ESBD_531522_1782404648228_Exhibit_G_FY27_Product-Price_List.xlsx
XLSX spreadsheet 22 KB Posted
- Attached to
- Orthotic Equipment and Services for Mexia SSLC
- Solicitation number
- HHS0017599
- Issued by
- Lampasas County, Texas
About this file
This is a Product-Price List exhibit for orthotic equipment and services provided by Mexia State Supported Living Center (SSLC) in Texas for fiscal year 2027. The document outlines pricing for a comprehensive range of orthotic and prosthetic devices and services, including repair of orthotic devices with labor components. The product categories include foot inserts and supports (HCPCS codes L3010-L5000), orthopedic footwear for men and women, ankle and foot orthoses, knee orthoses, custom diabetic shoes and inserts, and compression stockings. Services encompass fitting and follow-up care for custom-made orthotic devices. The pricing sheet identifies specific HCPCS codes for each product or service, along with units of measure (each, inch, or pair) and corresponding descriptions that detail material specifications, construction methods, and functional features.
The document presents a detailed pricing structure for Jobst Compression Hose offerings, categorized by stocking type (knee-high, knee-high with silicone band, thigh-high, and thigh-high with silicone band), compression levels (15-20 mmHg, 20-30 mmHg, and 30-40 mmHg), color options (beige and black with closed toe, and beige with open toe), and available sizes (S, M, L, XL). While specific pricing amounts are not visible in the provided content, the structure indicates a tiered pricing approach based on product complexity, customization level, compression specifications, and design variations. The document serves as the vendor's standardized pricing schedule for orthotic and prosthetic services to support the medical and rehabilitative needs of Mexia SSLC residents.
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Text version
Sheet1
| Product/Price Sheet | |
| Mexia SSLC - FY27 |
| Labor | Price Per Hour |
| REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT |
| HCPCS | UOM | DESCRIPTION | PRICE |
| L3010 | each | Foot, insert, removable, molded to patient model, longitudinal arch support | |
| L3020 | each | Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support | |
| L3030 | each | Foot, insert, removable | |
| L3310 | inch | Lift, elevation, heel and sole, neoprene | |
| L3332 | each | Lift, elevation, inside shoe, tapered, up to one-half inch | |
| L3216 | each | Orthopedic footwear, ladies shoe, depth inlay | |
| L3221 | each | Orthopedic footwear, men’s shoe, depth inlay | |
| L3300 | inch | Lift, elevation, heel, tapered to metatarsals | |
| L3230 | each | Custom shoe, orthopedic footwear, depth inlay | |
| L2360 | each | Addition to lower extremity, extended steel shank | |
| L5000 | each | Partial foot, shoe insert with longitudinal arch, toe filler | |
| L3580 | each | Orthopedic shoe addition, convert instep to velcro closure | |
| L1930 | each | Ankle foot orthosis, plastic or other material | |
| L1940 | each | Ankle foot orthosis, plastic or other material | |
| L1960 | each | Ankle foot orthosis, posterior solid ankle, plastic | |
| L1970 | each | Foot orthosis, plastic with ankle joint | |
| L1820 | each | Knee orthosis, elastic with condylar pads and joints, with or without patellar control | |
| Pair | Ankle socks | ||
| Pair | Crew socks | ||
| Pair | Over the calf socks |
| For Diabetics only - Custom Made for Patients | ||
| Fitting and Follow up fitting must be included | ||
| A5500 | each | Custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi- density insert(s), |
| A5501 | each | Custom preparation and supply of shoe molded from cast(s) of patients foot (custom molded shoe), |
| A5512 | each | Multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, |
| A5513 | each | Multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher, includes arch filler and other shaping material, custom fabricated |
| A5503 | each | Modification of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom |
Prosthetics & Orthotics
| Jobst Compression Hose | |
| HCPCS | DESCRIPTION |
| A6530 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 15-20 MMHG |
| A6531 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 20-30 MMHG |
| A6532 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG |
| A6533 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 15-20 MMHG |
| A6534 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 20-30 MMHG |
| A6535 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG |
| Beige w/ closed toe (sizes available) | |||
| Price Per Pair | Price Per Pair | Price per Pair | |
| 15-20 mmHg | 20-30 mmHg | 30-40 mmHg | |
| Knee High (S, M, L, XL) | |||
| Knee High w/ silicone band (M, L, XL) | n/a | ||
| Thigh High (S, M, L, XL) | n/a | ||
| Thigh high w/ silicone band (S, M, L, XL) |
| Black w/ closed toe (sizes available) | |||
| Price Per Pair | Price Per Pair | Price per Pair | |
| 15-20 mmHg | 20-30 mmHg | 30-40 mmHg | |
| Knee High (S, M, L, XL) | |||
| Knee High w/ silicone band (M, L, XL) | n/a | ||
| Thigh High (S, M, L, XL) | n/a | ||
| Thigh high w/ silicone band (S, M, L, XL) |
| Beige w/ Open toe (sizes available) | |||
| Price Per Pair | Price Per Pair | Price per Pair | |
| 15-20 mmHg | 20-30 mmHg | 30-40 mmHg | |
| Knee High (S, M, L, XL) | |||
| Knee High w/ silicone band (M, L, XL) | n/a | ||
| Thigh High (S, M, L, XL) | |||
| Thigh high w/ silicone band (S, M, L, XL) |
File details come from the government source that posted it. Updated .