Wyoming Administrative Code › Agency 053 - Workforce Services, Department of › Sub-Agency 0020 - Workers' Compensation Commission › Appendix C

Current through July 13, 2024
Unit Values for "L" Codes for Orthotic and Prosthetic Devices
				Vendors should charge only the usual and customary fee charged the general
				public for the same or similar services The following units are the maximum
				fees and will only be allowed when the services rendered warrant it.
CODE UNIT
CODE UNIT
CODE UNIT
L 0100 9.5
L 0110 2.5
L 0120 1.0
L 0130 2.7
L 0140 1.0
L 0150 2.0
L 0160 2.6
L 0170 11.0
L 0172 2.1
L 0174 4.5
L 0180 6.0
L 0190 8.0
L 0200 8.0
L 0210 0.9
L 0220 2.8
L 0300 3.0
L 0310 5.0
L 0315 5.0
L 0317 6.0
L 0320 6.0
L 0330 7.5
L 0340 11.0
L 0350 16.0
L 0360 23.0
L 0370 7.0
L 0380 10.0
L 0390 25.0
L 0400 28.0
L 0410 30.0
L 0420 31.0
L 0430 22.0
L 0440 19.0
L 0500 2.5
L 0510 4.5
L 0515 3.5
L 0520 6.5
L 0530 7.5
L 0540 7.5
L 0550 22.0
L 0560 24.0
L 0565 19.0
L 0600 2.0
L 0610 4.0
L 0620 7.0
L 0700 30.0
L 0710 34.0
L 0810 40.00
L 0820 35.00
L 0830 51.00
L 0860 22.00
L 0900 2.7
L 0910 5.7
L 0920 2,8
L 0930 6.0
L 0940 2.5
L 0950 5.5
L 0960 1.0
L 0970 2.0
L 0972 2.0
L 0974 3.5
L 0976 3.0
L 0978 3.0
L 0980 0.3
L 0982 0.3
L 0984 1.7
L 1000 33.0
L 1010 1.0
L 1020 1.5
L 1025 2.0
L 1030 1.0
L 1040 1.5
L 1050 1.5
L 1060 1.5
L 1070 1.5
L 1080 1.0
L 1085 2.5
L 1090 1.5
L 1100 2.7
L 1110 4.0
L 1120 1.0
L 1200 27.0
L 1210 4.0
L 1220 3.7
L 1230 10.0
L 1240 1.4
L 1250 1.0
L 1260 1.4
L 1270 1.4
L 1280 1.4
L 1290 1.4
L 1300 30.0
L 1310 29.0
L 1500 32.0
L 1510 20.0
L 1520 40.0
L 1600 2.0
L 1610 1.0
L 1620 2.0
L 1630 2.8
L 1640 8.0
L 1650 4.0
L 1660 3.0
L 1680 20.0
L 1685 20.0
L 1686 14.0
L 1800 1.0
L 1810 1.5
L 1815 2.0
L 1820 2.0
L 1825 1.0
L 1830 2.0
L 1832 10.0
L 1834 12.0
L 1840 15.0
L 1843 8.5
L 1844 26.0
L 1845 13.0
L 1846 17.0
L 1850 5.0
L 1855 17.0
L 1858 19.0
L 1860 17.0
L 1870 17.0
L 1880 11.5
L 1885 17.0
L 1900 4.5
L 1902 1.4
L 1904 7.5
L 1906 2.0
L 1910 4.0
L 1920 5.7
L 1930 4.0
L 1940 10.0
L 1945 15.0
L 1950 12.0
L 1960 10.0
L 1970 12.0
L 1980 6.0
L 1990 10.0
L 2000 24.0
L 2010 23.5
L 2020 27.0
L 2030 26.0
L 2035 3.0
L 2036 30.0
L 2037 25.0
L 2038 22.0
L 2039 35.0
L 2102 8.0
L 2104 8.0
L 2106 12.0
L 2108 17.0
L 2112 7.0
L 2114 9.0
L 2116 11.0
L 2122 12.0
L 2124 14.0
L 2126 19.0
L 2128 28.0
L 2132 15.0
L 2134 15.0
L 2136 19.0
L 2180 2.0
L 2182 1.5
L 2184 2.0
L 2186 2.5
L 2188 5.0
L 2190 1.5
L 2192 5.5
L 2200 1.0
L 2210 1.0
L 2220 1.5
L 2230 1.5
L 2240 1.5
L 2250 6.0
L 2260 3.0
L 2265 2.0
L 2270 1.0
L 2275 2.0
L 2280 7.0
L 2300 4.0
L 2310 2.0
L 2320 3.5
L 2330 6.5
L 2335 4.0
L 2340 7.0
L 2350 16.0
L 2360 1.0
L 2370 2.0
L 2375 2.0
L 2380 2.0
L 2385 2.5
L 2390 2.0
L 2395 2.5
L 2397 2.0
L 2405 0.75
L 2415 3.0
L 2425 3.0
L 2430 1.5
L 2435 3.0
L 2492 2.0
L 2500 5.0
L 2510 11.0
L 2520 7.5
L 2525 20.0
L 2526 12.0
L 2530 4.5
L 2540 7.5
L 2550 5.0
L 2570 7.0
L 2580 8.0
L 2600 3.5
L 2610 4.0
L 2620 4.0
L 2622 5.0
L 2624 5.0
L 2627 32.0
L 2628 32.0
L 2630 4.0
L 2640 5.0
L 2650 2.0
L 2660 3.5
L 2670 3.0
L 2680 3.0
L 2750 1.5
L 2755 2.0
L 2760 1.0
L 2770 1.0
L 2780 1.0
L 2785 0.5
L 2795 1.5
L 2800 2.0
L 2810 1.5
L 2820 2.0
L 2830 2.0
L 2840 1.0
L 2850 1.0
L 3000 2.0
L 3001 1.0
L 3002 1.0
L 3003 1.5
L 3010 2.0
L 3020 2.0
L 3030 1.0
L 3040 1.0
L 3050 1.0
L 3060 1.0
L 3070 0.2
L 3080 0.2
L 3090 0.3
L 3100 0.3
L 3140 NA
L 3150 NA
L 3170 0.2
L 3201 COST PLUS 30%
L 3202 COST PLUS 30%
L 3224 1.0
L 3225 1.0
L 3265 COST PLUS 30%
L 3300 0.3
L 3310 0.5
L 3320 1.0
L 3330 8.5
L 3332 1.0
L 3334 0.2
L 3340 2.5
L 3350 0.3
L 3360 0.3
L 3370 0.3
L 3380 0.5
L 3390 0.5
L 3400 1.0
L 3410 1.0
L 3420 1.0
L 3430 BR
L 3440 BR
L 3450 BR
L 3455 0.3
L 3460 0.3
L 3465 0.3
L 3470 BR
L 3480 0.5
L 3485 1.0
L 3500 0.2
L 3510 0.3
L 3520 0.3
L 3530 0.3
L 3540 0.5
L 3550 BR
L 3560 0.2
L 3570 0.5
L 3580 0.5
L 3590 BR
L 3595 BR
L 3600 1.5
L 3610 3.0
L 3620 2.0
L 3630 2.5
L 3640 BR
L 3649 BR
L 3650 1.0
L 3660 2.0
L 3670 2.0
L 3700 1.0
L 3710 2.0
L 3720 11.0
L 3730 15.0
L 3740 17.0
L 3800 3.5
L 3805 6.0
L 3810 1.0
L 3815 1.0
L 3820 2.0
L 3825 1.0
L 3830 1.5
L 3835 1.5
L 3840 1.0
L 3845 1.5
L 3850 2.0
L 3855 2.0
L 3860 3.0
L 3900 22.0
L 3901 30.0
L 3902 44.0
L 3904 52.0
L 3906 6.0
L 3907 8.0
L 3908 1.0
L 3910 6.0
L 3912 1.5
L 3914 1.5
L 3916 2.0
L 3918 1.5
L 3920 2.0
L 3922 2.0
L 3924 2.0
L 3926 2.0
L 3928 1.0
L 3930 1.0
L 3932 1.0
L 3934 1.0
L 3936 1.5
L 3938 1.5
L 3940 2.0
L 3942 1.5
L 3944 1.5
L 3946 1.5
L 3948 1.0
L 3950 2.5
L 3952 3.0
L 3954 2.0
L 3956 0
L 3960 12.0
L 3962 12.0
L 3963 28.0
L 3964 11.0
L 3965 18.0
L 3966 14.0
L 3968 17.0
L 3969 13.0
L 3970 5.0
L 3972 3.0
L 3974 3.0
L 3980 5.0
L 3982 6.0
L 3984 6.0
L 3985 10.0
L 3986 10.0
L 3995 0.5
L 3999 BR
L 4000 25.0
L 4010 12.0
L 4020 15.0
L 4030 9.0
L 4040 7.0
L 4045 6.0
L 4050 7.0
L 4055 5.0
L 4060 6.0
L 4070 5.0
L 4080 2.0
L 4090 2.0
L 4100 2.0
L 4110 1.5
L 4130 9.0
L 4310 7.0
L 4320 2.0
L 4350 1.5
L 4360 5.0
L 4370 3.5
L 4380 2.0
L 4390 3.0
L 4392 .5
L 4394 .5
L 4396 3.0
L 4398 1.5
L 5000 10.0
L 5010 22.0
L 5020 39.0
L 5050 44.0
L 5060 54.0
L 5100 44.0
L 5105 68.0
L 5150 68.0
L 5160 74.0
L 5200 65.0
L 5210 48.0
L 5220 54.0
L 5230 72.0
L 5250 100.0
L 5270 100.0
L 5280 100.0
L 5300 50.0
L 5310 80.0
L 5320 82.0
L 5330 116.0
L 5340 124.0
L 5400 12.0
L 5410 8.0
L 5420 30.0
L 5430 10.0
L 5450 8.0
L 5460 10.0
L 5500 28.0
L 5505 34.0
L 5510 29.0
L 5520 28.0
L 5530 30.0
L 5535 30.0
L 5540 36.0
L 5560 36.0
L 5570 40.0
L 5580 46.0
L 5585 50.0
L 5590 47.0
L 5595 70.0
L 5600 85.0
L 5610 41.0
L 5611 32.0
L 5613 48.0
L 5614 30.0
L 5616 27.0
L 5617 10.0
L 5618 5.0
L 5620 5.0
L 5622 7.0
L 5624 7.0
L 5626 9.0
L 5628 9.0
L 5629 5.5
L 5630 8.0
L 5631 8.0
L 5632 4.5
L 5634 6.0
L 5636 5.0
L 5637 6.0
L 5638 10.0
L 5639 23.0
L 5640 13.0
L 5642 13.0
L 5643 31.0
L 5644 12.0
L 5645 16.0
L 5646 11.0
L 5647 16.0
L 5648 13.0
L 5649 36.0
L 5650 10.0
L 5651 23.0
L 5652 9.0
L 5653 12.0
L 5654 6.0
L 5655 5.5
L 5656 7.0
L 5658 7.0
L 5660 11.0
L 5661 12.0
L 5662 10.0
L 5663 13.0
L 5664 13.0
L 5665 9.0
L 5666 1.2
L 5667 32.0
L 5668 2.0
L 5669 20.0
L 5670 5.5
L 5672 6.0
L 5674 1.5
L 5675 1.5
L 5676 7.0
L 5677 10.0
L 5678 1.0
L 5680 6.0
L 5682 12.0
L 5684 1.0
L 5686 1.0
L 5688 1.0
L 5690 2.0
L 5692 2.5
L 5694 3.5
L 5695 3.0
L 5696 3.5
L 5697 1.5
L 5698 2.0
L 5699 4.0
L 5700 54.0
L 5701 64.0
L 5702 80.0
L 5704 10.0
L 5705 17.0
L 5706 16.0
L 5707 23.0
L 5710 7.0
L 5711 10.0
L 5712 8.5
L 5714 8.0
L 5716 15.0
L 5718 18.5
L 5722 18.0
L 5724 30.0
L 5726 34.0
L 5728 47.0
L 5780 20.0
L 5785 10.0
L 5790 14.0
L 5795 19.0
L 5810 9.0
L 5811 14.0
L 5812 11.0
L 5814 60.0
L 5816 17.0
L 5818 20.0
L 5822 31.0
L 5824 31.0
L 5828 51.0
L 5830 34.0
L 5840 65.0
L 5845 31.0
L 5846 88.0
L 5850 2.0
L 5855 6.5
L 5910 7.0
L 5920 11.0
L 5925 7.0
L 5930 56.0
L 5940 10.0
L 5950 14.0
L 5960 16.0
L 5962 12.0
L 5964 18.0
L 5966 22.0
L 5970 4.0
L 5972 7.0
L 5974 5.0
L 5976 11.0
L 5978 6.0
L 5979 45.0
L 5980 74.0
L 5981 50.0
L 5982 11.5
L 5984 11.5
L 5985 5.0
L 5986 13.0
L 5987 110.0
L 5999 BR
L 6000 26.0
L 6010 30.0
L 6020 27.5
L 6050 34.0
L 6055 32.0
L 6100 34.0
L 6110 45.0
L 6120 49.0
L 6130 49.0
L 6200 49.0
L 6205 60.0
L 6250 47.0
L 6300 68.0
L 6310 48.0
L 6320 30.0
L 6350 71.0
L 6360 51.0
L 6370 34.0
L 6380 20.0
L 6382 26.0
L 6384 34.0
L 6386 8.0
L 6388 8.0
L 6400 46.0
L 6450 62.0
L 6500 60.5
L 6550 76.0
L 6570 82.0
L 6580 28.0
L 6582 28.0
L 6584 34.0
L 6586 36.0
L 6588 48.0
L 6590 47.0
L 6600 3.5
L 6605 3.5
L 6610 3.0
L 6615 3.5
L 6616 1.5
L 6620 6.0
L 6623 11.0
L 6625 9.0
L 6628 10.0
L 6629 3.0
L 6630 4.0
L 6632 1.5
L 6635 3.5
L 6637 7.0
L 6640 5.0
L 6641 3.0
L 6642 4.0
L 6645 6.0
L 6650 6.0
L 6655 1.5
L 6660 2.0
L 6665 1.0
L 6670 1.0
L 6672 3.5
L 6675 2.0
L 6676 2.5
L 6680 4.0
L 6682 5.0
L 6684 7.0
L 6686 11.0
L 6687 12.0
L 6688 9.0
L 6689 13.0
L 6690 13.0
L 6691 6.0
L 6692 11.0
L 6700 11.0
L 6705 6.0
L 6710 7.0
L 6715 7.0
L 6720 17.0
L 6725 8.0
L 6730 13.0
L 6735 6.0
L 6740 8.0
L 6745 7.5
L 6750 7.0
L 6755 7.0
L 6765 7.0
L 6770 7.0
L 6775 8.0
L 6780 8.0
L 6790 9.0
L 6795 22.0
L 6800 21.0
L 6805 6.0
L 6806 26.0
L 6807 24.0
L 6808 20.0
L 6809 7.0
L 6810 3.5
L 6825 19.0
L 6830 27.0
L 6835 24.0
L 6840 16.0
L 6845 14.0
L 6850 13.0
L 6855 16.0
L 6860 14.0
L 6865 6.0
L 6867 18.0
L 6868 5.0
L 6870 5.0
L 6872 18.0
L 6973 9.0
L 6875 13.5
L 6880 10.0
L 6890 3.0
L 6895 10.0
L 6900 27.0
L 6905 27.0
L 6910 26.0
L 6915 11.0
L 6920 126.0
L 6925 137.0
L 6930 127.0
L 6935 140.0
L 6940 174.0
L 6945 220.0
L 6950 198.0
L 6955 238.0
L 6960 240.0
L 6965 265.0
L 6970 271.0
L 6975 284.0
L 7010 63.0
L 7015 100.0
L 7020 60.0
L 7025 60.0
L 7030 100.0
L 7035 61.0
L 7040 48.0
L 7045 27.0
L 7160 198.5
L 7165 243.0
L 7170 96.0
L 7180 560.0
L 7185 100.0
L 7186 172.0
L 7190 130.0
L 7260 36.0
L 7261 68.0
L 7266 17.0
L 7272 37.0
L 7274 106.0
L 7360 4.0
L 7362 5.0
L 7364 8.0
L 7366 9.0
L 8300 1.5
L 8310 3.0
L 8320 1.0
L 8330 1.0
L 8400 0.4
L 8410 0.4
L 8415 0.5
L 8417 1.5
L 8420 0.5
L 8430 0.5
L 8435 0.5
L 8440 1.0
L 8460 1.0
L 8465 1.0
L 8470 0.2
L 8480 0.2
L 8485 0.2
L 8490 2.5
L 8500 12.0
L 8501 2.0
L 8610 12.0
L 8612 12.0
L 8613 5.0