ESBD_548801_1786654095643_Exhibit_G_FY27_Product-Price_List.xlsx
XLSX spreadsheet 22 KB Posted
- Attached to
- Orthotic Equipment and Services for Mexia SSLC
- Solicitation number
- HHS0017599V3
- Issued by
- Texas
About this file
This is a Product-Price List exhibit for orthotic equipment and services to be provided by Mexia SSLC for the State of Texas during fiscal year 2027. The document outlines pricing for a comprehensive range of orthotic devices and prosthetic services, including foot inserts, orthopedic footwear, ankle-foot orthoses, knee orthoses, compression hosiery, and diabetic-specific custom footwear solutions. The product list encompasses multiple HCPCS coded items with detailed descriptions of specifications such as material composition, dimensions, and functional features. Services include custom shoe modifications, fittings, and follow-up care as required for diabetic patients.
The pricing structure is organized by product category and unit of measure, with compression hose offerings specified by compression level (15-20 mmHg, 20-30 mmHg, and 30-40 mmHg), style (knee high, thigh high, with or without silicone band), color (beige or black), and toe configuration (closed or open). Specific pricing amounts are referenced but not populated in the exhibit, indicating this document serves as a template for the bidder's cost submission. The contract scope includes both off-the-shelf modifications and custom-fabricated prosthetic and orthotic solutions, with particular emphasis on diabetic-specific products manufactured to accommodate multi-density inserts and total contact requirements.
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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 .