Procedure Code Procedure Description Pricing Indicator Rate Type Mod1 Mod2 Mod3 Mod4 Max Fee Max Fee Eff. Date Max Fee End Date PA
A4593 NEUROMOD STI SYS ADJ REHAB PRXOVR DEF         NA NA NA Y
A4593 NEUROMOD STI SYS ADJ REHAB PADOLR DEF         NA NA NA Y
A4594 NEUROMOD ADJ REHAB MOUTHPIE PRXOVR DEF         NA NA NA Y
A4594 NEUROMOD ADJ REHAB MOUTHPIE PADOLR DEF         NA NA NA Y
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
E0425 GAS SYSTEM STATIONARY COMPRE PRXOVR DEF         NA NA NA E
E0425 GAS SYSTEM STATIONARY COMPRE MANUAL DEF         NA NA NA E
E0430 OXYGEN SYSTEM GAS PORTABLE PRXOVR DEF         NA NA NA E
E0430 OXYGEN SYSTEM GAS PORTABLE MANUAL DEF         NA NA NA E
E0431 PORTABLE GASEOUS 02 PRXOVR DEF         NA NA NA S
E0431 PORTABLE GASEOUS 02 MAXFEE DEF         40 7/16/2018 12/31/2299 S
E0433 PORTABLE LIQUID OXYGEN SYS PRXOVR DEF         NA NA NA E
E0433 PORTABLE LIQUID OXYGEN SYS MANUAL DEF         NA NA NA E
E0434 PORTABLE LIQUID 02 PRXOVR DEF         NA NA NA S
E0434 PORTABLE LIQUID 02 MAXFEE DEF         40 7/16/2018 12/31/2299 S
E0435 OXYGEN SYSTEM LIQUID PORTABL PRXOVR DEF         NA NA NA E
E0435 OXYGEN SYSTEM LIQUID PORTABL MANUAL DEF         NA NA NA E
E0439 STATIONARY LIQUID 02 PRXOVR DEF         NA NA NA S
E0439 STATIONARY LIQUID 02 MAXFEE DEF         220 7/1/2021 12/31/2299 S
E0440 OXYGEN SYSTEM LIQUID STATION PRXOVR DEF         NA NA NA E
E0440 OXYGEN SYSTEM LIQUID STATION MANUAL DEF         NA NA NA E
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
E0443 PORTABLE 02 CONTENTS; GAS PRXOVR DEF         NA NA NA E
E0443 PORTABLE 02 CONTENTS; GAS MANUAL DEF         NA NA NA E
E0444 PORTABLE 02 CONTENTS; LIQUID PRXOVR DEF         NA NA NA E
E0444 PORTABLE 02 CONTENTS; LIQUID MANUAL DEF         NA NA NA E
E0446 TOPICAL OX DELIVER SYS; NOS PRXOVR DEF         NA NA NA E
E0446 TOPICAL OX DELIVER SYS; NOS MANUAL DEF         NA NA NA E
E0447 PORT O2 CONT; LIQ OVER 4 LPM PRXOVR DEF         NA NA NA E
E0447 PORT O2 CONT; LIQ OVER 4 LPM MANUAL DEF         NA NA NA E
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         933 1/1/2024 12/31/2299 N
E0466 HOME VENT NON-INVASIVE INTER PRXOVR DEF         NA NA NA N
E0466 HOME VENT NON-INVASIVE INTER MAXFEE DEF         933 1/1/2024 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
E0468 HOME VENT DUAL FNCT INCL ALL PRXOVR DEF         NA NA NA N
E0468 HOME VENT DUAL FNCT INCL ALL MAXFEE DEF         950 4/1/2024 12/31/2299 N
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         398.25 1/1/2024 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 PADOLR DEF         NA NA NA Y
E0638 STANDING FRAME SYS PADOLR UC1         NA NA NA Y
E0638 STANDING FRAME SYS PADOLR UC4         NA NA NA Y
E0638 STANDING FRAME SYS PADOLR UC2         NA NA NA Y
E0638 STANDING FRAME SYS PADOLR UC3         NA NA NA 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
E0736 TRANSCUT TIBIAL NERV STIMULA PRXOVR DEF         NA NA NA Y
E0736 TRANSCUT TIBIAL NERV STIMULA PADOLR DEF         NA NA NA Y
E0738 UPPER EXTREMITY REHAB PRXOVR DEF         NA NA NA Y
E0738 UPPER EXTREMITY REHAB PADOLR DEF         NA NA NA Y
E0739 REHAB SYS ACTIVE ASSIST RT PRXOVR DEF         NA NA NA Y
E0739 REHAB SYS ACTIVE ASSIST RT PADOLR DEF         NA NA NA Y
E0747 ELEC OSTEOGEN STIM NOT SPINE PRXOVR DEF         NA NA NA Y
E0747 ELEC OSTEOGEN STIM NOT SPINE MAXFEE DEF         1965.59 1/1/2024 12/31/2299 Y
E0748 ELEC OSTEOGEN STIM SPINAL PRXOVR DEF         NA NA NA Y
E0748 ELEC OSTEOGEN STIM SPINAL MAXFEE DEF         1856.53 1/1/2024 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         10.12 1/1/2024 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         3300 1/1/2024 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         7035 1/1/2024 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
E1510 KIDNEY DIALYSATE DELIVRY SYS PRXOVR DEF         NA NA NA E
E1510 KIDNEY DIALYSATE DELIVRY SYS MANUAL DEF         NA NA NA E
E1590 HEMODIALYSIS MACHINE PRXOVR DEF         NA NA NA E
E1590 HEMODIALYSIS MACHINE MANUAL DEF         NA NA NA E
E1592 AUTO INTERM PERITONEAL DIALY PRXOVR DEF         NA NA NA E
E1592 AUTO INTERM PERITONEAL DIALY MANUAL DEF         NA NA NA E
E1594 CYCLER DIALYSIS MACHINE PRXOVR DEF         NA NA NA E
E1594 CYCLER DIALYSIS MACHINE MANUAL DEF         NA NA NA E
E1600 DELI/INSTALL CHRG HEMO EQUIP PRXOVR DEF         NA NA NA E
E1600 DELI/INSTALL CHRG HEMO EQUIP MANUAL DEF         NA NA NA E
E1632 WEARABLE ARTIFICIAL KIDNEY PRXOVR DEF         NA NA NA E
E1632 WEARABLE ARTIFICIAL KIDNEY MANUAL DEF         NA NA NA E
E1635 COMPACT TRAVEL HEMODIALYZER PRXOVR DEF         NA NA NA E
E1635 COMPACT TRAVEL HEMODIALYZER MANUAL DEF         NA NA NA E
E2298 PWR SEAT ELEV SYS FOR CRT PRXOVR DEF         NA NA NA Y
E2298 PWR SEAT ELEV SYS FOR CRT MAXFEE DEF         2750 4/1/2024 12/31/2299 Y
E2300 PWR SEAT ELEVATION SYS PRXOVR DEF         NA NA NA Y
E2300 PWR SEAT ELEVATION SYS MAXFEE DEF         NA     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         307.35 1/1/2024 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         700 1/1/2024 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         445 1/1/2024 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         401.48 1/1/2024 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 PADOLR DEF         NA NA NA Y
E8000 POSTERIOR GAIT TRAINER PADOLR UC1         NA NA NA Y
E8000 POSTERIOR GAIT TRAINER PADOLR UC2         NA NA NA Y
E8001 UPRIGHT GAIT TRAINER PRXOVR DEF         NA NA NA Y
E8001 UPRIGHT GAIT TRAINER PADOLR DEF         NA NA NA Y
E8002 ANTERIOR GAIT TRAINER PRXOVR DEF         NA NA NA Y
E8002 ANTERIOR GAIT TRAINER PADOLR DEF         NA NA NA 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         18.50 1/1/2024 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
S8120 O2 CONTENTS GAS CUBIC FT PRXOVR DEF         NA NA NA E
S8120 O2 CONTENTS GAS CUBIC FT MANUAL DEF         NA NA NA E
S8121 O2 CONTENTS LIQUID LB PRXOVR DEF         NA NA NA E
S8121 O2 CONTENTS LIQUID LB MANUAL DEF         NA NA NA E
Y2032 BACK-UP VENTILATOR(UNDER SPEC CONDITIONS PRXOVR DEF         NA NA NA Y
Y2032 BACK-UP VENTILATOR(UNDER SPEC CONDITIONS MAXFEE DEF         NA     Y