| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| A7025 | REPLACE CHEST COMPRESS VEST | PRXOVR | DEF | NA | NA | NA | Y | ||||
| A7025 | REPLACE CHEST COMPRESS VEST | MAXFEE | DEF | 400 | 8/1/2006 | 12/31/2299 | Y | ||||
| B9000 | ENTER INFUSION PUMP W/O ALRM | PRXOVR | DEF | NA | NA | NA | S | ||||
| B9000 | ENTER INFUSION PUMP W/O ALRM | MAXFEE | DEF | NA | S | ||||||
| B9002 | ENTER NUTR INF PUMP ANY TYPE | PRXOVR | DEF | NA | NA | NA | S | ||||
| B9002 | ENTER NUTR INF PUMP ANY TYPE | MAXFEE | DEF | 679 | 1/1/2010 | 12/31/2299 | S | ||||
| B9004 | PARENTERAL INFUS PUMP PORTAB | PRXOVR | DEF | NA | NA | NA | S | ||||
| B9004 | PARENTERAL INFUS PUMP PORTAB | MAXFEE | DEF | 2170.86 | 1/1/2010 | 12/31/2299 | S | ||||
| B9006 | PARENTERAL INFUS PUMP STATIO | PRXOVR | DEF | NA | NA | NA | S | ||||
| B9006 | PARENTERAL INFUS PUMP STATIO | MAXFEE | DEF | 2170.86 | 1/1/2010 | 12/31/2299 | S | ||||
| E0202 | PHOTOTHERAPY LIGHT W/ PHOTOM | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0202 | PHOTOTHERAPY LIGHT W/ PHOTOM | MAXFEE | DEF | 55 | 7/1/2018 | 12/31/2299 | S | ||||
| E0424 | STATIONARY COMPRESSED GAS 02 | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0424 | STATIONARY COMPRESSED GAS 02 | MAXFEE | DEF | 100 | 7/16/2018 | 12/31/2299 | S | ||||
| E0431 | PORTABLE GASEOUS 02 | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0431 | PORTABLE GASEOUS 02 | MAXFEE | DEF | 40 | 7/16/2018 | 12/31/2299 | S | ||||
| E0434 | PORTABLE LIQUID 02 | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0434 | PORTABLE LIQUID 02 | MAXFEE | DEF | 40 | 7/16/2018 | 12/31/2299 | S | ||||
| E0439 | STATIONARY LIQUID 02 | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0439 | STATIONARY LIQUID 02 | MAXFEE | DEF | 220 | 7/1/2021 | 12/31/2299 | S | ||||
| E0441 | STATIONARY O2 CONTENTS; GAS | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0441 | STATIONARY O2 CONTENTS; GAS | MAXFEE | DEF | 50 | 7/16/2018 | 12/31/2299 | S | ||||
| E0442 | STATIONARY O2 CONTENTS; LIQ | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0442 | STATIONARY O2 CONTENTS; LIQ | MAXFEE | DEF | 50 | 7/16/2018 | 12/31/2299 | S | ||||
| E0450 | VOL CONTROL VENT INVASIV INT | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0450 | VOL CONTROL VENT INVASIV INT | MAXFEE | DEF | NA | S | ||||||
| E0460 | NEG PRESS VENT PORTABL/STATN | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0460 | NEG PRESS VENT PORTABL/STATN | MAXFEE | DEF | NA | Y | ||||||
| E0463 | PRESS SUPP VENT INVASIVE INT | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0463 | PRESS SUPP VENT INVASIVE INT | MAXFEE | DEF | NA | Y | ||||||
| E0464 | PRESS SUPP VENT NONINV INT | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0464 | PRESS SUPP VENT NONINV INT | MAXFEE | DEF | NA | Y | ||||||
| E0465 | HOME VENT INVASIVE INTERFACE | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0465 | HOME VENT INVASIVE INTERFACE | MAXFEE | DEF | 900 | 1/1/2016 | 12/31/2299 | N | ||||
| E0466 | HOME VENT NON-INVASIVE INTER | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0466 | HOME VENT NON-INVASIVE INTER | MAXFEE | DEF | 900 | 1/1/2016 | 12/31/2299 | N | ||||
| E0467 | HOME VENT MULTI-FUNCTION | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0467 | HOME VENT MULTI-FUNCTION | MAXFEE | DEF | 1000 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0470 | RAD W/O BACKUP NON-INV INTFC | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0470 | RAD W/O BACKUP NON-INV INTFC | MAXFEE | DEF | 1900 | 8/1/2006 | 12/31/2299 | Y | ||||
| E0471 | RAD W/BACKUP NON INV INTRFC | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0471 | RAD W/BACKUP NON INV INTRFC | MAXFEE | DEF | 320 | 8/1/2006 | 12/31/2299 | Y | ||||
| E0472 | RAD W BACKUP INVASIVE INTRFC | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0472 | RAD W BACKUP INVASIVE INTRFC | MAXFEE | DEF | 320 | 8/1/2006 | 12/31/2299 | N | ||||
| E0600 | SUCTION PUMP PORTAB HOM MODL | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0600 | SUCTION PUMP PORTAB HOM MODL | MAXFEE | DEF | 379.75 | 7/16/2018 | 12/31/2299 | N | ||||
| E0618 | APNEA MONITOR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0618 | APNEA MONITOR | MAXFEE | DEF | 2626.50 | 10/15/2006 | 12/31/2299 | Y | ||||
| E0619 | APNEA MONITOR W RECORDER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0619 | APNEA MONITOR W RECORDER | MAXFEE | DEF | 2833.65 | 10/15/2006 | 12/31/2299 | Y | ||||
| E0625 | PATIENT LIFT BATHROOM OR TOI | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0625 | PATIENT LIFT BATHROOM OR TOI | MAXFEE | DEF | 447 | 3/20/2009 | 12/31/2299 | N | ||||
| E0630 | PATIENT LIFT HYDRAULIC | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0630 | PATIENT LIFT HYDRAULIC | MAXFEE | DEF | 761.60 | 7/16/2018 | 12/31/2299 | N | ||||
| E0638 | STANDING FRAME SYS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0638 | STANDING FRAME SYS | MAXFEE | UC2 | 2500 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0638 | STANDING FRAME SYS | MAXFEE | UC3 | 3000 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0638 | STANDING FRAME SYS | MAXFEE | DEF | 1700 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0638 | STANDING FRAME SYS | MAXFEE | UC1 | 2000 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0638 | STANDING FRAME SYS | MAXFEE | UC4 | 4000 | 7/1/2021 | 12/31/2299 | Y | ||||
| E0720 | TENS TWO LEAD | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0720 | TENS TWO LEAD | MAXFEE | DEF | 525 | 7/16/2018 | 12/31/2299 | N | ||||
| E0730 | TENS FOUR LEAD | PRXOVR | DEF | NA | NA | NA | S | ||||
| E0730 | TENS FOUR LEAD | MAXFEE | DEF | 564.18 | 7/16/2018 | 12/31/2299 | S | ||||
| E0747 | ELEC OSTEOGEN STIM NOT SPINE | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0747 | ELEC OSTEOGEN STIM NOT SPINE | MAXFEE | DEF | 1750 | 3/21/2007 | 12/31/2299 | Y | ||||
| E0748 | ELEC OSTEOGEN STIM SPINAL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0748 | ELEC OSTEOGEN STIM SPINAL | MAXFEE | DEF | 1750 | 3/21/2007 | 12/31/2299 | Y | ||||
| E0760 | OSTEOGEN ULTRASOUND STIMLTOR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0760 | OSTEOGEN ULTRASOUND STIMLTOR | MAXFEE | DEF | 1750 | 3/21/2007 | 12/31/2299 | Y | ||||
| E0770 | FUNCTIONAL ELECTRIC STIM NOS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0770 | FUNCTIONAL ELECTRIC STIM NOS | PADOLR | DEF | NA | NA | NA | Y | ||||
| E0781 | EXTERNAL AMBULATORY INFUS PU | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0781 | EXTERNAL AMBULATORY INFUS PU | MAXFEE | DEF | 8.73 | 8/1/2006 | 12/31/2299 | N | ||||
| E0784 | EXT AMB INFUSN PUMP INSULIN | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0784 | EXT AMB INFUSN PUMP INSULIN | MAXFEE | DEF | 4000 | 8/1/2006 | 12/31/2299 | Y | ||||
| E0787 | CGS DOSE ADJ INSULIN INF PMP | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E0787 | CGS DOSE ADJ INSULIN INF PMP | MANUAL | DEF | NA | NA | NA | Y | ||||
| E0791 | PARENTERAL INFUSION PUMP STA | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0791 | PARENTERAL INFUSION PUMP STA | MAXFEE | DEF | 8.73 | 8/1/2006 | 12/31/2299 | N | ||||
| E0935 | CONT PAS MOTION EXERCISE DEV | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0935 | CONT PAS MOTION EXERCISE DEV | MAXFEE | DEF | 18.18 | 8/1/2006 | 12/31/2299 | N | ||||
| E0985 | W/C SEAT LIFT MECHANISM | PRXOVR | DEF | NA | NA | NA | N | ||||
| E0985 | W/C SEAT LIFT MECHANISM | MAXFEE | DEF | 202.64 | 1/1/2017 | 12/31/2299 | N | ||||
| E1002 | PWR SEAT TILT | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1002 | PWR SEAT TILT | MAXFEE | DEF | 3056.22 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1003 | PWR SEAT RECLINE | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1003 | PWR SEAT RECLINE | MAXFEE | DEF | 3311.15 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1004 | PWR SEAT RECLINE MECH | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1004 | PWR SEAT RECLINE MECH | MAXFEE | DEF | 3671.38 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1005 | PWR SEAT RECLINE PWR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1005 | PWR SEAT RECLINE PWR | MAXFEE | DEF | 3973.98 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1006 | PWR SEAT COMBO W/O SHEAR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1006 | PWR SEAT COMBO W/O SHEAR | MAXFEE | DEF | 4867.76 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1007 | PWR SEAT COMBO W/SHEAR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1007 | PWR SEAT COMBO W/SHEAR | MAXFEE | DEF | 6591.14 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1008 | PWR SEAT COMBO PWR SHEAR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1008 | PWR SEAT COMBO PWR SHEAR | MAXFEE | DEF | 6591.74 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1010 | ADD PWR LEG ELEVATION | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E1010 | ADD PWR LEG ELEVATION | MAXFEE | DEF | 862.44 | 1/1/2017 | 12/31/2299 | Y | ||||
| E1390 | OXYGEN CONCENTRATOR | MAXFEE | NFO | 50 | 7/16/2018 | 12/31/2299 | S | ||||
| E1390 | OXYGEN CONCENTRATOR | PRXOVR | DEF | NA | NA | NA | S | ||||
| E1390 | OXYGEN CONCENTRATOR | MAXFEE | OTH | 140 | 2/1/2020 | 12/31/2299 | S | ||||
| E1390 | OXYGEN CONCENTRATOR | MAXFEE | DEF | 100 | 7/16/2018 | 12/31/2299 | S | ||||
| E1391 | OXYGEN CONCENTRATOR; DUAL | MAXFEE | NFO | 50 | 7/16/2018 | 12/31/2299 | S | ||||
| E1391 | OXYGEN CONCENTRATOR; DUAL | PRXOVR | DEF | NA | NA | NA | S | ||||
| E1391 | OXYGEN CONCENTRATOR; DUAL | MAXFEE | DEF | 100 | 7/16/2018 | 12/31/2299 | S | ||||
| E1392 | PORTABLE OXYGEN CONCENTRATOR | PRXOVR | DEF | NA | NA | NA | S | ||||
| E1392 | PORTABLE OXYGEN CONCENTRATOR | MAXFEE | DEF | 40 | 7/16/2018 | 12/31/2299 | S | ||||
| E2300 | PWR SEAT ELEVATION SYS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2300 | PWR SEAT ELEVATION SYS | MAXFEE | DEF | 2500 | 7/1/2021 | 12/31/2299 | Y | ||||
| E2301 | PWR STANDING | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2301 | PWR STANDING | MAXFEE | DEF | 5300 | 7/1/2021 | 12/31/2299 | Y | ||||
| E2310 | ELECTRO CONNECT BTW CONTROL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2310 | ELECTRO CONNECT BTW CONTROL | MAXFEE | DEF | 1023.77 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2311 | ELECTRO CONNECT BTW 2 SYS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2311 | ELECTRO CONNECT BTW 2 SYS | MAXFEE | DEF | 2072.66 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2312 | MINI-PROP REMOTE JOYSTICK | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2312 | MINI-PROP REMOTE JOYSTICK | MAXFEE | DEF | 2250.77 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2313 | PWC HARNESS; EXPAND CONTROL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2313 | PWC HARNESS; EXPAND CONTROL | MAXFEE | DEF | 280.17 | 1/1/2017 | 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 | ||||
| E2321 | HAND INTERFACE JOYSTICK | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2321 | HAND INTERFACE JOYSTICK | MAXFEE | DEF | 1198.22 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2322 | MULT MECH SWITCHES | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2322 | MULT MECH SWITCHES | MAXFEE | DEF | 1063.45 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2323 | SPECIAL JOYSTICK HANDLE | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2323 | SPECIAL JOYSTICK HANDLE | MAXFEE | DEF | 69.08 | 1/1/2017 | 12/31/2299 | N | ||||
| E2324 | CHIN CUP INTERFACE | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2324 | CHIN CUP INTERFACE | MAXFEE | DEF | 43.77 | 1/1/2017 | 12/31/2299 | N | ||||
| E2325 | SIP AND PUFF INTERFACE | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2325 | SIP AND PUFF INTERFACE | MAXFEE | DEF | 1015.54 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2326 | BREATH TUBE KIT | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2326 | BREATH TUBE KIT | MAXFEE | DEF | 330 | 7/1/2021 | 12/31/2299 | N | ||||
| E2327 | HEAD CONTROL INTERFACE MECH | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2327 | HEAD CONTROL INTERFACE MECH | MAXFEE | DEF | 2130 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2328 | HEAD/EXTREMITY CONTROL INTER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2328 | HEAD/EXTREMITY CONTROL INTER | MAXFEE | DEF | 3600 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2329 | HEAD CONTROL NONPROPORTIONAL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2329 | HEAD CONTROL NONPROPORTIONAL | MAXFEE | DEF | 1331.70 | 7/1/2020 | 12/31/2299 | Y | ||||
| E2330 | HEAD CONTROL PROXIMITY SWITC | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2330 | HEAD CONTROL PROXIMITY SWITC | MAXFEE | DEF | 3736.43 | 7/1/2020 | 12/31/2299 | Y | ||||
| E2331 | ATTENDANT CONTROL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2331 | ATTENDANT CONTROL | MAXFEE | DEF | 600 | 7/1/2021 | 12/31/2299 | Y | ||||
| E2351 | ELECTRONIC SGD INTERFACE | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2351 | ELECTRONIC SGD INTERFACE | MAXFEE | DEF | 526.78 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2368 | PWR WC DRIVEWHEEL MOTOR REPL | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2368 | PWR WC DRIVEWHEEL MOTOR REPL | MAXFEE | DEF | 516.02 | 1/1/2017 | 12/31/2299 | N | ||||
| E2369 | PWR WC DRIVEWHEEL GEAR REPL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2369 | PWR WC DRIVEWHEEL GEAR REPL | MAXFEE | DEF | 449.48 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2370 | PWR WC DR WH MOTOR/GEAR COMB | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2370 | PWR WC DR WH MOTOR/GEAR COMB | MAXFEE | DEF | 802 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2373 | HAND/CHIN CTRL SPEC JOYSTICK | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2373 | HAND/CHIN CTRL SPEC JOYSTICK | MAXFEE | DEF | 614.99 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2374 | HAND/CHIN CTRL STD JOYSTICK | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2374 | HAND/CHIN CTRL STD JOYSTICK | MAXFEE | DEF | 402.67 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2375 | NON-EXPANDABLE CONTROLLER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2375 | NON-EXPANDABLE CONTROLLER | MAXFEE | DEF | 855.66 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2376 | EXPANDABLE CONTROLLER; REPL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2376 | EXPANDABLE CONTROLLER; REPL | PADOLR | DEF | NA | NA | NA | Y | ||||
| E2377 | EXPANDABLE CONTROLLER; INITL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2377 | EXPANDABLE CONTROLLER; INITL | MAXFEE | DEF | 366.24 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2378 | PW ACTUATOR REPLACEMENT | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2378 | PW ACTUATOR REPLACEMENT | MAXFEE | DEF | 447.62 | 1/1/2017 | 12/31/2299 | Y | ||||
| E2609 | CUSTOM FABRICATE W/C CUSHION | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2609 | CUSTOM FABRICATE W/C CUSHION | PADOLR | DEF | NA | NA | NA | Y | ||||
| E2610 | POWERED W/C CUSHION | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2610 | POWERED W/C CUSHION | MAXFEE | DEF | 55 | 7/1/2021 | 12/31/2299 | N | ||||
| E2617 | CUSTOM FAB W/C BACK CUSHION | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E2617 | CUSTOM FAB W/C BACK CUSHION | PADOLR | DEF | NA | NA | NA | Y | ||||
| E2626 | SEO MOBILE ARM SUP ATT TO WC | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2626 | SEO MOBILE ARM SUP ATT TO WC | MAXFEE | DEF | 611.87 | 1/1/2017 | 12/31/2299 | N | ||||
| E2632 | OFFSET/LAT ROCKER ARM W/ELA | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2632 | OFFSET/LAT ROCKER ARM W/ELA | MAXFEE | DEF | 142.70 | 1/1/2017 | 12/31/2299 | N | ||||
| E2633 | MOBILE ARM SUPPORT SUPINATOR | PRXOVR | DEF | NA | NA | NA | N | ||||
| E2633 | MOBILE ARM SUPPORT SUPINATOR | MAXFEE | DEF | 121.04 | 1/1/2017 | 12/31/2299 | N | ||||
| E8000 | POSTERIOR GAIT TRAINER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E8000 | POSTERIOR GAIT TRAINER | MAXFEE | UC2 | 1500 | 7/1/2021 | 12/31/2299 | Y | ||||
| E8000 | POSTERIOR GAIT TRAINER | MAXFEE | DEF | 550 | 7/1/2021 | 12/31/2299 | Y | ||||
| E8000 | POSTERIOR GAIT TRAINER | MAXFEE | UC1 | 1100 | 7/1/2021 | 12/31/2299 | Y | ||||
| E8001 | UPRIGHT GAIT TRAINER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E8001 | UPRIGHT GAIT TRAINER | MAXFEE | DEF | 2100 | 7/1/2021 | 12/31/2299 | Y | ||||
| E8002 | ANTERIOR GAIT TRAINER | PRXOVR | DEF | NA | NA | NA | Y | ||||
| E8002 | ANTERIOR GAIT TRAINER | MAXFEE | DEF | 2700 | 7/1/2021 | 12/31/2299 | Y | ||||
| K0010 | STND WT FRAME POWER WHLCHR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0010 | STND WT FRAME POWER WHLCHR | MAXFEE | DEF | 3498.24 | 1/1/2017 | 12/31/2299 | Y | ||||
| K0011 | STND WT PWR WHLCHR W CONTROL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0011 | STND WT PWR WHLCHR W CONTROL | MAXFEE | DEF | 4481.60 | 1/1/2017 | 12/31/2299 | Y | ||||
| K0012 | LTWT PORTBL POWER WHLCHR | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0012 | LTWT PORTBL POWER WHLCHR | MAXFEE | DEF | 2842.56 | 1/1/2017 | 12/31/2299 | Y | ||||
| K0014 | OTHER POWER WHLCHR BASE | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0014 | OTHER POWER WHLCHR BASE | PADOLR | DEF | NA | NA | NA | Y | ||||
| K0098 | DRIVE BELT FOR PWC; REPL | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0098 | DRIVE BELT FOR PWC; REPL | MAXFEE | DEF | 26.38 | 1/1/2017 | 12/31/2299 | Y | ||||
| K0606 | AED GARMENT W ELEC ANALYSIS | PRXOVR | DEF | NA | NA | NA | N | ||||
| K0606 | AED GARMENT W ELEC ANALYSIS | MAXFEE | DEF | 23200 | 7/1/2021 | 12/31/2299 | N | ||||
| K0738 | PORTABLE GAS OXYGEN SYSTEM | PRXOVR | DEF | NA | NA | NA | S | ||||
| K0738 | PORTABLE GAS OXYGEN SYSTEM | MAXFEE | DEF | 40 | 7/16/2018 | 12/31/2299 | S | ||||
| K0740 | REPAIR/SVC OXYGEN EQUIPMENT | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K0740 | REPAIR/SVC OXYGEN EQUIPMENT | MAXFEE | DEF | 12.17 | 7/1/2020 | 12/31/2299 | Y | ||||
| K1016 | TRANS ELEC NERV FOR TRIGEMIN | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K1016 | TRANS ELEC NERV FOR TRIGEMIN | MANUAL | DEF | NA | NA | NA | Y | ||||
| K1017 | MONTHLY SUPP USE WITH K1016 | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K1017 | MONTHLY SUPP USE WITH K1016 | MANUAL | DEF | NA | NA | NA | Y | ||||
| K1018 | EXT UP LIMB TREMOR STIM WRIS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K1018 | EXT UP LIMB TREMOR STIM WRIS | MANUAL | DEF | NA | NA | NA | Y | ||||
| K1019 | SUPP EXT UP LIMB TREMOR STIM | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K1019 | SUPP EXT UP LIMB TREMOR STIM | MANUAL | DEF | NA | NA | NA | Y | ||||
| K1020 | NON-INVASIVE VAGUS NERV STIM | PRXOVR | DEF | NA | NA | NA | Y | ||||
| K1020 | NON-INVASIVE VAGUS NERV STIM | MANUAL | DEF | NA | NA | NA | Y | ||||
| Y2032 | BACK-UP VENTILATOR(UNDER SPEC CONDITIONS | PRXOVR | DEF | NA | NA | NA | Y | ||||
| Y2032 | BACK-UP VENTILATOR(UNDER SPEC CONDITIONS | MAXFEE | DEF | 375 | 8/1/2006 | 12/31/2299 | Y |