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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Sheet1

Product/Price Sheet
Mexia SSLC - FY27
LaborPrice Per Hour
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT
HCPCSUOMDESCRIPTIONPRICE
L3010eachFoot, insert, removable, molded to patient model, longitudinal arch support
L3020eachFoot, insert, removable, molded to patient model, longitudinal/ metatarsal support
L3030eachFoot, insert, removable
L3310inchLift, elevation, heel and sole, neoprene
L3332eachLift, elevation, inside shoe, tapered, up to one-half inch
L3216eachOrthopedic footwear, ladies shoe, depth inlay
L3221eachOrthopedic footwear, men’s shoe, depth inlay
L3300inchLift, elevation, heel, tapered to metatarsals
L3230eachCustom shoe, orthopedic footwear, depth inlay
L2360eachAddition to lower extremity, extended steel shank
L5000eachPartial foot, shoe insert with longitudinal arch, toe filler
L3580eachOrthopedic shoe addition, convert instep to velcro closure
L1930eachAnkle foot orthosis, plastic or other material
L1940eachAnkle foot orthosis, plastic or other material
L1960eachAnkle foot orthosis, posterior solid ankle, plastic
L1970eachFoot orthosis, plastic with ankle joint
L1820eachKnee orthosis, elastic with condylar pads and joints, with or without patellar control
PairAnkle socks
PairCrew socks
PairOver the calf socks
For Diabetics only - Custom Made for Patients
Fitting and Follow up fitting must be included
A5500eachCustom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi- density insert(s),
A5501eachCustom preparation and supply of shoe molded from cast(s) of patients foot (custom molded shoe),
A5512eachMultiple 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,
A5513eachMultiple 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
A5503eachModification of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom

Prosthetics & Orthotics

Jobst Compression Hose
HCPCSDESCRIPTION
A6530GRADIENT COMPRESSION STOCKING, BELOW KNEE, 15-20 MMHG
A6531GRADIENT COMPRESSION STOCKING, BELOW KNEE, 20-30 MMHG
A6532GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG
A6533GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 15-20 MMHG
A6534GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 20-30 MMHG
A6535GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG
Beige w/ closed toe (sizes available)
Price Per PairPrice Per PairPrice per Pair
15-20 mmHg20-30 mmHg30-40 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 PairPrice Per PairPrice per Pair
15-20 mmHg20-30 mmHg30-40 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 PairPrice Per PairPrice per Pair
15-20 mmHg20-30 mmHg30-40 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 .