🔧 TEST VERSION • This is a preview of upcoming features
V2710 Prosthetics & Orthotics 53 States

Slab off prism, glass or plastic, per lens

Short Desc Glass/plastic slab off prism
Coverage determined by local carrier discretion.
Added Date
1985-01-01
Effective From
2003-10-01
National Floor
$78.50
National Ceiling
$104.66

Fee Schedule Rates

Effective Jan 2026

Official Medicare DMEPOS pricing for 2026.

State Modifier Non-Rural Rural
AK
Base Rate
$107.53
Same
AL
Base Rate
$78.50
Same
AR
Base Rate
$97.39
Same
AZ
Base Rate
$99.11
Same
CA
Base Rate
$99.11
Same
CO
Base Rate
$94.65
Same
CT
Base Rate
$78.50
Same
DC
Base Rate
$92.08
Same
DE
Base Rate
$92.08
Same
FL
Base Rate
$78.50
Same
GA
Base Rate
$78.50
Same
HI
Base Rate
$114.97
Same
IA
Base Rate
$92.66
Same
ID
Base Rate
$78.50
Same
IL
Base Rate
$89.99
Same
IN
Base Rate
$89.99
Same
KS
Base Rate
$92.66
Same
KY
Base Rate
$78.50
Same
LA
Base Rate
$97.39
Same
MA
Base Rate
$78.50
Same
MD
Base Rate
$92.08
Same
ME
Base Rate
$78.50
Same
MI
Base Rate
$89.99
Same
MN
Base Rate
$89.99
Same
MO
Base Rate
$92.66
Same
MS
Base Rate
$78.50
Same
MT
Base Rate
$94.65
Same
NC
Base Rate
$78.50
Same
ND
Base Rate
$94.65
Same
NE
Base Rate
$92.66
Same
NH
Base Rate
$78.50
Same
NJ
Base Rate
$104.66
Same
NM
Base Rate
$97.39
Same
NV
Base Rate
$99.11
Same
NY
Base Rate
$104.66
Same
OH
Base Rate
$89.99
Same
OK
Base Rate
$97.39
Same
OR
Base Rate
$78.50
Same
PA
Base Rate
$92.08
Same
PR
Base Rate
$154.85
Same
RI
Base Rate
$78.50
Same
SC
Base Rate
$78.50
Same
SD
Base Rate
$94.65
Same
TN
Base Rate
$78.50
Same
TX
Base Rate
$97.39
Same
UT
Base Rate
$94.65
Same
VA
Base Rate
$92.08
Same
VI
Base Rate
$104.66
Same
VT
Base Rate
$78.50
Same
WA
Base Rate
$78.50
Same
WI
Base Rate
$89.99
Same
WV
Base Rate
$92.08
Same
WY
Base Rate
$94.65
Same