Finger/Thumb Splint. Finger Cots. Frog Splints. Finger Protectors. Curved Finger Splints

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1 Ossur Custom Price List Sorted by catalog page, includes: part #, description, catalog page #, unit of measure (UOM), list price, customer price, suggested HCPCS* and CMS fee for Q by state fee**. *The responsibility for accurate coding lies solely with the provider treating the patient. Ossur assumes no responsibility or liability for the provider's coding decision. Ossur's coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. **CMS Fee 2012 may be subject to change. Please check with your CMS governing jursidiction for the most up to date fees. Customer Name To place an order contact... Questions? Concerns? Contact... Address 1, Address2 TM NAME TM NAME City, State Zip Territory Manager Territory Manager **CMS Fee for 2013 for the T. (888) C. (111) C. (111) state of: NA F. (888) F. (222) F. (222) Ossur Account#: XXXXXX % Off List: 0% Finger/Thumb Splint Finger/Thumb Splint SML, 6Pk 66 6/PK $31.50 $31.50 Q4049 #N/A Finger/Thumb Splint MED, 6Pk 66 6/PK $31.50 $31.50 Q4049 #N/A Finger/Thumb Splint LRG, 6Pk 66 6/PK $31.50 $31.50 Q4049 #N/A Finger Cots Finger Cot Padded XSM, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Finger Cot Padded SML, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Finger Cot Padded MED, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Finger Cot Padded LRG, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Frog Splints Frog Splints Padded SML, 12Pk 66 12/PK $25.25 $25.25 Q4049 #N/A Frog Splints Padded MED, 12Pk 66 12/PK $25.25 $25.25 Q4049 #N/A Frog Splints Padded LRG, 12Pk 66 12/PK $25.25 $25.25 Q4049 #N/A Finger Protectors Finger Protectors Padded SML, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Finger Protectors Padded MED, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Finger Protectors Padded LRG, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Curved Finger Splints Curved Finger Splints Padded SML, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Curved Finger Splints Padded MED, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Curved Finger Splints Padded LRG, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A Curved Finger Splints Padded XLG, 12Pk 66 12/PK $21.00 $21.00 Q4049 #N/A

2 Stack Splints Stack Splints 1" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 2" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 3" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 4" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 5" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 5.5" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 6" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splints 7" 10Pk 66 10/PK $17.85 $17.85 Q4049 #N/A Stack Splint Kit Stack Splints Kit (5 each of size 1,2,3,4,5,6) 66 KIT $ $ Q4049 #N/A Aluminum Strips Aluminum Strips Padded SML, 12Pk 66 12/PK $22.00 $22.00 Q4049 #N/A Aluminum Strips Padded MED, 12Pk 66 12/PK $22.00 $22.00 Q4049 #N/A Aluminum Strips Padded LRG, 12Pk 66 12/PK $22.00 $22.00 Q4049 #N/A Oval-8 Finger Splints Kits W Oval-8 Finger Splint Kit (44 splints, size 2 thru 15) 66 KIT $ $ Q4049 #N/A W Oval-8 Finger Splint Pediatric Kit (3 ea splints, size 2 thru 7) 66 KIT $ $ Q4049 #N/A W Oval-8 Finger Splint Sizing Set 66 KIT $79.75 $79.75 Q4049 #N/A Single Slints W Oval-8 Finger Splint Size 2 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 3 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 4 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 5 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 6 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 7 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 8 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size 9 67 EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A W Oval-8 Finger Splint Size EA $16.80 $16.80 Q4049 #N/A 5-Packs W Oval-8 Finger Splint Size 2 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 3 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 4 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 5 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 6 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 7 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 8 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 9 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 10 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 11 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 12 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 13 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 14 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A W Oval-8 Finger Splint Size 15 5Pk 67 5/PK $47.25 $47.25 Q4049 #N/A

3 3PP Buddy Loops 1/2" Thick W Buddy Loops 1/2" 5Pk 67 5/PK $17.85 $17.85 Q4049 #N/A W Buddy Loops 1/2" 25Pk 67 25/PK $84.00 $84.00 Q4049 #N/A W Buddy Loops 1/2" 50Pk 67 50/PK $ $ Q4049 #N/A W Buddy Loops 1/2" 100Pk /PK $ $ Q4049 #N/A 1" Thick W Buddy Loops 1" 5Pk 67 5/PK $17.85 $17.85 Q4049 #N/A W Buddy Loops 1" 25Pk 67 25/PK $84.00 $84.00 Q4049 #N/A W Buddy Loops 1" 50Pk 67 50/PK $ $ Q4049 #N/A W Buddy Loops 1" 100Pk /PK $ $ Q4049 #N/A Cold Rush Cold Therapy Cold Rush Unit B Cold Rush Device 85 EA $ $ E0218 #N/A Cold Rush Pads B Cold Rush Knee Pad 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Hip Pad Left 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Hip Pad Right 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Shoulder Pad Small 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Shoulder Pad Large 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Universal Pad 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Rectangular Pad Sml 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Lumbar Pad 85 EA $42.00 $42.00 N/A #N/A B Cold Rush Ankle Pad 85 EA $42.00 $42.00 N/A #N/A Push-Button Crutches Case (8 pairs) R80334CS Push-Button Crutches, Case, Tall Adult 95 EA $ $ E0114 #N/A R80335CS Push-Button Crutches, Case, Medium Adult 95 EA $ $ E0114 #N/A R80336CS Push-Button Crutches, Case, Youth 95 EA $ $ E0114 #N/A R80337CS Push-Button Crutches, Case, Child Adult 95 EA $ $ E0114 #N/A Pair R80334PR Push-Button Crutches, Pair, Tall Adult 95 EA $16.00 $16.00 E0114 #N/A R80335PR Push-Button Crutches, Pair, Medium Adult 95 EA $16.00 $16.00 E0114 #N/A R80336PR Push-Button Crutches, Pair, Youth 95 EA $16.00 $16.00 E0114 #N/A R80337PR Push-Button Crutches, Pair, Child Adult 95 EA $16.00 $16.00 E0114 #N/A Adjustable Aluminum Canes MDS86420 Adjustable Aluminum Cane, EACH 95 EA $13.75 $13.75 E0100 #N/A MDS86420-CS Adjustable Aluminum Cane, 6 PACK 95 EA $80.00 $80.00 E0100 #N/A

4 Cast Padding Synthetic V Cast Padding, Synthetic, 2", 12 Rolls 96 12/Rolls $18.00 $18.00 n/a #N/A V Cast Padding, Synthetic, 3", 12 Rolls 96 12/Rolls $27.00 $27.00 n/a #N/A V Cast Padding, Synthetic, 4", 12 Rolls 96 12/Rolls $34.00 $34.00 n/a #N/A V Cast Padding, Synthetic, 6", 6 Rolls 96 6/Rolls $25.00 $25.00 n/a #N/A Cotton V Cast Padding, Cotton 2", 12 Rolls 96 12/Rolls $22.00 $22.00 n/a #N/A V Cast Padding, Cotton 3", 12 Rolls 96 12/Rolls $25.00 $25.00 n/a #N/A V Cast Padding, Cotton 4", 12 Rolls 96 12/Rolls $27.00 $27.00 n/a #N/A V Cast Padding, Cotton 6", 6 Rolls 96 6/Rolls $22.00 $22.00 n/a #N/A Stockinette Synthetic 2101 Stockinette, Synthetic, 1" 96 EA $14.70 $14.70 n/a #N/A 2102 Stockinette, Synthetic, 2" 96 EA $14.70 $14.70 n/a #N/A 2103 Stockinette, Synthetic, 3" 96 EA $20.00 $20.00 n/a #N/A 2104 Stockinette, Synthetic, 4" 96 EA $24.00 $24.00 n/a #N/A 2106 Stockinette, Synthetic, 6" 96 EA $33.00 $33.00 n/a #N/A Cotton 2000A Stockinette, Cotton 1" 96 EA $14.70 $14.70 n/a #N/A 2001 Stockinette, Cotton 2" 96 EA $14.70 $14.70 n/a #N/A 2002 Stockinette, Cotton 3" 96 EA $17.00 $17.00 n/a #N/A 2003 Stockinette, Cotton 4" 96 EA $19.00 $19.00 n/a #N/A 2005 Stockinette, Cotton 6" 96 EA $40.00 $40.00 n/a #N/A Elastic Bandage (no photo) Metal Tab 2020 Elastic Bandage, Metal Tab, 2" 96 10/EA $30.00 $30.00 n/a #N/A 2021 Elastic Bandage, Metal Tab, 3" 96 10/EA $30.00 $30.00 n/a #N/A 2022 Elastic Bandage, Metal Tab, 4" 96 10/EA $30.00 $30.00 n/a #N/A 2023 Elastic Bandage, Metal Tab, 6" 96 10/EA $30.00 $30.00 n/a #N/A Velcro C5920 Elastic Bandage, Velcro, 2" 96 10/EA $30.00 $30.00 n/a #N/A C5930 Elastic Bandage, Velcro, 3" 96 10/EA $30.00 $30.00 n/a #N/A C5940 Elastic Bandage, Velcro, 4" 96 10/EA $30.00 $30.00 n/a #N/A C5960 Elastic Bandage, Velcro, 6" 96 10/EA $30.00 $30.00 n/a #N/A Unna Boot Unna Boot, 3" x 10yds 96 EA $14.00 $14.00 n/a #N/A Unna Boot, 4" x 10yds 96 EA $14.00 $14.00 n/a #N/A Plaster X Fast Plaster Rolls 2220 X Fast Plaster Rolls, 2" x 3yds 96 12/EA $24.00 $24.00 n/a #N/A 2221 X Fast Plaster Rolls, 3" x 3yds 96 12/EA $28.00 $28.00 n/a #N/A 2226 X Fast Plaster Rolls, 3" x 5yds 96 12/EA $37.00 $37.00 n/a #N/A 2222 X Fast Plaster Rolls, 4" x 5yds 96 12/EA $38.00 $38.00 n/a #N/A 2223 X Fast Plaster Rolls, 5" x 5yds 96 12/EA $45.00 $45.00 n/a #N/A 2224 X Fast Plaster Rolls, 6" x 5yds 96 12/EA $50.00 $50.00 n/a #N/A 2226 X Fast Plaster Rolls, 8" x 5yds 96 12/EA $37.00 $37.00 n/a #N/A X Fast Plaster Splints 2240 X Fast Plaster Splints, 3" x 15" 96 50/EA $20.00 $20.00 n/a #N/A 2241 X Fast Plaster Splints, 4" x 15" 96 50/EA $21.00 $21.00 n/a #N/A 2242 X Fast Plaster Splints, 5" x 30" 96 50/EA $35.00 $35.00 n/a #N/A

5 PREMIUM TechForm Premium Casting Tape White 154WH TechForm Premium Casting Tape, White, 1.5" 97 10/Rolls $31.00 $31.00 n/a #N/A 204WH TechForm Premium Casting Tape, White, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304WH TechForm Premium Casting Tape, White, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404WH TechForm Premium Casting Tape, White, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A 504WH TechForm Premium Casting Tape, White, 5" 97 10/Rolls $74.00 $74.00 n/a #N/A Black 204BK TechForm Premium Casting Tape, Black, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304BK TechForm Premium Casting Tape, Black, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404BK TechForm Premium Casting Tape, Black, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Orange 204OR TechForm Premium Casting Tape, Orange, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304OR TechForm Premium Casting Tape, Orange, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404OR TechForm Premium Casting Tape, Orange, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Red 204RD TechForm Premium Casting Tape, Red, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304RD TechForm Premium Casting Tape, Red, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404RD TechForm Premium Casting Tape, Red, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Pink 204PK TechForm Premium Casting Tape, Pink, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304PK TechForm Premium Casting Tape, Pink, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404PK TechForm Premium Casting Tape, Pink, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Hot Pink 204HP TechForm Premium Casting Tape, Hot Pink, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304HP TechForm Premium Casting Tape, Hot Pink, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404HP TechForm Premium Casting Tape, Hot Pink, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Light Blue 204LB TechForm Premium Casting Tape, Light Blue, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304LB TechForm Premium Casting Tape, Light Blue, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404LB TechForm Premium Casting Tape, Light Blue, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Dark Blue 204DB TechForm Premium Casting Tape, Dark Blue, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304DB TechForm Premium Casting Tape, Dark Blue, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404DB TechForm Premium Casting Tape, Dark Blue, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Purple 204PR TechForm Premium Casting Tape, Purple, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304PR TechForm Premium Casting Tape, Purple, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404PR TechForm Premium Casting Tape, Purple, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Green 204GN TechForm Premium Casting Tape, Green, 2" 97 10/Rolls $31.00 $31.00 n/a #N/A 304GN TechForm Premium Casting Tape, Green, 3" 97 10/Rolls $47.00 $47.00 n/a #N/A 404GN TechForm Premium Casting Tape, Green, 4" 97 10/Rolls $55.50 $55.50 n/a #N/A Rainbow (2 rolls each of: light blue, dark blue, hot pink, red & black) 204RB TechForm Premium Casting Tape, Rainbow, 2" 97 10/Rolls $40.00 $40.00 n/a #N/A 304RB TechForm Premium Casting Tape, Rainbow, 3" 97 10/Rolls $50.00 $50.00 n/a #N/A 404RB TechForm Premium Casting Tape, Rainbow, 4" 97 10/Rolls $58.00 $58.00 n/a #N/A

6 STANDARD TechForm Standard Casting Tape White 100WH TechForm Standard Casting Tape, White, 1.5" 97 10/Rolls $29.00 $29.00 n/a #N/A 200WH TechForm Standard Casting Tape, White, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300WH TechForm Standard Casting Tape, White, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400WH TechForm Standard Casting Tape, White, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A 500WH TechForm Standard Casting Tape, White, 5" 97 10/Rolls $70.00 $70.00 n/a #N/A Black 200BK TechForm Standard Casting Tape, Black, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300BK TechForm Standard Casting Tape, Black, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400BK TechForm Standard Casting Tape, Black, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Orange 200OR TechForm Standard Casting Tape, Orange, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300OR TechForm Standard Casting Tape, Orange, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400OR TechForm Standard Casting Tape, Orange, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Red 200RD TechForm Standard Casting Tape, Red, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300RD TechForm Standard Casting Tape, Red, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400RD TechForm Standard Casting Tape, Red, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Pink 200PK TechForm Standard Casting Tape, Pink, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300PK TechForm Standard Casting Tape, Pink, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400PK TechForm Standard Casting Tape, Pink, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Hot Pink 200HP TechForm Standard Casting Tape, Hot Pink, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300HP TechForm Standard Casting Tape, Hot Pink, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400HP TechForm Standard Casting Tape, Hot Pink, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Light Blue 200LB TechForm Standard Casting Tape, Light Blue, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300LB TechForm Standard Casting Tape, Light Blue, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400LB TechForm Standard Casting Tape, Light Blue, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Dark Blue 200DB TechForm Standard Casting Tape, Dark Blue, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300DB TechForm Standard Casting Tape, Dark Blue, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400DB TechForm Standard Casting Tape, Dark Blue, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Purple 200PR TechForm Standard Casting Tape, Purple, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300PR TechForm Standard Casting Tape, Purple, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400PR TechForm Standard Casting Tape, Purple, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Green 200GN TechForm Standard Casting Tape, Green, 2" 97 10/Rolls $29.00 $29.00 n/a #N/A 300GN TechForm Standard Casting Tape, Green, 3" 97 10/Rolls $45.00 $45.00 n/a #N/A 400GN TechForm Standard Casting Tape, Green, 4" 97 10/Rolls $53.00 $53.00 n/a #N/A Rainbow (2 rolls each of: light blue, dark blue, hot pink, red & black) 200RB TechForm Standard Casting Tape, Rainbow, 2" 97 10/Rolls $38.00 $38.00 n/a #N/A 300RB TechForm Standard Casting Tape, Rainbow, 3" 97 10/Rolls $54.00 $54.00 n/a #N/A 400RB TechForm Standard Casting Tape, Rainbow, 4" 97 10/Rolls $61.00 $61.00 n/a #N/A

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