Package Name | Category | A1 | A2 | A3 | A4 | A5 | A6 | S1 | S2 |
---|---|---|---|---|---|---|---|---|---|
CM0821-I A : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 1 | PMR | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 |
CM0821-I B : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 2 | PMR | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 |
CM0821-I C : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 3 | PMR | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 |
CM0821-I D : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 1 | PMR | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 |
CM0821-I E : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 2 | PMR | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 |
CM0821-I F : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 3 | PMR | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 |
CM0821-I G : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 1 | PMR | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 |
CM0821-I H : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 2 | PMR | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 |
CM0821-I I : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 3 | PMR | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 |
CM0821-I J : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 1 | PMR | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 |
CM0821-I K : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 2 | PMR | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 |
CM0821-I L : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 3 | PMR | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 |
CM0821-II A : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 1 | PMR | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 | 25500 |
CM0821-II B : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 2 | PMR | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 | 62500 |
CM0821-II C : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSTIBIAL - MOBILITY GRADE 3 | PMR | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 |
CM0821-II D : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 1 | PMR | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 | 69000 |
CM0821-II E : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 2 | PMR | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 | 176500 |
CM0821-II F : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSFEMORAL - MOBILITY GRADE 3 | PMR | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 | 177000 |
CM0821-II G : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 1 | PMR | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 | 39000 |
CM0821-II H : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 2 | PMR | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 | 94500 |
CM0821-II I : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSRADIAL - MOBILITY GRADE 3 | PMR | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 | 183000 |
CM0821-II J : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 1 | PMR | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 | 74000 |
CM0821-II K : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 2 | PMR | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 | 79000 |
CM0821-II L : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (except fingers, toes and small joints) - TRANSHUMERAL - MOBILITY GRADE 3 | PMR | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 | 197000 |
CM0821-IV : AMPUTATION OF ANY SITE / ANY CAUSE WITH CUSTOM MADE PROSTHESIS (fingers, toes and small joints) | PMR | 50000 | 45000 | 40500 | 36450 | 32805 | 29525 | 50000 | 36450 |