
K0102 CRUTCH AND CANE HOLDER MAXFEE DEF         NA     S
K0103 TRANSFER BOARD < 25 PRXOVR DEF         NA NA NA S
K0103 TRANSFER BOARD < 25 MAXFEE DEF         0 6/16/2006 12/31/2299 S
K0104 CYLINDER TANK CARRIER PRXOVR DEF         NA NA NA S
K0104 CYLINDER TANK CARRIER MAXFEE DEF         NA     S
K0105 IV HANGER PRXOVR DEF         NA NA NA N
K0105 IV HANGER MAXFEE DEF         99.32 1/1/2017 12/31/2299 N
K0106 ARM TROUGH EACH PRXOVR DEF         NA NA NA Y
K0106 ARM TROUGH EACH MAXFEE DEF         NA     Y
K0108 W/C COMPONENT-ACCESSORY NOS PRXOVR DEF         NA NA NA Y
K0108 W/C COMPONENT-ACCESSORY NOS PADOLR DEF         NA NA NA Y
K0108 W/C COMPONENT-ACCESSORY NOS REPAIR DEF         NA NA NA Y
K0115 BACK MODULE ORTHOTIC SYSTEM PRXOVR DEF         NA NA NA Y
K0115 BACK MODULE ORTHOTIC SYSTEM MAXFEE DEF         NA     Y
K0116 BACK & SEAT MODUL ORTHOT SYS PRXOVR DEF         NA NA NA Y
K0116 BACK & SEAT MODUL ORTHOT SYS MAXFEE DEF         NA     Y
K0183 NASAL APPLICATION DEVICE PRXOVR DEF         NA NA NA S
K0183 NASAL APPLICATION DEVICE MAXFEE DEF         NA     S
K0184 NASAL PILLOW OR FACE SEAL PRXOVR DEF         NA NA NA S
K0184 NASAL PILLOW OR FACE SEAL MAXFEE DEF         NA     S
K0195 ELEVATING WHLCHAIR LEG RESTS PRXOVR DEF         NA NA NA Y
K0195 ELEVATING WHLCHAIR LEG RESTS MAXFEE DEF         117.45 1/1/2024 12/31/2299 Y
K0268 HUMIDIFIER NONHEATED W PAP PRXOVR DEF         NA NA NA Y
K0268 HUMIDIFIER NONHEATED W PAP MAXFEE DEF         NA     Y
K0280 EXTENSION DRAINAGE TUBING PRXOVR DEF         NA NA NA S
K0280 EXTENSION DRAINAGE TUBING MAXFEE DEF         NA     S
K0452 WHEELCHAIR BEARINGS PRXOVR DEF         NA NA NA S
K0452 WHEELCHAIR BEARINGS MAXFEE DEF         NA     S
K0455 PUMP UNINTERRUPTED INFUSION PRXOVR DEF         NA NA NA E
K0455 PUMP UNINTERRUPTED INFUSION MANUAL DEF         NA NA NA E
K0532 NONINVASIVE ASSIST WO BACKUP PRXOVR DEF         NA NA NA Y
K0532 NONINVASIVE ASSIST WO BACKUP MAXFEE DEF         NA     Y
K0533 NONINVASIVE ASSIST W BACKUP PRXOVR DEF         NA NA NA Y
K0533 NONINVASIVE ASSIST W BACKUP MAXFEE DEF         NA     Y
K0534 INVASIVE ASSIST W BACKUP PRXOVR DEF         NA NA NA Y
K0534 INVASIVE ASSIST W BACKUP MAXFEE DEF         NA     Y
K0541 SGD PRERECORDED MSG <= 8 MIN PRXOVR DEF         NA NA NA N
K0541 SGD PRERECORDED MSG <= 8 MIN MAXFEE DEF         NA     N
K0542 SGD PRERECORDED MSG > 8 MIN PRXOVR DEF         NA NA NA Y
K0542 SGD PRERECORDED MSG > 8 MIN MAXFEE DEF         NA     Y
K0543 SGD MSG FORMED BY SPELLING PRXOVR DEF         NA NA NA Y
K0543 SGD MSG FORMED BY SPELLING MAXFEE DEF         NA     Y
K0544 SGD W MULTI METHODS MSG/ACCS PRXOVR DEF         NA NA NA Y
K0544 SGD W MULTI METHODS MSG/ACCS MAXFEE DEF         NA     Y
K0552 SUP/EXT NON-INS INF PUMP SYR PRXOVR DEF         NA NA NA N
K0552 SUP/EXT NON-INS INF PUMP SYR MAXFEE DEF         2.65 10/15/2006 12/31/2299 N
K0553 THER CGM SUPPLY ALLOWANCE PRXOVR DEF         NA NA NA Y
K0553 THER CGM SUPPLY ALLOWANCE MAXFEE DEF         NA     Y
K0554 THER CGM RECEIVER/MONITOR PRXOVR DEF         NA NA NA Y
K0554 THER CGM RECEIVER/MONITOR MAXFEE DEF         NA     Y
K0601 REPL BATT SILVER OXIDE 1.5 V PRXOVR DEF         NA NA NA E
K0601 REPL BATT SILVER OXIDE 1.5 V MANUAL DEF         NA NA NA E
K0602 REPL BATT SILVER OXIDE 3 V PRXOVR DEF         NA NA NA E
K0602 REPL BATT SILVER OXIDE 3 V MANUAL DEF         NA NA NA E
K0603 REPL BATT ALKALINE 1.5 V PRXOVR DEF         NA NA NA E
K0603 REPL BATT ALKALINE 1.5 V MANUAL DEF         NA NA NA E
K0604 REPL BATT LITHIUM 3.6 V PRXOVR DEF         NA NA NA E
K0604 REPL BATT LITHIUM 3.6 V MANUAL DEF         NA NA NA E
K0605 REPL BATT LITHIUM 4.5 V PRXOVR DEF         NA NA NA E
K0605 REPL BATT LITHIUM 4.5 V MANUAL DEF         NA NA NA E
K0630 SIO FLEX PELVISACRAL PREFAB PRXOVR DEF         NA NA NA Y
K0630 SIO FLEX PELVISACRAL PREFAB MAXFEE DEF         NA     Y
K0634 LO FLEXIBL L1-BELOW L5 PRE PRXOVR DEF         NA NA NA Y
K0634 LO FLEXIBL L1-BELOW L5 PRE MAXFEE DEF         NA     Y
K0635 LO SAG STAYS/PANELS PRE-FAB PRXOVR DEF         NA NA NA Y
K0635 LO SAG STAYS/PANELS PRE-FAB MAXFEE DEF         NA     Y
K0636 LO SAGITT RIGID PANEL PREFAB PRXOVR DEF         NA NA NA Y
K0636 LO SAGITT RIGID PANEL PREFAB MAXFEE DEF         NA     Y
K0637 LO FLEX W/O RIGID STAYS PRE PRXOVR DEF         NA NA NA Y
K0637 LO FLEX W/O RIGID STAYS PRE MAXFEE DEF         NA     Y
K0638 LSO FLEX W/RIGID STAYS CUST PRXOVR DEF         NA NA NA Y
K0638 LSO FLEX W/RIGID STAYS CUST MAXFEE DEF         NA     Y
K0639 LSO POST RIGID PANEL PRE PRXOVR DEF         NA NA NA Y
K0639 LSO POST RIGID PANEL PRE MAXFEE DEF         NA     Y
K0640 LSO SAG-CORO RIGID FRAME PRE PRXOVR DEF         NA NA NA Y
K0640 LSO SAG-CORO RIGID FRAME PRE MAXFEE DEF         NA     Y
K0641 LSO SAG-COR RIGID FRAME CUST PRXOVR DEF         NA NA NA Y
K0641 LSO SAG-COR RIGID FRAME CUST MAXFEE DEF         NA     Y
K0642 LSO FLEXION CONTROL PREFAB PRXOVR DEF         NA NA NA Y
K0642 LSO FLEXION CONTROL PREFAB MAXFEE DEF         NA     Y
K0643 LSO FLEXION CONTROL CUSTOM PRXOVR DEF         NA NA NA Y
K0643 LSO FLEXION CONTROL CUSTOM MAXFEE DEF         NA     Y
K0644 LSO SAGIT RIGID PANEL PREFAB PRXOVR DEF         NA NA NA Y
K0644 LSO SAGIT RIGID PANEL PREFAB MAXFEE DEF         NA     Y
K0645 LSO SAGITTAL RIGID PANEL CUS PRXOVR DEF         NA NA NA Y
K0645 LSO SAGITTAL RIGID PANEL CUS MAXFEE DEF         NA     Y
K0648 LSO S/C SHELL/PANEL PREFAB PRXOVR DEF         NA NA NA Y
K0648 LSO S/C SHELL/PANEL PREFAB MAXFEE DEF         NA     Y
K0649 LSO S/C SHELL/PANEL CUSTOM PRXOVR DEF         NA NA NA Y
K0649 LSO S/C SHELL/PANEL CUSTOM MAXFEE DEF         NA     Y
K0650 GEN W/C CUSHION WIDTH < 22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0650,GEN W/C CUSHION WIDTH < 22 PADOLR DEF         NA NA NA Y
K0651 GEN W/C CUSHION WIDTH > 22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0651,GEN W/C CUSHION WIDTH > 22 PADOLR DEF         NA NA NA Y
K0652 SKIN PRO W/C CUS WD < 22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0652,SKIN PRO W/C CUS WD < 22 PADOLR DEF         NA NA NA Y
K0653 SKIN PROTECT W/C CUS WD>=22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0653,SKIN PROTECT W/C CUS WD>=22 PADOLR DEF         NA NA NA Y
K0654 POSITION W/C CUSH WIDTH <22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0654,POSITION W/C CUSH WIDTH <22 PADOLR DEF         NA NA NA Y
K0655 POSITION W/C CUSH WIDTH >22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0655,POSITION W/C CUSH WIDTH >22 PADOLR DEF         NA NA NA Y
K0656 SKIN PRO/POS W/C CUS WD <22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0656,SKIN PRO/POS W/C CUS WD <22 PADOLR DEF         NA NA NA Y
K0657 SKIN PRO/POS W/C CUS WD>=22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0657,SKIN PRO/POS W/C CUS WD>=22 PADOLR DEF         NA NA NA Y
K0658 CUSTOM FABRICATE W/C CUSHION PRXOVR DEF         NA NA NA Y
K0658 CUSTOM FABRICATE W/C CUSHION PADOLR DEF         NA NA NA Y
K0659 POWERED W/C CUSHION PRXOVR DEF         NA NA NA Y
K0659 POWERED W/C CUSHION PADOLR DEF         NA NA NA Y
K0660 GEN USE BACK CUSH WIDTH <22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0660,GEN USE BACK CUSH WIDTH <22 PADOLR DEF         NA NA NA Y
K0661 GEN USE BACK CUSH WIDTH >22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0661,GEN USE BACK CUSH WIDTH >22 PADOLR DEF         NA NA NA Y
K0662 POSITION BACK CUSH WDTH <22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0662,POSITION BACK CUSH WDTH <22 PADOLR DEF         NA NA NA Y
K0663 POSITION BACK CUSH WDTH >22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0663,POSITION BACK CUSH WDTH >22 PADOLR DEF         NA NA NA Y
K0664 POS BACK POST/LAT WIDTH <22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0664,POS BACK POST/LAT WIDTH <22 PADOLR DEF         NA NA NA Y
K0665 POS BACK POST/LAT WIDTH >22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0665,POS BACK POST/LAT WIDTH >22 PADOLR DEF         NA NA NA Y
K0666 CUSTOM FAB W/C BACK CUSHION PRXOVR DEF         NA NA NA Y
K0666 CUSTOM FAB W/C BACK CUSHION PADOLR DEF         NA NA NA Y
K0667 MT HARDWRE MAN/LIGHT PWR W/C PRXOVR DEF         NA NA NA Y
K0667 MT HARDWRE MAN/LIGHT PWR W/C PADOLR DEF         NA NA NA Y
K0668 REPLACE COVER W/C SEAT CUSH PRXOVR DEF         NA NA NA Y
K0668 REPLACE COVER W/C SEAT CUSH PADOLR DEF         NA NA NA Y
K0672 REMOVABLE SOFT INTERFACE LE PRXOVR DEF         NA NA NA E
K0672 REMOVABLE SOFT INTERFACE LE MANUAL DEF         NA NA NA E
K0730 CTRL DOSE INH DRUG DELIV SYS PRXOVR DEF         NA NA NA N
K0730 CTRL DOSE INH DRUG DELIV SYS MAXFEE DEF         1379.20 10/15/2006 12/31/2299 N
K0733 12-24HR SEALED LEAD ACID PRXOVR DEF         NA NA NA Y
K0733 12-24HR SEALED LEAD ACID MAXFEE DEF         30.19 1/1/2017 12/31/2299 Y
K0734 ADJ SKIN PRO W/C CUS WD<22IN PRXOVR DEF         NA NA NA Y
K0734 ADJ SKIN PRO W/C CUS WD<22IN MAXFEE DEF         NA     Y
K0735 ADJ SKIN PRO WC CUS WD>=22IN PRXOVR DEF         NA NA NA Y
K0735 ADJ SKIN PRO WC CUS WD>=22IN MAXFEE DEF         NA     Y
K0736 ADJ SKIN PRO/POS WC CUS<22IN PRXOVR DEF         NA NA NA Y
K0736 ADJ SKIN PRO/POS WC CUS<22IN MAXFEE DEF         NA     Y
K0737 ADJ SKIN PRO/POS WC CUS>=22,PRXOVR,DEF,,,,,NA,NA,NA,Y, =K0737,ADJ SKIN PRO/POS WC CUS>=22 MAXFEE DEF         NA     Y
K0739 REPAIR/SVC DME NON-OXYGEN EQ PRXOVR DEF         NA NA NA S
K0739 REPAIR/SVC DME NON-OXYGEN EQ MAXFEE DEF         18.50 1/1/2024 12/31/2299 S
K0743 PORTABLE HOME SUCTION PUMP PRXOVR DEF         NA NA NA E
K0743 PORTABLE HOME SUCTION PUMP MANUAL DEF         NA NA NA E
K0744 ABSORP DRG <= 16 SUC PUMP PRXOVR DEF         NA NA NA E
K0744 ABSORP DRG <= 16 SUC PUMP MANUAL DEF         NA NA NA E
K0745 ABSORP DRG >16<=48 SUC PUMP PRXOVR DEF         NA NA NA E
K0745 ABSORP DRG >16<=48 SUC PUMP MANUAL DEF         NA NA NA E
K0746 ABSORP DRG >48 SUC PUMP PRXOVR DEF         NA NA NA E
K0746 ABSORP DRG >48 SUC PUMP MANUAL DEF         NA NA NA E
K0800 POV GROUP 1 STD UP TO 300LBS PRXOVR DEF         NA NA NA N
K0800 POV GROUP 1 STD UP TO 300LBS MAXFEE DEF         974.78 1/1/2017 12/31/2299 N
K0801 POV GROUP 1 HD 301-450 LBS PRXOVR DEF         NA NA NA Y
K0801 POV GROUP 1 HD 301-450 LBS MAXFEE DEF         1200 1/1/2017 12/31/2299 Y
K0802 POV GROUP 1 VHD 451-600 LBS PRXOVR DEF         NA NA NA Y
K0802 POV GROUP 1 VHD 451-600 LBS MAXFEE DEF         1528.40 1/1/2017 12/31/2299 Y
K0806 POV GROUP 2 STD UP TO 300LBS PRXOVR DEF         NA NA NA N
K0806 POV GROUP 2 STD UP TO 300LBS MAXFEE DEF         1179.22 1/1/2017 12/31/2299 N
K0807 POV GROUP 2 HD 301-450 LBS PRXOVR DEF         NA NA NA Y
K0807 POV GROUP 2 HD 301-450 LBS MAXFEE DEF         1789.34 1/1/2017 12/31/2299 Y
K0808 POV GROUP 2 VHD 451-600 LBS PRXOVR DEF         NA NA NA Y
K0808 POV GROUP 2 VHD 451-600 LBS MAXFEE DEF         2768.48 1/1/2017 12/31/2299 Y
K0812 POWER OPERATED VEHICLE NOC PRXOVR DEF         NA NA NA Y
K0812 POWER OPERATED VEHICLE NOC MAXFEE DEF         1100 7/1/2021 12/31/2299 Y
K0813 PWC GP 1 STD PORT SEAT/BACK PRXOVR DEF         NA NA NA N
K0813 PWC GP 1 STD PORT SEAT/BACK MAXFEE DEF         1818.98 1/1/2017 12/31/2299 N
K0814 PWC GP 1 STD PORT CAP CHAIR PRXOVR DEF         NA NA NA N
K0814 PWC GP 1 STD PORT CAP CHAIR MAXFEE DEF         2328.48 1/1/2017 12/31/2299 N
K0815 PWC GP 1 STD SEAT/BACK PRXOVR DEF         NA NA NA N
K0815 PWC GP 1 STD SEAT/BACK MAXFEE DEF         2651.26 1/1/2017 12/31/2299 N
K0816 PWC GP 1 STD CAP CHAIR PRXOVR DEF         NA NA NA N
K0816 PWC GP 1 STD CAP CHAIR MAXFEE DEF         2539.14 1/1/2017 12/31/2299 N
K0820 PWC GP 2 STD PORT SEAT/BACK PRXOVR DEF         NA NA NA N
K0820 PWC GP 2 STD PORT SEAT/BACK MAXFEE DEF         1942.94 1/1/2017 12/31/2299 N
K0821 PWC GP 2 STD PORT CAP CHAIR PRXOVR DEF         NA NA NA N
K0821 PWC GP 2 STD PORT CAP CHAIR MAXFEE DEF         2494.08 1/1/2017 12/31/2299 N
K0822 PWC GP 2 STD SEAT/BACK PRXOVR DEF         NA NA NA N
K0822 PWC GP 2 STD SEAT/BACK MAXFEE DEF         3014.24 1/1/2017 12/31/2299 N
K0823 PWC GP 2 STD CAP CHAIR PRXOVR DEF         NA NA NA N
K0823 PWC GP 2 STD CAP CHAIR MAXFEE DEF         3034.08 1/1/2017 12/31/2299 N
K0824 PWC GP 2 HD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0824 PWC GP 2 HD SEAT/BACK MAXFEE DEF         3384.64 1/1/2017 12/31/2299 Y
K0825 PWC GP 2 HD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0825 PWC GP 2 HD CAP CHAIR MAXFEE DEF         3342.94 1/1/2017 12/31/2299 Y
K0826 PWC GP 2 VHD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0826 PWC GP 2 VHD SEAT/BACK MAXFEE DEF         4727.36 1/1/2017 12/31/2299 Y
K0827 PWC GP VHD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0827 PWC GP VHD CAP CHAIR MAXFEE DEF         4019.58 1/1/2017 12/31/2299 Y
K0828 PWC GP 2 XTRA HD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0828 PWC GP 2 XTRA HD SEAT/BACK MAXFEE DEF         5208.96 1/1/2017 12/31/2299 Y
K0829 PWC GP 2 XTRA HD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0829 PWC GP 2 XTRA HD CAP CHAIR MAXFEE DEF         4783.42 1/1/2017 12/31/2299 Y
K0830 PWC GP2 STD SEAT ELEVATE S/B PRXOVR DEF         NA NA NA Y
K0830 PWC GP2 STD SEAT ELEVATE S/B MAXFEE DEF         3000 1/1/2024 12/31/2299 Y
K0831 PWC GP2 STD SEAT ELEVATE CAP PRXOVR DEF         NA NA NA Y
K0831 PWC GP2 STD SEAT ELEVATE CAP MAXFEE DEF         3800 1/1/2024 12/31/2299 Y
K0835 PWC GP2 STD SING POW OPT S/B PRXOVR DEF         NA NA NA N
K0835 PWC GP2 STD SING POW OPT S/B MAXFEE DEF         3627.83 1/1/2024 12/31/2299 N
K0836 PWC GP2 STD SING POW OPT CAP PRXOVR DEF         NA NA NA N
K0836 PWC GP2 STD SING POW OPT CAP MAXFEE DEF         NA     N
K0837 PWC GP 2 HD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0837 PWC GP 2 HD SING POW OPT S/B MAXFEE DEF         3651.46 1/1/2017 12/31/2299 Y
K0838 PWC GP 2 HD SING POW OPT CAP PRXOVR DEF         NA NA NA Y
K0838 PWC GP 2 HD SING POW OPT CAP MAXFEE DEF         3266.56 1/1/2017 12/31/2299 Y
K0839 PWC GP2 VHD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0839 PWC GP2 VHD SING POW OPT S/B MAXFEE DEF         3545.52 1/1/2017 12/31/2299 Y
K0840 PWC GP2 XHD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0840 PWC GP2 XHD SING POW OPT S/B MAXFEE DEF         7161.82 1/1/2017 12/31/2299 Y
K0841 PWC GP2 STD MULT POW OPT S/B PRXOVR DEF         NA NA NA N
K0841 PWC GP2 STD MULT POW OPT S/B MAXFEE DEF         4884.64 1/1/2017 12/31/2299 N
K0842 PWC GP2 STD MULT POW OPT CAP PRXOVR DEF         NA NA NA N
K0842 PWC GP2 STD MULT POW OPT CAP MAXFEE DEF         3256.42 1/1/2017 12/31/2299 N
K0843 PWC GP2 HD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0843 PWC GP2 HD MULT POW OPT S/B MAXFEE DEF         3920.64 1/1/2017 12/31/2299 Y
K0848 PWC GP 3 STD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0848 PWC GP 3 STD SEAT/BACK MAXFEE DEF         3984.54 1/1/2017 12/31/2299 Y
K0849 PWC GP 3 STD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0849 PWC GP 3 STD CAP CHAIR MAXFEE DEF         3830.98 1/1/2017 12/31/2299 Y
K0850 PWC GP 3 HD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0850 PWC GP 3 HD SEAT/BACK MAXFEE DEF         4621.98 1/1/2017 12/31/2299 Y
K0851 PWC GP 3 HD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0851 PWC GP 3 HD CAP CHAIR MAXFEE DEF         4444 1/1/2017 12/31/2299 Y
K0852 PWC GP 3 VHD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0852 PWC GP 3 VHD SEAT/BACK MAXFEE DEF         5340.38 1/1/2017 12/31/2299 Y
K0853 PWC GP 3 VHD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0853 PWC GP 3 VHD CAP CHAIR MAXFEE DEF         5485.92 1/1/2017 12/31/2299 Y
K0854 PWC GP 3 XHD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0854 PWC GP 3 XHD SEAT/BACK MAXFEE DEF         7267.62 1/1/2017 12/31/2299 Y
K0855 PWC GP 3 XHD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0855 PWC GP 3 XHD CAP CHAIR MAXFEE DEF         6865.38 1/1/2017 12/31/2299 Y
K0856 PWC GP3 STD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0856 PWC GP3 STD SING POW OPT S/B MAXFEE DEF         5795.62 1/1/2024 12/31/2299 Y
K0857 PWC GP3 STD SING POW OPT CAP PRXOVR DEF         NA NA NA Y
K0857 PWC GP3 STD SING POW OPT CAP MAXFEE DEF         4283.52 1/1/2017 12/31/2299 Y
K0858 PWC GP3 HD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0858 PWC GP3 HD SING POW OPT S/B MAXFEE DEF         5306.56 1/1/2017 12/31/2299 Y
K0859 PWC GP3 HD SING POW OPT CAP PRXOVR DEF         NA NA NA Y
K0859 PWC GP3 HD SING POW OPT CAP MAXFEE DEF         5060.80 1/1/2017 12/31/2299 Y
K0860 PWC GP3 VHD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0860 PWC GP3 VHD SING POW OPT S/B MAXFEE DEF         7581.02 1/1/2017 12/31/2299 Y
K0861 PWC GP3 STD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0861 PWC GP3 STD MULT POW OPT S/B MAXFEE DEF         6250 1/1/2024 12/31/2299 Y
K0862 PWC GP3 HD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0862 PWC GP3 HD MULT POW OPT S/B MAXFEE DEF         5306.56 1/1/2017 12/31/2299 Y
K0863 PWC GP3 VHD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0863 PWC GP3 VHD MULT POW OPT S/B MAXFEE DEF         7580.96 1/1/2017 12/31/2299 Y
K0864 PWC GP3 XHD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0864 PWC GP3 XHD MULT POW OPT S/B MAXFEE DEF         9021.50 1/1/2017 12/31/2299 Y
K0868 PWC GP 4 STD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0868 PWC GP 4 STD SEAT/BACK MAXFEE DEF         4382.99 1/1/2017 12/31/2299 Y
K0869 PWC GP 4 STD CAP CHAIR PRXOVR DEF         NA NA NA Y
K0869 PWC GP 4 STD CAP CHAIR MAXFEE DEF         4214.08 1/1/2017 12/31/2299 Y
K0870 PWC GP 4 HD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0870 PWC GP 4 HD SEAT/BACK MAXFEE DEF         5084.18 1/1/2017 12/31/2299 Y
K0871 PWC GP 4 VHD SEAT/BACK PRXOVR DEF         NA NA NA Y
K0871 PWC GP 4 VHD SEAT/BACK MAXFEE DEF         4888.40 1/1/2017 12/31/2299 Y
K0877 PWC GP4 STD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0877 PWC GP4 STD SING POW OPT S/B MAXFEE DEF         4704.72 1/1/2017 12/31/2299 Y
K0878 PWC GP4 STD SING POW OPT CAP PRXOVR DEF         NA NA NA Y
K0878 PWC GP4 STD SING POW OPT CAP MAXFEE DEF         4711.87 1/1/2017 12/31/2299 Y
K0879 PWC GP4 HD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0879 PWC GP4 HD SING POW OPT S/B MAXFEE DEF         5837.22 1/1/2017 12/31/2299 Y
K0880 PWC GP4 VHD SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0880 PWC GP4 VHD SING POW OPT S/B MAXFEE DEF         5566.88 1/1/2017 12/31/2299 Y
K0884 PWC GP4 STD MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0884 PWC GP4 STD MULT POW OPT S/B MAXFEE DEF         6070 1/1/2017 12/31/2299 Y
K0885 PWC GP4 STD MULT POW OPT CAP PRXOVR DEF         NA NA NA Y
K0885 PWC GP4 STD MULT POW OPT CAP MAXFEE DEF         6070 1/1/2017 12/31/2299 Y
K0886 PWC GP4 HD MULT POW S/B PRXOVR DEF         NA NA NA Y
K0886 PWC GP4 HD MULT POW S/B MAXFEE DEF         5837.22 1/1/2017 12/31/2299 Y
K0890 PWC GP5 PED SING POW OPT S/B PRXOVR DEF         NA NA NA Y
K0890 PWC GP5 PED SING POW OPT S/B MAXFEE DEF         7272 7/1/2021 12/31/2299 Y
K0891 PWC GP5 PED MULT POW OPT S/B PRXOVR DEF         NA NA NA Y
K0891 PWC GP5 PED MULT POW OPT S/B MAXFEE DEF         7500 7/1/2021 12/31/2299 Y
K0898 POWER WHEELCHAIR NOC PRXOVR DEF         NA NA NA Y
K0898 POWER WHEELCHAIR NOC MANUAL DEF         NA NA NA Y
K0899 POW MOBIL DEV NO DMEPDAC PRXOVR DEF         NA NA NA Y
K0899 POW MOBIL DEV NO DMEPDAC MAXFEE DEF         0 1/1/2007 12/31/2299 Y
K1001 ELECTRONIC POSA TREATMENT PRXOVR DEF         NA NA NA E
K1001 ELECTRONIC POSA TREATMENT MANUAL DEF         NA NA NA E
K1002 CES SYSTEM PRXOVR DEF         NA NA NA E
K1002 CES SYSTEM MANUAL DEF         NA NA NA E
K1003 WHIRLPOOL TUB WALKIN PORTABL PRXOVR DEF         NA NA NA E
K1003 WHIRLPOOL TUB WALKIN PORTABL MANUAL DEF         NA NA NA E
K1004 LO FREQ US DIATHERMY DEVICE PRXOVR DEF         NA NA NA E
K1004 LO FREQ US DIATHERMY DEVICE MANUAL DEF         NA NA NA E
K1005 DISP COL STO BAG BREAST MILK PRXOVR DEF         NA NA NA N
K1005 DISP COL STO BAG BREAST MILK MANUAL DEF         NA NA NA N
K1006 SUCT PUM EXT URINE MGMT SYS PRXOVR DEF         NA NA NA Y
K1006 SUCT PUM EXT URINE MGMT SYS MAXFEE DEF         NA     Y
K1007 BIL HKAF PC S/D MICRO SENSOR PRXOVR DEF         NA NA NA E
K1007 BIL HKAF PC S/D MICRO SENSOR MANUAL DEF         NA NA NA E
K1009 SPEECH VOLUME MODULATION SYS PRXOVR DEF         NA NA NA Y
K1009 SPEECH VOLUME MODULATION SYS MAXFEE DEF         NA     Y
K1010 INTRAURETHRAL DRAINAG DEVICE PRXOVR DEF         NA NA NA E
K1010 INTRAURETHRAL DRAINAG DEVICE MANUAL DEF         NA NA NA E
K1011 ACTI INTRAURETHRAL DRAINAGE PRXOVR DEF         NA NA NA E
K1011 ACTI INTRAURETHRAL DRAINAGE MANUAL DEF         NA NA NA E
K1012 CHARGER BASE STATION INTRAUR PRXOVR DEF         NA NA NA E
K1012 CHARGER BASE STATION INTRAUR MANUAL DEF         NA NA NA E
K1013 ENEMA TUBE ANY TYPE REPL PRXOVR DEF         NA NA NA E
K1013 ENEMA TUBE ANY TYPE REPL MANUAL DEF         NA NA NA E
K1014 AK 4 BAR LINK HYDL SWG/STANC PRXOVR DEF         NA NA NA E
K1014 AK 4 BAR LINK HYDL SWG/STANC MANUAL DEF         NA NA NA E
K1016 TRANS ELEC NERV FOR TRIGEMIN PRXOVR DEF         NA NA NA E
K1016 TRANS ELEC NERV FOR TRIGEMIN MANUAL DEF         NA NA NA E
K1017 MONTHLY SUPP USE WITH K1016 PRXOVR DEF         NA NA NA E
K1017 MONTHLY SUPP USE WITH K1016 MANUAL DEF         NA NA NA E
K1018 EXT UP LIMB TREMOR STIM WRIS PRXOVR DEF         NA NA NA E
K1018 EXT UP LIMB TREMOR STIM WRIS MANUAL DEF         NA NA NA E
K1019 SUPP EXT UP LIMB TREMOR STIM PRXOVR DEF         NA NA NA E
K1019 SUPP EXT UP LIMB TREMOR STIM MANUAL DEF         NA NA NA E
K1021 EXSUFF BELT INCL ALL SUP ACC PRXOVR DEF         NA NA NA E
K1021 EXSUFF BELT INCL ALL SUP ACC MANUAL DEF         NA NA NA E
K1023 TRANS ELEC NERV PERIPH NERV PRXOVR DEF         NA NA NA E
K1023 TRANS ELEC NERV PERIPH NERV MANUAL DEF         NA NA NA E
K1030 EXT RECHARGE BAT REPLACEMENT PRXOVR DEF         NA NA NA S
K1030 EXT RECHARGE BAT REPLACEMENT MANUAL DEF         NA NA NA S
K1031 NON PNEU COMP CONTROL W/O CA PRXOVR DEF         NA NA NA S
K1031 NON PNEU COMP CONTROL W/O CA MANUAL DEF         NA NA NA S
K1032 NON PNEUM SEQ COMP FULL LEG PRXOVR DEF         NA NA NA S
K1032 NON PNEUM SEQ COMP FULL LEG MANUAL DEF         NA NA NA S
K1033 NON PNEUM SEQ COMP HALF LEG PRXOVR DEF         NA NA NA S
K1033 NON PNEUM SEQ COMP HALF LEG MANUAL DEF         NA NA NA S
K1034 COVID TEST SELF-ADMN/COLLECT PRXOVR DEF         NA NA NA N
K1034 COVID TEST SELF-ADMN/COLLECT MAXFEE DEF         12 4/4/2022 12/31/2299 N
K1037 DOCKING STATION FOR ORAL DEV PRXOVR DEF         NA NA NA Y
K1037 DOCKING STATION FOR ORAL DEV PADOLR DEF         NA NA NA Y
L0112 CRANIAL CERVICAL ORTHOSIS PRXOVR DEF         NA NA NA E
L0112 CRANIAL CERVICAL ORTHOSIS MANUAL DEF         NA NA NA E
L0113 CRANIAL CERVICAL TORTICOLLIS PRXOVR DEF         NA NA NA E
L0113 CRANIAL CERVICAL TORTICOLLIS MANUAL DEF         NA NA NA E
L0130 FLEX THERMOPLASTIC COLLAR MO PRXOVR DEF         NA NA NA E
L0130 FLEX THERMOPLASTIC COLLAR MO MANUAL DEF         NA NA NA E
L0150 CERV SEMI-RIG ADJ MOLDED CHN PRXOVR DEF         NA NA NA E
L0150 CERV SEMI-RIG ADJ MOLDED CHN MANUAL DEF         NA NA NA E
Q9994 ENZYME CARTRIDGE ENTERAL NUT PRXOVR DEF         NA NA NA Y
Q9994 ENZYME CARTRIDGE ENTERAL NUT MAXFEE DEF         31.20 1/1/2019 12/31/2299 Y
S1035 ART PANCREAS INV DISP SENSOR PRXOVR DEF         NA NA NA E
S1035 ART PANCREAS INV DISP SENSOR MANUAL DEF         NA NA NA E
S1036 ART PANCREAS EXT TRANSMITTER PRXOVR DEF         NA NA NA E
S1036 ART PANCREAS EXT TRANSMITTER MANUAL DEF         NA NA NA E
S1037 ART PANCREAS EXT RECEIVER PRXOVR DEF         NA NA NA E
S1037 ART PANCREAS EXT RECEIVER MANUAL DEF         NA NA NA E
S8100 SPACER WITHOUT MASK PRXOVR DEF         NA NA NA E
S8100 SPACER WITHOUT MASK MANUAL DEF         NA NA NA E
S8101 SPACER WITH MASK PRXOVR DEF         NA NA NA S
S8101 SPACER WITH MASK MAXFEE DEF         8 4/1/2006 12/31/2299 S
S8182 HUMIDIFIER NON-SERVO PRXOVR DEF         NA NA NA Y
S8182 HUMIDIFIER NON-SERVO MAXFEE DEF         NA     Y
S8183 HUMIDIFIER DUAL SERVO PRXOVR DEF         NA NA NA Y
S8183 HUMIDIFIER DUAL SERVO MAXFEE DEF         NA     Y
S8420 CUSTOM GRADIENT SLEEV/GLOV PRXOVR DEF         NA NA NA Y
S8420 CUSTOM GRADIENT SLEEV/GLOV PADOLR DEF         NA NA NA Y
S8421 READY GRADIENT SLEEV/GLOV PRXOVR DEF         NA NA NA N
S8421 READY GRADIENT SLEEV/GLOV MAXFEE DEF         95 7/1/2021 12/31/2299 N
S8422 CUSTOM GRAD SLEEVE MED PRXOVR DEF         NA NA NA Y
S8422 CUSTOM GRAD SLEEVE MED PADOLR DEF         NA NA NA Y
S8423 CUSTOM GRAD SLEEVE HEAVY PRXOVR DEF         NA NA NA Y
S8423 CUSTOM GRAD SLEEVE HEAVY PADOLR DEF         NA NA NA Y
S8424 READY GRADIENT SLEEVE PRXOVR DEF         NA NA NA N
S8424 READY GRADIENT SLEEVE MAXFEE DEF         50 7/1/2021 12/31/2299 N
S8425 CUSTOM GRAD GLOVE MED PRXOVR DEF         NA NA NA Y
S8425 CUSTOM GRAD GLOVE MED PADOLR DEF         NA NA NA Y
S8426 CUSTOM GRAD GLOVE HEAVY PRXOVR DEF         NA NA NA Y
S8426 CUSTOM GRAD GLOVE HEAVY PADOLR DEF         NA NA NA Y
S8427 READY GRADIENT GLOVE PRXOVR DEF         NA NA NA N
S8427 READY GRADIENT GLOVE MAXFEE DEF         70 7/1/2021 12/31/2299 N
S8428 READY GRADIENT GAUNTLET PRXOVR DEF         NA NA NA N
S8428 READY GRADIENT GAUNTLET MAXFEE DEF         35 7/1/2021 12/31/2299 N
S8429 GRADIENT PRESSURE WRAP PRXOVR DEF         NA NA NA E
S8429 GRADIENT PRESSURE WRAP MANUAL DEF         NA NA NA E
S8430 PADDING FOR COMPRSSN BDG PRXOVR DEF         NA NA NA E
S8430 PADDING FOR COMPRSSN BDG MANUAL DEF         NA NA NA E
S8431 COMPRESSION BANDAGE PRXOVR DEF         NA NA NA E
S8431 COMPRESSION BANDAGE MANUAL DEF         NA NA NA E
S8450 SPLINT DIGIT PRXOVR DEF         NA NA NA E
S8450 SPLINT DIGIT MANUAL DEF         NA NA NA E
S8451 SPLINT WRIST OR ANKLE PRXOVR DEF         NA NA NA E
S8451 SPLINT WRIST OR ANKLE MANUAL DEF         NA NA NA E
S8452 SPLINT ELBOW PRXOVR DEF         NA NA NA E
S8452 SPLINT ELBOW MANUAL DEF         NA NA NA E
S8490 100 INSULIN SYRINGES PRXOVR DEF         NA NA NA E
S8490 100 INSULIN SYRINGES MANUAL DEF         NA NA NA E
S8999 RESUSCITATION BAG PRXOVR DEF         NA NA NA E
S8999 RESUSCITATION BAG MANUAL DEF         NA NA NA E
S9432 MED FOOD NON INBORN ERR META PRXOVR DEF         NA NA NA Y
S9432 MED FOOD NON INBORN ERR META MANUAL DEF         NA NA NA Y
S9433 MEDICAL FOOD ORAL 100% NUTR PRXOVR DEF         NA NA NA E
S9433 MEDICAL FOOD ORAL 100% NUTR MANUAL DEF         NA NA NA E
S9434 MOD SOLID FOOD SUPPL PRXOVR DEF         NA NA NA E
S9434 MOD SOLID FOOD SUPPL MANUAL DEF         NA NA NA E
S9435 MEDICAL FOODS FOR INBORN ERR PRXOVR DEF         NA NA NA N
S9435 MEDICAL FOODS FOR INBORN ERR MANUAL DEF         NA NA NA N
T2101 BREAST MILK PROC/STORE/DIST PRXOVR DEF         NA NA NA N
T2101 BREAST MILK PROC/STORE/DIST MAXFEE DEF         4.75 7/1/2018 12/31/2299 N
T4521 ADULT SIZE BRIEF/DIAPER SM PRXOVR DEF         NA NA NA S
T4521 ADULT SIZE BRIEF/DIAPER SM MAXFEE DEF         0.58 1/1/2024 12/31/2299 S
T4522 ADULT SIZE BRIEF/DIAPER MED PRXOVR DEF         NA NA NA S
T4522 ADULT SIZE BRIEF/DIAPER MED MAXFEE DEF         0.68 1/1/2024 12/31/2299 S
T4523 ADULT SIZE BRIEF/DIAPER LG PRXOVR DEF         NA NA NA S
T4523 ADULT SIZE BRIEF/DIAPER LG MAXFEE DEF         0.76 1/1/2024 12/31/2299 S
T4524 ADULT SIZE BRIEF/DIAPER XL PRXOVR DEF         NA NA NA S
T4524 ADULT SIZE BRIEF/DIAPER XL MAXFEE DEF         0.85 1/1/2024 12/31/2299 S
T4525 ADULT SIZE PULL-ON SM PRXOVR DEF         NA NA NA S
T4525 ADULT SIZE PULL-ON SM MAXFEE DEF         0.59 1/1/2024 12/31/2299 S
T4526 ADULT SIZE PULL-ON MED PRXOVR DEF         NA NA NA S
T4526 ADULT SIZE PULL-ON MED MAXFEE DEF         0.68 1/1/2024 12/31/2299 S
T4527 ADULT SIZE PULL-ON LG PRXOVR DEF         NA NA NA S
T4527 ADULT SIZE PULL-ON LG MAXFEE DEF         0.76 1/1/2024 12/31/2299 S
T4528 ADULT SIZE PULL-ON XL PRXOVR DEF         NA NA NA S
T4528 ADULT SIZE PULL-ON XL MAXFEE DEF         0.85 1/1/2024 12/31/2299 S
T4529 PED SIZE BRIEF/DIAPER SM/MED PRXOVR DEF         NA NA NA S
T4529 PED SIZE BRIEF/DIAPER SM/MED MAXFEE DEF         0.43 1/1/2024 12/31/2299 S
T4530 PED SIZE BRIEF/DIAPER LG PRXOVR DEF         NA NA NA S
T4530 PED SIZE BRIEF/DIAPER LG MAXFEE DEF         0.43 1/1/2024 12/31/2299 S
T4531 PED SIZE PULL-ON SM/MED PRXOVR DEF         NA NA NA S
T4531 PED SIZE PULL-ON SM/MED MAXFEE DEF         0.40 1/1/2005 12/31/2299 S
T4532 PED SIZE PULL-ON LG PRXOVR DEF         NA NA NA S
T4532 PED SIZE PULL-ON LG MAXFEE DEF         0.43 1/1/2024 12/31/2299 S
T4533 YOUTH SIZE BRIEF/DIAPER PRXOVR DEF         NA NA NA S
T4533 YOUTH SIZE BRIEF/DIAPER MAXFEE DEF         0.49 1/1/2024 12/31/2299 S
T4534 YOUTH SIZE PULL-ON PRXOVR DEF         NA NA NA S
T4534 YOUTH SIZE PULL-ON MAXFEE DEF         0.49 1/1/2024 12/31/2299 S
T4535 DISPOSABLE LINER/SHIELD/PAD PRXOVR DEF         NA NA NA S
T4535 DISPOSABLE LINER/SHIELD/PAD MAXFEE DEF         0.43 1/1/2024 12/31/2299 S
T4536 REUSABLE PULL-ON ANY SIZE PRXOVR DEF         NA NA NA S
T4536 REUSABLE PULL-ON ANY SIZE MAXFEE DEF         11 1/1/2005 12/31/2299 S
T4537 REUSABLE UNDERPAD BED SIZE PRXOVR DEF         NA NA NA S
T4537 REUSABLE UNDERPAD BED SIZE MAXFEE DEF         20 1/1/2005 12/31/2299 S
T4538 DIAPER SERV REUSABLE DIAPER PRXOVR DEF         NA NA NA S
T4538 DIAPER SERV REUSABLE DIAPER MAXFEE DEF         0.53 1/1/2005 12/31/2299 S
T4539 REUSE DIAPER/BRIEF ANY SIZE PRXOVR DEF         NA NA NA S
T4539 REUSE DIAPER/BRIEF ANY SIZE MAXFEE DEF         11 3/28/2005 12/31/2299 S
T4540 REUSABLE UNDERPAD CHAIR SIZE PRXOVR DEF         NA NA NA S
T4540 REUSABLE UNDERPAD CHAIR SIZE MAXFEE DEF         10 1/1/2005 12/31/2299 S
T4541 LARGE DISPOSABLE UNDERPAD PRXOVR DEF         NA NA NA S
T4541 LARGE DISPOSABLE UNDERPAD MAXFEE DEF         0.30 1/1/2024 12/31/2299 S
T4542 SMALL DISPOSABLE UNDERPAD PRXOVR DEF         NA NA NA S
T4542 SMALL DISPOSABLE UNDERPAD MAXFEE DEF         0.28 1/1/2005 12/31/2299 S
T4543 ADULT DISP BRIEF/DIAP ABV XL PRXOVR DEF         NA NA NA S
T4543 ADULT DISP BRIEF/DIAP ABV XL MAXFEE DEF         2.12 1/1/2010 12/31/2299 S
T4544 ADLT DISP UND/PULL ON ABV XL PRXOVR DEF         NA NA NA S
T4544 ADLT DISP UND/PULL ON ABV XL MAXFEE DEF         2.12 7/1/2018 12/31/2299 S
T4545 INCON DISPOSABLE PENILE WRAP PRXOVR DEF         NA NA NA E
T4545 INCON DISPOSABLE PENILE WRAP MANUAL DEF         NA NA NA E
T5001 POSITION SEAT SPEC ORTH NEED PRXOVR DEF         NA NA NA E
T5001 POSITION SEAT SPEC ORTH NEED MANUAL DEF         NA NA NA E
T5999 SUPPLY; NOS PRXOVR DEF         NA NA NA N
T5999 SUPPLY; NOS MAXFEE DEF         NA     N
V2100 LENS SPHER SINGLE PLANO 4.00 PRXOVR DEF         NA NA NA E
V2100 LENS SPHER SINGLE PLANO 4.00 MANUAL DEF         NA NA NA E
V2101 SINGLE VISN SPHERE 4.12-7.00 PRXOVR DEF         NA NA NA E
V2101 SINGLE VISN SPHERE 4.12-7.00 MANUAL DEF         NA NA NA E
V2102 SINGL VISN SPHERE 7.12-20.00 PRXOVR DEF         NA NA NA E
V2102 SINGL VISN SPHERE 7.12-20.00 MANUAL DEF         NA NA NA E
V2103 SPHEROCYLINDR 4.00D/12-2.00D PRXOVR DEF         NA NA NA E
V2103 SPHEROCYLINDR 4.00D/12-2.00D MANUAL DEF         NA NA NA E
V2104 SPHEROCYLINDR 4.00D/2.12-4D PRXOVR DEF         NA NA NA E
V2104 SPHEROCYLINDR 4.00D/2.12-4D MANUAL DEF         NA NA NA E
V2105 SPHEROCYLINDER 4.00D/4.25-6D PRXOVR DEF         NA NA NA E
V2105 SPHEROCYLINDER 4.00D/4.25-6D MANUAL DEF         NA NA NA E
V2106 SPHEROCYLINDER 4.00D/>6.00D PRXOVR DEF         NA NA NA E
V2106 SPHEROCYLINDER 4.00D/>6.00D MANUAL DEF         NA NA NA E
V2107 SPHEROCYLINDER 4.25D/12-2D PRXOVR DEF         NA NA NA E
V2107 SPHEROCYLINDER 4.25D/12-2D MANUAL DEF         NA NA NA E
V2108 SPHEROCYLINDER 4.25D/2.12-4D PRXOVR DEF         NA NA NA E
V2108 SPHEROCYLINDER 4.25D/2.12-4D MANUAL DEF         NA NA NA E
V2109 SPHEROCYLINDER 4.25D/4.25-6D PRXOVR DEF         NA NA NA E
V2109 SPHEROCYLINDER 4.25D/4.25-6D MANUAL DEF         NA NA NA E
V2110 SPHEROCYLINDER 4.25D/OVER 6D PRXOVR DEF         NA NA NA E
V2110 SPHEROCYLINDER 4.25D/OVER 6D MANUAL DEF         NA NA NA E
V2111 SPHEROCYLINDR 7.25D/.25-2.25 PRXOVR DEF         NA NA NA E
V2111 SPHEROCYLINDR 7.25D/.25-2.25 MANUAL DEF         NA NA NA E
V2112 SPHEROCYLINDR 7.25D/2.25-4D PRXOVR DEF         NA NA NA E
V2112 SPHEROCYLINDR 7.25D/2.25-4D MANUAL DEF         NA NA NA E
V2113 SPHEROCYLINDR 7.25D/4.25-6D PRXOVR DEF         NA NA NA E
V2113 SPHEROCYLINDR 7.25D/4.25-6D MANUAL DEF         NA NA NA E
V2114 SPHEROCYLINDER OVER 12.00D PRXOVR DEF         NA NA NA E
V2114 SPHEROCYLINDER OVER 12.00D MANUAL DEF         NA NA NA E
V2115 LENS LENTICULAR BIFOCAL PRXOVR DEF         NA NA NA E
V2115 LENS LENTICULAR BIFOCAL MANUAL DEF         NA NA NA E
V2118 LENS ANISEIKONIC SINGLE PRXOVR DEF         NA NA NA E
V2118 LENS ANISEIKONIC SINGLE MANUAL DEF         NA NA NA E
V2121 LENTICULAR LENS; SINGLE PRXOVR DEF         NA NA NA E
V2121 LENTICULAR LENS; SINGLE MANUAL DEF         NA NA NA E
V2199 LENS SINGLE VISION NOT OTH C PRXOVR DEF         NA NA NA E
V2199 LENS SINGLE VISION NOT OTH C MANUAL DEF         NA NA NA E
V2200 LENS SPHER BIFOC PLANO 4.00D PRXOVR DEF         NA NA NA E
V2200 LENS SPHER BIFOC PLANO 4.00D MANUAL DEF         NA NA NA E
V2201 LENS SPHERE BIFOCAL 4.12-7.0 PRXOVR DEF         NA NA NA E
V2201 LENS SPHERE BIFOCAL 4.12-7.0 MANUAL DEF         NA NA NA E
V2202 LENS SPHERE BIFOCAL 7.12-20. PRXOVR DEF         NA NA NA E
V2202 LENS SPHERE BIFOCAL 7.12-20. MANUAL DEF         NA NA NA E
V2203 LENS SPHCYL BIFOCAL 4.00D/.1 PRXOVR DEF         NA NA NA E
V2203 LENS SPHCYL BIFOCAL 4.00D/.1 MANUAL DEF         NA NA NA E
V2204 LENS SPHCY BIFOCAL 4.00D/2.1 PRXOVR DEF         NA NA NA E
V2204 LENS SPHCY BIFOCAL 4.00D/2.1 MANUAL DEF         NA NA NA E
V2205 LENS SPHCY BIFOCAL 4.00D/4.2 PRXOVR DEF         NA NA NA E
V2205 LENS SPHCY BIFOCAL 4.00D/4.2 MANUAL DEF         NA NA NA E
V2206 LENS SPHCY BIFOCAL 4.00D/OVE PRXOVR DEF         NA NA NA E
V2206 LENS SPHCY BIFOCAL 4.00D/OVE MANUAL DEF         NA NA NA E
V2207 LENS SPHCY BIFOCAL 4.25-7D/. PRXOVR DEF         NA NA NA E
V2207 LENS SPHCY BIFOCAL 4.25-7D/. MANUAL DEF         NA NA NA E
V2208 LENS SPHCY BIFOCAL 4.25-7/2. PRXOVR DEF         NA NA NA E
V2208 LENS SPHCY BIFOCAL 4.25-7/2. MANUAL DEF         NA NA NA E
V2209 LENS SPHCY BIFOCAL 4.25-7/4. PRXOVR DEF         NA NA NA E
V2209 LENS SPHCY BIFOCAL 4.25-7/4. MANUAL DEF         NA NA NA E
V2210 LENS SPHCY BIFOCAL 4.25-7/OV PRXOVR DEF         NA NA NA E
V2210 LENS SPHCY BIFOCAL 4.25-7/OV MANUAL DEF         NA NA NA E
V2211 LENS SPHCY BIFO 7.25-12/.25- PRXOVR DEF         NA NA NA E
V2211 LENS SPHCY BIFO 7.25-12/.25- MANUAL DEF         NA NA NA E
V2212 LENS SPHCYL BIFO 7.25-12/2.2 PRXOVR DEF         NA NA NA E
V2212 LENS SPHCYL BIFO 7.25-12/2.2 MANUAL DEF         NA NA NA E
V2213 LENS SPHCYL BIFO 7.25-12/4.2 PRXOVR DEF         NA NA NA E
V2213 LENS SPHCYL BIFO 7.25-12/4.2 MANUAL DEF         NA NA NA E
V2214 LENS SPHCYL BIFOCAL OVER 12. PRXOVR DEF         NA NA NA E
V2214 LENS SPHCYL BIFOCAL OVER 12. MANUAL DEF         NA NA NA E
V2215 LENS LENTICULAR BIFOCAL PRXOVR DEF         NA NA NA E
V2215 LENS LENTICULAR BIFOCAL MANUAL DEF         NA NA NA E
V2218 LENS ANISEIKONIC BIFOCAL PRXOVR DEF         NA NA NA E
V2218 LENS ANISEIKONIC BIFOCAL MANUAL DEF         NA NA NA E
V2219 LENS BIFOCAL SEG WIDTH OVER PRXOVR DEF         NA NA NA E
V2219 LENS BIFOCAL SEG WIDTH OVER MANUAL DEF         NA NA NA E
V2220 LENS BIFOCAL ADD OVER 3.25D PRXOVR DEF         NA NA NA E
V2220 LENS BIFOCAL ADD OVER 3.25D MANUAL DEF         NA NA NA E
V2221 LENTICULAR LENS; BIFOCAL PRXOVR DEF         NA NA NA E
V2221 LENTICULAR LENS; BIFOCAL MANUAL DEF         NA NA NA E
V2299 LENS BIFOCAL SPECIALITY PRXOVR DEF         NA NA NA E
V2299 LENS BIFOCAL SPECIALITY MANUAL DEF         NA NA NA E
V2300 LENS SPHERE TRIFOCAL 4.00D PRXOVR DEF         NA NA NA E
V2300 LENS SPHERE TRIFOCAL 4.00D MANUAL DEF         NA NA NA E
V2301 LENS SPHERE TRIFOCAL 4.12-7. PRXOVR DEF         NA NA NA E
V2301 LENS SPHERE TRIFOCAL 4.12-7. MANUAL DEF         NA NA NA E
V2302 LENS SPHERE TRIFOCAL 7.12-20 PRXOVR DEF         NA NA NA E
V2302 LENS SPHERE TRIFOCAL 7.12-20 MANUAL DEF         NA NA NA E
V2303 LENS SPHCY TRIFOCAL 4.0/.12- PRXOVR DEF         NA NA NA E
V2303 LENS SPHCY TRIFOCAL 4.0/.12- MANUAL DEF         NA NA NA E
V2304 LENS SPHCY TRIFOCAL 4.0/2.25 PRXOVR DEF         NA NA NA E
V2304 LENS SPHCY TRIFOCAL 4.0/2.25 MANUAL DEF         NA NA NA E
V2305 LENS SPHCY TRIFOCAL 4.0/4.25 PRXOVR DEF         NA NA NA E
V2305 LENS SPHCY TRIFOCAL 4.0/4.25 MANUAL DEF         NA NA NA E
V2306 LENS SPHCYL TRIFOCAL 4.00/>6 PRXOVR DEF         NA NA NA E
V2306 LENS SPHCYL TRIFOCAL 4.00/>6 MANUAL DEF         NA NA NA E
V2307 LENS SPHCY TRIFOCAL 4.25-7/. PRXOVR DEF         NA NA NA E
V2307 LENS SPHCY TRIFOCAL 4.25-7/. MANUAL DEF         NA NA NA E
V2308 LENS SPHC TRIFOCAL 4.25-7/2. PRXOVR DEF         NA NA NA E
V2308 LENS SPHC TRIFOCAL 4.25-7/2. MANUAL DEF         NA NA NA E
V2309 LENS SPHC TRIFOCAL 4.25-7/4. PRXOVR DEF         NA NA NA E
V2309 LENS SPHC TRIFOCAL 4.25-7/4. MANUAL DEF         NA NA NA E
V2310 LENS SPHC TRIFOCAL 4.25-7/>6 PRXOVR DEF         NA NA NA E
V2310 LENS SPHC TRIFOCAL 4.25-7/>6 MANUAL DEF         NA NA NA E
V2311 LENS SPHC TRIFO 7.25-12/.25- PRXOVR DEF         NA NA NA E
V2311 LENS SPHC TRIFO 7.25-12/.25- MANUAL DEF         NA NA NA E
V2312 LENS SPHC TRIFO 7.25-12/2.25 PRXOVR DEF         NA NA NA E
V2312 LENS SPHC TRIFO 7.25-12/2.25 MANUAL DEF         NA NA NA E
V2313 LENS SPHC TRIFO 7.25-12/4.25 PRXOVR DEF         NA NA NA E
V2313 LENS SPHC TRIFO 7.25-12/4.25 MANUAL DEF         NA NA NA E
V2314 LENS SPHCYL TRIFOCAL OVER 12 PRXOVR DEF         NA NA NA E
V2314 LENS SPHCYL TRIFOCAL OVER 12 MANUAL DEF         NA NA NA E
V2315 LENS LENTICULAR TRIFOCAL PRXOVR DEF         NA NA NA E
V2315 LENS LENTICULAR TRIFOCAL MANUAL DEF         NA NA NA E
V2318 LENS ANISEIKONIC TRIFOCAL PRXOVR DEF         NA NA NA E
V2318 LENS ANISEIKONIC TRIFOCAL MANUAL DEF         NA NA NA E
V2319 LENS TRIFOCAL SEG WIDTH > 28 PRXOVR DEF         NA NA NA E
V2319 LENS TRIFOCAL SEG WIDTH > 28 MANUAL DEF         NA NA NA E
V2320 LENS TRIFOCAL ADD OVER 3.25D PRXOVR DEF         NA NA NA E
V2320 LENS TRIFOCAL ADD OVER 3.25D MANUAL DEF         NA NA NA E
V2321 LENTICULAR LENS; TRIFOCAL PRXOVR DEF         NA NA NA E
V2321 LENTICULAR LENS; TRIFOCAL MANUAL DEF         NA NA NA E
V2399 LENS TRIFOCAL SPECIALITY PRXOVR DEF         NA NA NA E
V2399 LENS TRIFOCAL SPECIALITY MANUAL DEF         NA NA NA E
V2410 LENS VARIAB ASPHERICITY SING PRXOVR DEF         NA NA NA E
V2410 LENS VARIAB ASPHERICITY SING MANUAL DEF         NA NA NA E
V2430 LENS VARIABLE ASPHERICITY BI PRXOVR DEF         NA NA NA E
V2430 LENS VARIABLE ASPHERICITY BI MANUAL DEF         NA NA NA E
V2499 VARIABLE ASPHERICITY LENS PRXOVR DEF         NA NA NA E
V2499 VARIABLE ASPHERICITY LENS MANUAL DEF         NA NA NA E
V2600 HAND HELD LOW VISION AIDS PRXOVR DEF         NA NA NA E
V2600 HAND HELD LOW VISION AIDS MANUAL DEF         NA NA NA E
V2610 SINGLE LENS SPECTACLE MOUNT PRXOVR DEF         NA NA NA E
V2610 SINGLE LENS SPECTACLE MOUNT MANUAL DEF         NA NA NA E
V2615 TELESCOP/OTHR COMPOUND LENS PRXOVR DEF         NA NA NA E
V2615 TELESCOP/OTHR COMPOUND LENS MANUAL DEF         NA NA NA E
V2623 PLASTIC EYE PROSTH CUSTOM PRXOVR DEF         NA NA NA E
V2623 PLASTIC EYE PROSTH CUSTOM MAXFEE DEF         685.77 1/1/2024 12/31/2299 E
V2625 ENLARGEMNT OF EYE PROSTHESIS PRXOVR DEF         NA NA NA E
V2625 ENLARGEMNT OF EYE PROSTHESIS MAXFEE DEF         350.62 1/1/2024 12/31/2299 E
V2626 REDUCTION OF EYE PROSTHESIS PRXOVR DEF         NA NA NA E
V2626 REDUCTION OF EYE PROSTHESIS MAXFEE DEF         145.09 1/1/2024 12/31/2299 E
V2627 SCLERAL COVER SHELL PRXOVR DEF         NA NA NA E
V2627 SCLERAL COVER SHELL MAXFEE DEF         901.93 1/1/2024 12/31/2299 E
V2628 FABRICATION & FITTING PRXOVR DEF         NA NA NA E
V2628 FABRICATION & FITTING MAXFEE DEF         221.27 1/1/2024 12/31/2299 E
V2629 PROSTHETIC EYE OTHER TYPE PRXOVR DEF         NA NA NA E
V2629 PROSTHETIC EYE OTHER TYPE MANUAL DEF         NA NA NA E
V2630 ANTER CHAMBER INTRAOCUL LENS PRXOVR DEF         NA NA NA E
V2630 ANTER CHAMBER INTRAOCUL LENS MANUAL DEF         NA NA NA E
V2631 IRIS SUPPORT INTRAOCLR LENS PRXOVR DEF         NA NA NA E
V2631 IRIS SUPPORT INTRAOCLR LENS MANUAL DEF         NA NA NA E
V2632 POST CHMBR INTRAOCULAR LENS PRXOVR DEF         NA NA NA E
V2632 POST CHMBR INTRAOCULAR LENS MANUAL DEF         NA NA NA E
V2700 BALANCE LENS PRXOVR DEF         NA NA NA E
V2700 BALANCE LENS MANUAL DEF         NA NA NA E
V2702 DELUXE LENS FEATURE PRXOVR DEF         NA NA NA E
V2702 DELUXE LENS FEATURE MANUAL DEF         NA NA NA E
V2710 GLASS/PLASTIC SLAB OFF PRISM PRXOVR DEF         NA NA NA E
V2710 GLASS/PLASTIC SLAB OFF PRISM MANUAL DEF         NA NA NA E
V2715 PRISM LENS/ES PRXOVR DEF         NA NA NA E
V2715 PRISM LENS/ES MANUAL DEF         NA NA NA E
V2718 FRESNELL PRISM PRESS-ON LENS PRXOVR DEF         NA NA NA E
V2718 FRESNELL PRISM PRESS-ON LENS MANUAL DEF         NA NA NA E
V2730 SPECIAL BASE CURVE PRXOVR DEF         NA NA NA E
V2730 SPECIAL BASE CURVE MANUAL DEF         NA NA NA E
V2744 TINT PHOTOCHROMATIC LENS/ES PRXOVR DEF         NA NA NA E
V2744 TINT PHOTOCHROMATIC LENS/ES MANUAL DEF         NA NA NA E
V2745 TINT; ANY COLOR/SOLID/GRAD PRXOVR DEF         NA NA NA E
V2745 TINT; ANY COLOR/SOLID/GRAD MANUAL DEF         NA NA NA E
V2750 ANTI-REFLECTIVE COATING PRXOVR DEF         NA NA NA E
V2750 ANTI-REFLECTIVE COATING MANUAL DEF         NA NA NA E
V2755 UV LENS/ES PRXOVR DEF         NA NA NA E
V2755 UV LENS/ES MANUAL DEF         NA NA NA E
V2756 EYE GLASS CASE PRXOVR DEF         NA NA NA E
V2756 EYE GLASS CASE MANUAL DEF         NA NA NA E
V2760 SCRATCH RESISTANT COATING PRXOVR DEF         NA NA NA E
V2760 SCRATCH RESISTANT COATING MANUAL DEF         NA NA NA E
V2761 MIRROR COATING PRXOVR DEF         NA NA NA E
V2761 MIRROR COATING MANUAL DEF         NA NA NA E
V2762 POLARIZATION; ANY LENS PRXOVR DEF         NA NA NA E
V2762 POLARIZATION; ANY LENS MANUAL DEF         NA NA NA E
V2770 OCCLUDER LENS/ES PRXOVR DEF         NA NA NA E
V2770 OCCLUDER LENS/ES MANUAL DEF         NA NA NA E
V2780 OVERSIZE LENS/ES PRXOVR DEF         NA NA NA E
V2780 OVERSIZE LENS/ES MANUAL DEF         NA NA NA E
V2781 PROGRESSIVE LENS PER LENS PRXOVR DEF         NA NA NA E
V2781 PROGRESSIVE LENS PER LENS MANUAL DEF         NA NA NA E
V2782 LENS; 1.54-1.65 P/1.60-1.79G PRXOVR DEF         NA NA NA E
V2782 LENS; 1.54-1.65 P/1.60-1.79G MANUAL DEF         NA NA NA E
V2783 LENS; >= 1.66 P/>=1.80 G PRXOVR DEF         NA NA NA E
V2783 LENS; >= 1.66 P/>=1.80 G MANUAL DEF         NA NA NA E
V2784 LENS POLYCARB OR EQUAL PRXOVR DEF         NA NA NA E
V2784 LENS POLYCARB OR EQUAL MANUAL DEF         NA NA NA E
V2786 OCCUPATIONAL MULTIFOCAL LENS PRXOVR DEF         NA NA NA E
V2786 OCCUPATIONAL MULTIFOCAL LENS MANUAL DEF         NA NA NA E
V2787 ASTIGMATISM-CORRECT FUNCTION PRXOVR DEF         NA NA NA E
V2787 ASTIGMATISM-CORRECT FUNCTION MANUAL DEF         NA NA NA E
V2788 PRESBYOPIA-CORRECT FUNCTION PRXOVR DEF         NA NA NA E
V2788 PRESBYOPIA-CORRECT FUNCTION MANUAL DEF         NA NA NA E
V2797 VIS ITEM/SVC IN OTHER CODE PRXOVR DEF         NA NA NA E
V2797 VIS ITEM/SVC IN OTHER CODE MANUAL DEF         NA NA NA E
V2799 MISC VISION ITEM OR SERVICE PRXOVR DEF         NA NA NA E
V2799 MISC VISION ITEM OR SERVICE MANUAL DEF         NA NA NA E
V5010 ASSESSMENT FOR HEARING AID PRXOVR DEF         NA NA NA E
V5010 ASSESSMENT FOR HEARING AID MANUAL DEF         NA NA NA E
V5011 HEARING AID FITTING/CHECKING PRXOVR DEF         NA NA NA E
V5011 HEARING AID FITTING/CHECKING MANUAL DEF         NA NA NA E
V5020 CONFORMITY EVALUATION PRXOVR DEF         NA NA NA E
V5020 CONFORMITY EVALUATION MANUAL DEF         NA NA NA E
V5090 HEARING AID DISPENSING FEE PRXOVR DEF         NA NA NA E
V5090 HEARING AID DISPENSING FEE MANUAL DEF         NA NA NA E
V5095 IMPLANT MID EAR HEARING PROS PRXOVR DEF         NA NA NA E
V5095 IMPLANT MID EAR HEARING PROS MANUAL DEF         NA NA NA E
V5100 BODY-WORN BILAT HEARING AID PRXOVR DEF         NA NA NA E
V5100 BODY-WORN BILAT HEARING AID MANUAL DEF         NA NA NA E
V5120 BODY-WORN BINAUR HEARING AID PRXOVR DEF         NA NA NA E
V5120 BODY-WORN BINAUR HEARING AID MANUAL DEF         NA NA NA E
V5242 HEARING AID; MONAURAL; CIC PRXOVR DEF         NA NA NA E
V5242 HEARING AID; MONAURAL; CIC MANUAL DEF         NA NA NA E
V5243 HEARING AID; MONAURAL; ITC PRXOVR DEF         NA NA NA E
V5243 HEARING AID; MONAURAL; ITC MANUAL DEF         NA NA NA E
V5244 HEARING AID; PROG; MON; CIC PRXOVR DEF         NA NA NA E
V5244 HEARING AID; PROG; MON; CIC MANUAL DEF         NA NA NA E
V5245 HEARING AID; PROG; MON; ITC PRXOVR DEF         NA NA NA E
V5245 HEARING AID; PROG; MON; ITC MANUAL DEF         NA NA NA E
V5248 HEARING AID; BINAURAL; CIC PRXOVR DEF         NA NA NA E
V5248 HEARING AID; BINAURAL; CIC MANUAL DEF         NA NA NA E
V5249 HEARING AID; BINAURAL; ITC PRXOVR DEF         NA NA NA E
V5249 HEARING AID; BINAURAL; ITC MANUAL DEF         NA NA NA E
V5250 HEARING AID; PROG; BIN; CIC PRXOVR DEF         NA NA NA E
V5250 HEARING AID; PROG; BIN; CIC MANUAL DEF         NA NA NA E
V5251 HEARING AID; PROG; BIN; ITC PRXOVR DEF         NA NA NA E
V5251 HEARING AID; PROG; BIN; ITC MANUAL DEF         NA NA NA E
V5254 HEARING ID; DIGIT; MON; CIC PRXOVR DEF         NA NA NA E
V5254 HEARING ID; DIGIT; MON; CIC MANUAL DEF         NA NA NA E
V5255 HEARING AID; DIGIT; MON; ITC PRXOVR DEF         NA NA NA E
V5255 HEARING AID; DIGIT; MON; ITC MANUAL DEF         NA NA NA E
V5258 HEARING AID; DIGIT; BIN; CIC PRXOVR DEF         NA NA NA E
V5258 HEARING AID; DIGIT; BIN; CIC MANUAL DEF         NA NA NA E
V5259 HEARING AID; DIGIT; BIN; ITC PRXOVR DEF         NA NA NA E
V5259 HEARING AID; DIGIT; BIN; ITC MANUAL DEF         NA NA NA E
V5262 HEARING AID; DISP; MONAURAL PRXOVR DEF         NA NA NA E
V5262 HEARING AID; DISP; MONAURAL MANUAL DEF         NA NA NA E
V5263 HEARING AID; DISP; BINAURAL PRXOVR DEF         NA NA NA E
V5263 HEARING AID; DISP; BINAURAL MANUAL DEF         NA NA NA E
V5265 EAR MOLD/INSERT; DISP PRXOVR DEF         NA NA NA E
V5265 EAR MOLD/INSERT; DISP MANUAL DEF         NA NA NA E
V5268 ALD TELEPHONE AMPLIFIER PRXOVR DEF         NA NA NA E
V5268 ALD TELEPHONE AMPLIFIER MANUAL DEF         NA NA NA E
V5269 ALERTING DEVICE; ANY TYPE PRXOVR DEF         NA NA NA E
V5269 ALERTING DEVICE; ANY TYPE MANUAL DEF         NA NA NA E
V5272 TDD PRXOVR DEF         NA NA NA E
V5272 TDD MANUAL DEF         NA NA NA E
V5273 ALD FOR COCHLEAR IMPLANT PRXOVR DEF         NA NA NA E
V5273 ALD FOR COCHLEAR IMPLANT MANUAL DEF         NA NA NA E
V5274 ALD UNSPECIFIED PRXOVR DEF         NA NA NA E
V5274 ALD UNSPECIFIED MANUAL DEF         NA NA NA E
V5275 EAR IMPRESSION PRXOVR DEF         NA NA NA E
V5275 EAR IMPRESSION MANUAL DEF         NA NA NA E
V5281 ALD FM/DM SYSTEM; MONAURAL PRXOVR DEF         NA NA NA E
V5281 ALD FM/DM SYSTEM; MONAURAL MANUAL DEF         NA NA NA E
V5282 ALD FM/DM SYSTEM BINAURAL PRXOVR DEF         NA NA NA E
V5282 ALD FM/DM SYSTEM BINAURAL MANUAL DEF         NA NA NA E
V5283 ALD NECK; LOOP IND RECEIVER PRXOVR DEF         NA NA NA E
V5283 ALD NECK; LOOP IND RECEIVER MANUAL DEF         NA NA NA E
V5284 ALD FM/DM EAR LEVEL RECEIVER PRXOVR DEF         NA NA NA E
V5284 ALD FM/DM EAR LEVEL RECEIVER MANUAL DEF         NA NA NA E
V5285 ALD FM/DM AUD INPUT RECEIVER PRXOVR DEF         NA NA NA E
V5285 ALD FM/DM AUD INPUT RECEIVER MANUAL DEF         NA NA NA E
V5286 ALD BLU TOOTH FM/DM RECEIVER PRXOVR DEF         NA NA NA E
V5286 ALD BLU TOOTH FM/DM RECEIVER MANUAL DEF         NA NA NA E
V5287 ALD FM/DM RECEIVER; NOS PRXOVR DEF         NA NA NA E
V5287 ALD FM/DM RECEIVER; NOS MANUAL DEF         NA NA NA E
V5288 ALD FM/DM TRANSMITTER ALD PRXOVR DEF         NA NA NA E
V5288 ALD FM/DM TRANSMITTER ALD MANUAL DEF         NA NA NA E
V5289 ALD FM/DM ADAPT/BOOT COUPLIN PRXOVR DEF         NA NA NA E
V5289 ALD FM/DM ADAPT/BOOT COUPLIN MANUAL DEF         NA NA NA E
V5290 ALD TRANSMITTER MICROPHONE PRXOVR DEF         NA NA NA E
V5290 ALD TRANSMITTER MICROPHONE MANUAL DEF         NA NA NA E
V5298 HEARING AID NOC PRXOVR DEF         NA NA NA E
V5298 HEARING AID NOC MANUAL DEF         NA NA NA E
V5299 HEARING SERVICE PRXOVR DEF         NA NA NA E
V5299 HEARING SERVICE MANUAL DEF         NA NA NA E
V5336 REPAIR COMMUNICATION DEVICE PRXOVR DEF         NA NA NA E
V5336 REPAIR COMMUNICATION DEVICE MANUAL DEF         NA NA NA E
XX001 STERILE SALINE NEBULIZER SOLUTION 5 ML PRXOVR DEF         NA NA NA S
XX001 STERILE SALINE NEBULIZER SOLUTION 5 ML MAXFEE DEF         NA     S
Y2090 HOME DIALYSIS FOR ESRD PRXOVR DEF         NA NA NA S
Y2090 HOME DIALYSIS FOR ESRD MAXFEE DEF         NA     S
Y2091 CAPD HOME DIALYSIS PRXOVR DEF         NA NA NA S
Y2091 CAPD HOME DIALYSIS MAXFEE DEF         NA     S
Y2092 CCPD HOME DIALYSIS PRXOVR DEF         NA NA NA S
Y2092 CCPD HOME DIALYSIS MAXFEE DEF         1500 4/1/2001 12/31/2299 S
Y9125 CONTRACEPTIVE SPONGE PRXOVR DEF         NA NA NA S
Y9125 CONTRACEPTIVE SPONGE MAXFEE DEF         NA     S
Y9139 INCONTINENCE SUPPLIES; NOT OTHRWISE SPEC PRXOVR DEF         NA NA NA Y
Y9139 INCONTINENCE SUPPLIES; NOT OTHRWISE SPEC MAXFEE DEF         0 12/1/2005 12/31/2299 Y
Y9167 SHARPS DISPOSAL CONTAINER; CAPACITY 200 PRXOVR DEF         NA NA NA S
Y9167 SHARPS DISPOSAL CONTAINER; CAPACITY 200 MAXFEE DEF         4 6/20/1990 12/31/2299 S
Y9170 STETHOSCOPE (REPLCMNT FOR BLOOD PRES.SET PRXOVR DEF         NA NA NA S
Y9170 STETHOSCOPE (REPLCMNT FOR BLOOD PRES.SET MAXFEE DEF         NA     S
Y9189 HOME SUBCU TOCOLYTIC INFUSION THER; 1DAY PRXOVR DEF         NA NA NA Y
Y9189 HOME SUBCU TOCOLYTIC INFUSION THER; 1DAY MAXFEE DEF         120 1/1/1997 12/31/2299 Y
Y9998 VISITS HOME/NURSING HOME HOSPITAL PRXOVR DEF         NA NA NA Y
Y9998 VISITS HOME/NURSING HOME HOSPITAL MAXFEE DEF         NA     Y