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 |