Shoulder and Elbow Team

EPIC Orthoses

 

Manufacturer

Part #

Description

Cash Pay Price

HCPCS Code

Aircast

01AL

Aircast Semi Pneumatic Boot Walker

$67.50

L4360

Aircast

01AM

Aircast Semi Pneumatic Boot Walker

$67.50

L4360

Aircast

01AS

Aircast Semi Pneumatic Boot Walker

$67.50

L4360

Aircast

01FL

Aircast Foam Boot Walker

$75.75

L4386

Aircast

01FM

Aircast Foam Boot Walker

$75.75

L4386

Aircast

01FS

Aircast Foam Boot Walker

$75.75

L4386

Aircast

01FXL

Aircast Foam Boot Walker

$75.75

L4386

Aircast

01PDL

Aircast Pneumatic Diabetic Boot

$173.13

L4360

Aircast

01PDM

Aircast Pneumatic Diabetic Boot

$173.13

L4360

Aircast

01PDS

Aircast Pneumatic Diabetic Boot

$173.13

L4360

Aircast

01PDXL

Aircast Pneumatic Diabetic Boot

$173.13

L4360

Aircast

02MLL

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

02MLR

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

02MML

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

02MMR

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

02MSL

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

02MSR

Aircast Airsport Ankle Brace

$35.75

L4350

Aircast

09AM

Aircast Air Heel

$32.50

L1906

Aircast

16A01

Hand and Wrist Cryo Cuff

$56.25

A9270

Alimed

60404-L

Desc Uco Adjustable Heel Lift

$15.00

L3350

Alimed

60404-M

Desc Uco Adjustable Heel Lift

$15.00

L3350

Alimed

60404-S

Uco Adj Heel Lift

$15.00

L3350

Alimed

64321

Dorsal Night Splint

$44.99

L4396

Alimed

64322

Dorsal Night Splint

$44.99

L4396

Bauerfeind

11011101010705

Malleotrain

$56.25

L1906

Bauerfeind

11011101010706

Malleotrain

$56.25

L1906

Bauerfeind

11011101070605

Malleotrain

$56.25

L1906

Bauerfeind

11011101070606

Malleotrain

$56.25

L1906

Bauerfeind

13017001000003

Visco Heel N (pair)

$28.75

L3485

Bauerfeind

13017301000001

Visco Peds (pair)

$71.25

L3485

Bauerfeind

13017301000002

Visco Peds (pair)

$71.25

L3003

Bauerfeind

13017301000003

Visco Peds (pair)

$71.25

L3003

Benik

E50003

Tennis Elbow w/strap

$30.00

L3700

Benik

E50005

Tennis Elbow w/strap

$30.00

L3700

Benik

E50007

Tennis Elbow w/strap

$30.00

L3700

Benik

W200

Wrist Wrap

$15.31

L3908

Benik

W201T-L

Wrist Wrap W/ Thumb

$17.49

L3807

Benik

W201T-M

Wrist Wrap W/ Thumb

$17.49

L3807

Benik

W201T-S

Wrist Wrap W/ Thumb

$17.49

L3807

Breg

07171

Adj. Knee Support

$60.00

L1825+L2795

Breg

07172

Adj. Knee Support

$60.00

L1825+L2795

Breg

07173

Adj. Knee Support

$60.00

L1825+L2795

Breg

07174

Adj. Knee Support

$60.00

L1825+L2795

Breg

07175

Adj. Knee Support

$60.00

L1825+L2795

Breg

07176

Adj. Knee Support

$60.00

L1825+L2795

Breg

07593

Quick Fit Post-Op

$141.25

L1832

Breg

07594

Quick Fit Post-Op

$141.25

L1832

Breg

08710

Knee Support, Neo w/open pat

$30.00

L1825

Breg

08720

Knee Support, Neo w/open pat

$30.00

L1825

Breg

08730

Knee Support, Neo w/open pat

$30.00

L1825

Breg

08740

Knee Support, Neo w/open pat

$30.00

L1825

Breg

08750

Knee Support, Neo w/open pat

$30.00

L1825

Breg

08760

Knee Support, Neo w/open pat

$30.00

L1825

Breg

14304

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14305

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14306

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14312

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14314

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14315

PTO airmesh, Open Back

$148.75

L1810 + L2795

Breg

14316

PTO airmesh, Open Back

$148.75

L1810 + L2795

Darco

OQ1B

Darco Ortho Wedge

$15.00

L3260

Darco

OQ2B

Darco Ortho Wedge

$15.00

L3260

Darco

OQ3B

Darco Ortho Wedge

$15.00

L3260

DJ Ortho

11-0180-2

IROM Elbow Brace

$116.25

L3760

DJ Ortho

11-0180-4

IROM Elbow Brace

$116.25

L3760

DJ Ortho

11-0181-2

IROM Elbow Brace

$116.25

L3760

DJ Ortho

11-0181-4

IROM Elbow Brace

$116.25

L3760

DJ Ortho

11-0467-9

Forearm Support w/ Pad

$30.00

L3701

DJ Ortho

11-0666-1

Drytex Playmaker Wraparound

$176.25

L1832

DJ Ortho

11-0966-9

TROM Enhanced Bilateral Shells

$163.75

L1832

hapad

HP2-1

2-1/2 x 1/2" Heel Pads (pair)

$15.00

L3480

hapad

HP25 (PAIR)

2 ½" x 5/16" Hapad heel pad (pair)

$15.83

L3480

hely & weber

304L

Webly Ankle Stabilizing Orthosis Ankle Brace

$16.80

L1906

hely & weber

304M

Webly Ankle Stabilizing Orthosis Ankle Brace

$16.80

L1906

hely & weber

304S

Webly Ankle Stabilizing Orthosis Ankle Brace

$16.80

L1906

hely & weber

3838-BLK-L

Tennis Elbow w/Compression Pad,Elastic Strap

$30.00

L3701

hely & weber

3838-BLK-M

Tennis Elbow w/Compression Pad,Elastic Strap

$30.00

L3701

hely & weber

3838-BLK-S

Tennis Elbow w/Compression Pad,Elastic Strap

$30.00

L3701

hely & weber

3838-BLK-XL

Tennis Elbow w/Compression Pad,Elastic Strap

$30.00

L3701

hely & weber

3838-BLK-XS

Tennis Elbow w/Compression Pad,Elastic Strap

$30.00

L3701

Jim Hughes Co

10385

Silipos Achilles Heel Pad

$18.13

L3350

Jim Hughes Co

10395

Silipos Achilles Heel Pad

$18.13

L3350

Medical Ortho

507-7 SZ 1

Ankle Support

$46.19

L1902

Medical Ortho

507-7 SZ 2

Ankle Support

$46.19

L1902

Medical Ortho

507-7 SZ 3

Ankle Support

$46.19

L1902

Medical Ortho

507-7 SZ 4

Ankle Support

$46.19

L1902

Medical Ortho

507-7 SZ 5

Ankle Support

$46.19

L1902

Medical Ortho

507-7 SZ 6

Ankle Support

$46.19

L1902

Medical Ortho

5115 SZ 1

Achilles Support

$59.94

L1902

Medical Ortho

5115 SZ 3

Achilles Support

$59.94

L1902

Medical Ortho

5115 SZ 4

Achilles Support

$59.94

L1902

Medical Ortho

5115 SZ 5

Achilles Support

$59.94

L1902

Medical Ortho

5115 SZ 6

Achilles Support

$59.94

L1902

Medical Ortho

5115-SZ 2

Achilles Support

$59.94

L1902

Medline

MDS86420

Aluminum Offset Cane

$15.00

E0100

Medline

MDS86615

Walker

$36.25

E0135

Medline

mds86615w3

3" Wheels for Walkers

$24.44

E0146 INCLUDES WALKER

Medline

MDSV80534

Crutches

$25.00

E0114

Medline

MDSV80535

Crutches

$25.00

E0114

Medline

mdsv80536

Crutches

$25.00

E0114

Moore Medical

76557

Active Ankle Dorsal Night Splint

$39.85

L4396

Moore Medical

76558

Active Ankle Dorsal Night Splint

$39.85

L4396

North Coast Med

NC79556

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79557

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79558

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79559

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79560

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79561

CMC Thumb Splint Plus

$18.71

L3807

North Coast Med

NC79562

Comfort Cool Thumb

$18.71

L3807

North Coast Med

NC79563

Comfort Cool Thumb

$18.71

L3807

North Coast Med

NC79564

Comfort Cool Thumb

$18.71

L3807

North Coast Med

NC79565

Comfort Cool Thumb

$18.71

L3807

North Coast Med

NC79566

Comfort Cool Thumb

$18.71

L3807

North Coast Med

NC79567

Comfort Cool Thumb

$18.71

L3807

Ortho America

1089

Humeral Fracture Brace

$115.00

L3980

Ortho America

1090

Humeral Fracture Brace

$115.00

L3980

Ortho America

1091

Humeral Fracture Brace

$115.00

L3980

Ortho America

1092

Humeral Fracture Brace

$115.00

L3980

Ortho America

1093

Humeral Fracture Brace

$115.00

L3980

Ortho Outfitter

264032

Ankle Stabilizing Orthosis Ankle Brace w/ Stays

$29.94

L1906

Ortho Outfitter

264034

Ankle Stabilizing Orthosis Ankle Brace w/ Stays

$29.94

L1906

Ortho Outfitter

264035

Ankle Stabilizing Orthosis Ankle Brace w/ Stays

$29.94

L1906

Ortho Outfitter

264036

Ankle Stabilizing Orthosis Ankle Brace w/ Stays

$29.94

L1906

Orthomed

A21

Half Arm

$15.00

E1399

Orthomed

A31

Full Arm

$15.00

E1399

Orthomed

L25

Half Leg

$15.00

E1399

Orthomed

L44

Full  Leg

$20.31

E1399

Ossur

3030

FormFit Thumb Spica

$20.00

L3807

Ossur

3050

FormFit Thumb Spica

$20.00

L3807

Ossur

3070

FormFit Thumb Spica

$20.00

L3807

Ossur

3080

FormFit Thumb Spica

$20.00

L3807

Ossur

3130

FormFit Thumb Spica

$20.00

L3807

Ossur

3150

FormFit Thumb Spica

$20.00

L3807

Ossur

3170

FormFit Thumb Spica

$20.00

L3807

Ossur

317072

FormFit Thumb Spica

$20.00

L3807

Ossur

317073

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317075

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317077

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317078

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317082

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317083

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317085

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317087

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

317088

8" Formfit Wrist Splint Brace

$15.00

L3908

Ossur

3180

FormFit Thumb Spica

$20.00

L3807

Ossur

50007

FormFit Night Splint

$30.00

L4396

Ossur

S180WL

Darco Med-Surg Shoe

$15.00

L3260

Ossur

S180WM

Darco Med-Surg Shoe

$15.00

L3260

Ossur

S180WS

Darco Med-Surg Shoe

$15.00

L3260

Ossur

S190ML

Darco Med-Surg Shoe

$15.00

L3260

Ossur

S190MM

Darco Med-Surg Shoe

$15.00

L3260

Ossur

S190MS

Darco Med-Surg Shoe

$15.00

L3260

Procare

72273

Tuli's Pro Heel Cup Pair

$15.24

L3332

Procare

72275

Tuli's Pro Heel Cup Pair

$15.24

L3332

Procare

72277

Tuli's Pro Heel Cup Pair

$15.24

L3332

Procare

80020

20" 3 Panel Knee Splint

$37.25

L1830

Procare

80110

16" 3 Panel Knee Splint

$32.25

L1830

Procare

81113

Rocker Cast Boot/Sandal

$15.00

L3260

Procare

81115

Rocker Cast Boot/Sandal

$15.00

L3260

Procare

81117

Rocker Cast Boot/Sandal

$15.00

L3260

Procare

81372

Elastic Ankle Support w/ Figure 8 Strap

$17.81

L1902

Procare

81373

Elastic Ankle Support w/ Figure 8 Strap

$17.81

L1902

Procare

81375

Elastic Ankle Support w/ Figure 8 Strap

$17.81

L1902

Procare

81377

Elastic Ankle Support w/ Figure 8 Strap

$17.81

L1902

Procare

82392

Reddie Brace

$57.50

L1810

Procare

82393

Reddie Brace

$57.50

L1810

Procare

82395

Reddie Brace

$57.50

L1810

Procare

82397

Reddie Brace

$57.50

L1810

Procare

82398

Reddie Brace

$57.50

L1810

Procare

82399

Reddie Brace

$57.50

L1810

Procare

82399

Reddie Brace

$57.50

L1810

Procare

82702

Sports Knee w/ Buttress

$30.00

L1825

Procare

82703

Sports Knee w/ Buttress

$30.00

L1825

Procare

82705

Sports Knee w/ Buttress

$30.00

L1825

Procare

82707

Sports Knee w/ Buttress

$30.00

L1825

Procare

82708

Sports Knee w/ Buttress

$30.00

L1825

Procare

84013

Clinical Shoulder Immobilizer

$15.00

L3650

Procare

84015

Clinical Shoulder Immobilizer

$15.00

L3650

Procare

84017

Clinical Shoulder Immobilizer

$15.00

L3650

Procare

84153

Arm Sling w/ Pad Strap

$17.50

L3660

Procare

84155

Arm Sling w/ Pad Strap

$17.50

L3660

Procare

84157

Arm Sling w/ Pad Strap

$17.50

L3660

Procare

85100

Clavical Splint

$16.66

L3650

Procare

89070

9" 3-Pannel Binder (30"-45")

$30.00

L0210

Procare

89071

9" 3-Panel Binder (45"-62")

$30.00

L0210

Procare

92170

Thumb Support

$15.00

L3807

Procare

92470

Cuff & Collar

$15.00

L3660

Procare

92471

Cuff & Collar

$15.00

L3660

Procare

95130

Achilles Wedge

$21.35

L3350

Procare

96100

Thumb Spica

$15.00

L3807

Procare

96820

Shoulder Immobilizer - Deluxe

$18.23

L3650

Procare

97867

Surround Gel Ankle Reg 10"

$33.69

L4350

Sammons Preston

55984302

Back Sppt (Waist to Hip)

$50.00

L0625

Sammons Preston

55984303

Back Sppt (Waist to Hip)

$50.00

L0625

Sammons Preston

564743

Wrist Widget

$50.55

L3908

Sammons Preston

C55984301

Back Sppt (Waist to Hip)

$50.00

L0625

Sammons Preston

C55984301

Back support

$50.00

L0625

Sammons Preston

C55984302

Back support

$50.00

L0625

Sammons Preston

C55984303

Back support

$50.00

L0625

Sammons Preston

C55984304

Back Sppt (Waist to Hip)

$50.00

L0625

Sammons Preston

C55984304

Back support

$50.00

L0625

Sammons Preston

C55984305

Back Sppt (Waist to Hip)

$50.00

L0625

Sammons Preston

C55984305

Back support

$50.00

L0625

Sammons Preston

C55984306

Back Sppt (Waist to Hip)

$50.00

L0625

Top Shelf

501922

Ankle Stabilizer

$26.25

L1906

Top Shelf

502023

Arm Sling w/ Padded Strap

$15.00

L3660

Top Shelf

502024

Arm Sling w/ Padded Strap

$15.00

L3660

Top Shelf

502025

Arm Sling w/ Padded Strap

$15.00

L3660

Top Shelf

502026

Arm Sling w/ Padded Strap

$15.00

L3660

Top Shelf

502054

Stable Sling

$77.50

L3670

Top Shelf

502055

Stable Sling

$77.50

L3670

Top Shelf

502070

Stable Sling

$77.50

L3670

Top Shelf

502504

Low-Profile Cast Shoe

$15.00

L3260

Top Shelf

502602

Walk on Walker,Short

$47.50

L4386

Top Shelf

502603

Walk on Walker,Short

$47.50

L4386

Top Shelf

502604

Walk on Walker,Short

$47.50

L4386

Top Shelf

502605

Walk on Walker,Short

$47.50

L4386

Top Shelf

502606

Walk on Walker,Short

$47.50

L4386

Top Shelf

502612

Walk on Walker,Tall

$48.75

L4386

Top Shelf

502613

Walk on Walker,Tall

$48.75

L4386

Top Shelf

502614

Walk on Walker,Tall

$48.75

L4386

Top Shelf

502615

Walk on Walker,Tall

$48.75

L4386

Top Shelf

502616

Walk on Walker,Tall

$48.75

L4386

Top Shelf

505202

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505203

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505204

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505205

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505206

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505212

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505213

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505214

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505215

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505216

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505217

Lateral Patella Stabilizer,Kewl Mesh

$60.00

L1800+L2795

Top Shelf

505393

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

Top Shelf

505394

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

Top Shelf

505395

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

Top Shelf

505396

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

Top Shelf

505397

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

Top Shelf

505398

Hinged Knee Plus,Wrprnd,w/ Open Pop,Kewl Mesh

$150.00

L1832

 

 

 

EPIC Index