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PRI_Materials_with_HCPCS

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					                                                                                                                                                                   Maximum
  HCPCS                                                                                                                                     MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                       Part Number(s)        Product Description                                                            Amount
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                               302433         Total Face Mask with Headgear                             $249.10
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1010868         ComfortFull 2 Mask Only, Size Small                       $237.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1010869         ComfortFull 2 Mask Only, Size Medium                      $237.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1010870         ComfortFull 2 Mask Only, Size Large                       $237.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1040568         ComfortGel Full mask without headgear, small              $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1040569         ComfortGel Full mask without headgear, medium             $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1040570         ComfortGel Full mask without headgear, large              $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1051032         ComfortGel Full mask duopack without headgear, small      $272.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1051033         ComfortGel Full mask duopack without headgear, medium     $272.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1051034         ComfortGel Full mask duopack without headgear, large      $272.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1052158         FullLife mask without headgear, small                     $242.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1052159         FullLife mask without headgear, medium                    $242.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1052160         FullLife mask without headgear, large                     $242.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1060801         FitLife total full-face mask, small                       $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1060802         FitLife total full-face mask, large                       $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1062003         ComfortGel Full mask without headgear, extra large        $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                              1062005         ComfortGel Full mask DuoPack, extra large                 $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION         1002854         ComfortGel Full mask DuoPack, small                       $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION         1002855         ComfortGel Full mask DuoPack, med                         $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION         1002856         ComfortGel Full mask DuoPack, large                       $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1004872         ComfortFull 2 Mask and Headgear, Size Medium              $249.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1004880         ComfortFull 2 Mask and Headgear, Size Small               $249.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1004950         ComfortFull 2 Mask and Headgear, Size Large               $249.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1040135         ComfortGel Full mask with premium headgear, small         $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1040136         ComfortGel Full mask with premium headgear, med           $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1040137         ComfortGel Full mask with premium headgear, large         $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1040138         ComfortGel Full premium headgear                           $44.95
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1047916         FullLife mask with headgear, small                        $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1047917         FullLife mask with headgear, medium                       $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1047918         FullLife mask with headgear, large                        $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1047919         FullLife mask FitPack with headgear                       $316.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1052149         FullLife mask DuoPack with headgear, small                $291.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1052153         FullLife mask DuoPack with headgear, medium               $291.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1052156         FullLife mask DuoPack with headgear, large                $291.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                             1062004         ComfortGel Full mask with premium headgear, extra large   $274.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                             1040798         ComfortGel Full cushion, small                             $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                             1040799         ComfortGel Full cushion, medium                            $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                             1040800         ComfortGel Full cushion, large                             $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                             1044861         ComfortGel Full cushion and SST flap, small               $106.88
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                             1044862         ComfortGel Full cushion and SST flap, medium              $106.88




                                                                                Page 1 of 70
                                                                                                                                                                                 Maximum
  HCPCS                                                                                                                                                   MSRP      Your Price     Bid
  Code(s)   HCPCS Code Description(s)                         Part Number(s)        Product Description                                                                           Amount
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1044863         ComfortGel Full cushion and SST flap, large                              $106.88
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1047922         FullLife cushion, small                                                   $84.00
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1047923         FullLife cushion, medium                                                  $84.00
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1047924         FullLife cushion, large                                                   $84.00
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1062030         ComfortGel Full cushion, extra large                                      $83.13
            CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031       REPLACEMENT ONLY, EACH                               1062032         ComfortGel Full cushion and SST flap, extra large                        $106.88
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1003656         Medium Replacement Cushion, 5 per pack                                   $232.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1003657         Small Replacement Cushion, 5 per pack                                    $232.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1003658         Small Replacement Cushion, Single                                         $46.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1003659         Medium Replacement Cushion, Single                                        $45.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1007935         ComfortSelect Cushion with Retaining Ring, Size Medium                    $57.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1007936         ComfortSelect Cushion with Retaining Ring, Size Small                     $57.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1007937         ComfortSelect Cushion with Retaining Ring, Size Small Wide                $57.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1009048         ComfortGel Cushion, Size Petite                                           $41.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1009049         ComfortGel Cushion, Size Small                                            $41.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1009050         ComfortGel Cushion, Size Medium                                           $41.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1009051         ComfortGel Cushion, Size Large                                            $41.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1020411         ComfortLite 2 Simple Cushion Pack, Size Large, 5 per pack                $309.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1020412         ComfortLite 2 Simple Cushion Pack, Size Medium, 5 per pack               $309.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1020413         ComfortLite 2 Simple Cushion Pack, Size Small, 5 per pack                $309.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1020414         ComfortLite 2 Simple Cushion Pack, Size Petite, 5 per pack               $309.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1021821         ComfortLite 2 Simple Cushion, Size Large, 1 per pack                      $60.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1021823         ComfortLite 2 Simple Cushion, Size Medium, 1 per pack                     $60.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1021830         ComfortLite 2 Simple Cushion, Size Small, 1 per pack                      $60.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1021835         ComfortLite 2 Simple Cushion, Size Petite, 1 per pack                     $60.80
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1031391         ComfortGel Cushion and Silicone Flap, Size Petite                         $47.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1031392         ComfortGel Cushion and Silicone Flap, Size Small                          $47.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1031403         ComfortGel Cushion and Silicone Flap, Size Medium                         $47.50
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1050090         P EASYLIFE CUSHION SET                                                    $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1050091         EasyLife cushion, small                                                   $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1050092         EasyLife cushion, med                                                     $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1050093         EasyLife cushion, med wide                                                $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1050094         EasyLife cushion, large                                                   $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070101         ComfortGel Blue cushion, large                                            $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070102         ComfortGel Blue cushion, medium                                           $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070103         ComfortGel Blue cushion, small                                            $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070104         ComfortGel Blue cushion, petite                                           $42.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070105         ComfortGel Blue cushion and flap, large                                   $48.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070106         ComfortGel Blue cushion and flap, medium                                  $48.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070107         ComfortGel Blue cushion and flap, small                                   $48.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1070108         ComfortGel Blue cushion and flap, petite                                  $48.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1071861         TrueBlue cushion and flap, petite                                         $45.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1071862         TrueBlue cushion and flap, small                                          $45.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1071863         TrueBlue cushion and flap, medium                                         $45.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1071864         TrueBlue cushion and flap, medium wide                                    $45.00
            CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032       REPLACEMENT ONLY, EACH                               1071865         TrueBlue cushion and flap, large                                          $45.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                               1020407         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 4, 5 per pack   $152.00




                                                                               Page 2 of 70
                                                                                                                                                                                  Maximum
  HCPCS                                                                                                                                                    MSRP      Your Price     Bid
  Code(s)   HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                           Amount
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1020408         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 5, 5 per pack   $152.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1020409         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 6, 5 per pack   $152.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1020930         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 3, 5 per pack   $152.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021802         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 1, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021806         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 2, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021807         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 3, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021815         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 4, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021816         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 5, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1021817         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 6, 1 per pack         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1030502         ComfortLite 2 Pillow Cushions, Size Petite, 1 per pack                    $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1030503         ComfortLite 2 Pillow Cushions, Size Small, 1 per pack                     $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1030504         ComfortLite 2 Pillow Cushions, Size Medium, 1 per pack                    $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1030505         ComfortLite 2 Pillow Cushions, Size Large, 1 per pack                     $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1036838         Petite OptiLife Pillow Replacement                                        $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1036839         Small OptiLife Pillow Replacement                                         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1036840         Medium OptiLife Pillow Replacement                                        $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1036841         Large OptiLife Pillow Replacement                                         $30.40
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1073332         GoLIfe Replacement cushion, petite                                        $42.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1073333         GoLife Replacement cushion, small                                         $42.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1073334         GoLife Replacement cushion, medium                                        $42.00
            PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033       REPLACEMENT ONLY, PAIR                                1073335         GoLife Replacement cushion, large                                         $42.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302180         Reusable Nasal Mask, Size Medium                                         $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302183         Reusable Nasal Mask, Size Medium Wide                                    $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302186         Reusable Nasal Mask, Size Medium Small                                   $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302187         Reusable Nasal Mask, Size Small                                          $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302188         Reusable Nasal Mask, Size Large                                          $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302218         Reusable Nasal Mask, Size Large Narrow                                   $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302219         Reusable Nasal Mask, Size Petite                                         $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                             302279         Reusable Nasal Mask, Size Small Child                                    $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002370         Profile Lite Mask Only, Size Medium Small                                $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002371         Profile Lite Mask Only, Size Medium                                      $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002372         Profile Lite Mask Only, Size Medium Wide                                 $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002373         Profile Lite Mask Only, Size Large                                       $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002374         Profile Lite Mask Only, Size Large Narrow                                $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002849         Profile Lite Mask Only, Size Petite                                      $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1002850         Profile Lite Mask Only, Size Small                                       $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1007932         ComfortSelect Mask Only, Size Medium                                     $167.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1007933         ComfortSelect Mask Only, Size Small                                      $167.00




                                                                                Page 3 of 70
                                                                                                                                                                                      Maximum
  HCPCS                                                                                                                                                        MSRP      Your Price     Bid
  Code(s)   HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                               Amount
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1007934         ComfortSelect Mask Only, Size Small Wide                                     $167.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1007965         Comfort Classic Mask Only, Size Medium                                       $139.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1007966         Comfort Classic Mask Only, Size Small                                        $139.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1010518         ComfortGel Mask Only, Size Petite                                            $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1010519         ComfortGel Mask Only, Size Small                                             $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1010640         ComfortGel Mask Only, Size Medium                                            $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1010641         ComfortGel Mask Only, Size Large                                             $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1018158         Medium Simplicity with Deluxe Softcap                                        $170.49
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1025120         ComfortLite 2 Mask Combo, Mask Only, Size S, M, L Simple Cushions            $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo, Mask Only, Size 4, 5 Direct Seal Cushion, S, M
A7034       HEAD STRAP                                            1025121         Simple Cushion                                                               $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 mask Combo, Mask Only, Size 5, 6 Direct Seal Cushion, M, L
A7034       HEAD STRAP                                            1025122         Simple Cushion                                                               $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1025123         ComfortLite 2 Mask Combo, Mask Only, Size 4, 5, 6 Direct Seal Cushions       $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1025127         ComfortLite 2 Mask Combo and Headgear, Size 4, 5, 6 Direct Seal Cushions     $209.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo, Mask Only, Size S, M Pillows and Simple
A7034       HEAD STRAP                                            1030496         Cushions                                                                     $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1030497         ComfortLite 2 Mask Combo, Mask Only, Size M, L Pillows and Simple Cushions   $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1030498         ComfortLite 2 Mask Combo, Mask Only, S, M, L Pillow Cushions                 $193.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1031406         Medium ComfortGel Mask Only with Small Gel Cushion and Silicone Flap         $200.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1036804         OptiLife Mask only with Petite, Small, Medium and Large Pillows              $204.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1040836         ComfortFusion without Headgear FitPack , Small & Medium                      $169.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1042205         ComfortFusion without Headgear, Small                                        $159.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1042206         ComfortFusion without Headgear, Medium                                       $159.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1050010         EasyLife without headgear, petite                                            $191.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1050011         EasyLife without headgear, small                                             $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1050012         EasyLife without headgear, med                                               $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1050013         EasyLife without headgear, med wide                                          $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1050014         EasyLife without headgear, large                                             $171.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1070041         ComfortGel Blue Mask without headgear, large                                 $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1070042         ComfortGel Blue Mask without headgear, medium                                $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1070043         ComfortGel Blue Mask without headgear, small                                 $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1070044         ComfortGel Blue Mask without headgear, petite                                $190.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                            1070053         ComfortGel Blue Fitpack, small and medium cushion                             $42.00




                                                                                Page 4 of 70
                                                                                                                                                                                  Maximum
  HCPCS                                                                                                                                                    MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                        Amount
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071806         TrueBlue Mask without headgear, petite                                $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071807         TrueBlue Mask without headgear, small                                 $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071808         TrueBlue Mask without headgear, medium                                $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071809         TrueBlue Mask without headgear, medium wide                           $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071810         TrueBlue Mask without headgear, large                                 $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071816         TrueBlue Mask Fitpack, small and medium                               $215.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071817         TrueBlue Mask Fitpack, medium wide and large                          $215.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                 1073329         GoLife Fitpack: mask only plus petite, small, medium, large cushion   $188.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                 1082578         GoLife For Women Mask only                                             $81.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                 1082579         GoLife For Women Fit pack – mask and cushions only                    $188.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070049         ComfortGel Blue Mask Duopack, large                                   $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070050         ComfortGel Blue Mask Duopack, medium                                  $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070051         ComfortGel Blue Mask Duopack, small                                   $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070052         ComfortGel Blue Mask Duopack, petite                                  $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071818         TrueBlue Mask Duopack, petite                                         $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071819         TrueBlue Mask Duopack, small                                          $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071820         TrueBlue Mask Duopack, medium                                         $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071821         TrueBlue Mask Duopack, medium wide                                    $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071822         TrueBlue Mask Duopack, large                                          $229.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1002757         Simplicity Mask and Headgear, Size Small                              $170.49

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1002759         Simplicity Mask and Headgear, Size Medium                             $170.49

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004086         Profile Lite Mask and Headgear, Size Petite                           $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004087         Profile Lite Mask and Headgear, Size Small                            $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004088         Profile Lite Mask and Headgear, Size Medium Small                     $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004089         Profile Lite Mask and Headgear, Size Medium                           $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004110         Profile Lite Mask and Headgear, Size Medium Wide                      $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004111         Profile Lite Mask and Headgear, Size Large                            $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1004112         Profile Lite Mask and Headgear, Size Large Narrow                     $195.00




                                                                                   Page 5 of 70
                                                                                                                                                                                         Maximum
  HCPCS                                                                                                                                                           MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                               Amount

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1007919         ComfortSelect Mask and Headgear, Size Medium                                 $179.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1007930         ComfortSelect Mask and Headgear, Size Small                                  $179.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1007931         ComfortSelect Mask and Headgear, Size Small Wide                             $179.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1007963         ComfortClassic Mask and Headgear, Size Small                                 $159.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1007964         ComfortClassic Mask and Headgear, Size Medium                                $159.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1009040         ComfortGel Mask and Headgear, Size Petite                                    $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1009041         ComfortGel Mask and Headgear, Size Small                                     $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1009042         ComfortGel Mask and Headgear, Size Medium                                    $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1009043         ComfortGel Mask and Headgear, Size Large                                     $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1018138         Small Simplicity with Deluxe Softcap                                         $170.49

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025111         ComfortLite 2 mask Combo and Headgear, Size S, M, L Simple Cushions          $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size 4, 5 Direct Seal Cushion, S, M
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025112         Simple Cushion                                                               $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size 5, 6 Direct Seal, M, L Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025113         Cushion                                                                      $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortSelect Mask and Headgear with Size Small, Medium and Small Wide
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1026880         Cushions with Retaining Rings                                                $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030493         ComfortLite 2 Mask Combo and Headgear, Size S, M, L Pillow Cushions          $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size S, M Pillows and Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030494         Cushions                                                                     $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size M, L Pillows and Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030495         Cushions                                                                     $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      Medium ComfortGel Mask and Headgear with Small Gel Cushion and Silicone
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1031405         Flap                                                                         $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035931         Medium ComfortGel with Headgear plus Medium Gel/Silicone Cushions            $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035932         Large ComfortGel with Headgear plus Large Gel/Silicone Cushions              $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035966         Small ComfortSelect with Headgear Plus Small Cushion                         $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035967         Medium ComfortSelect with Headgear Plus Medium Cushion                       $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035968         Small Wide ComfortSelect with Headgear Plus Small Wide Cushion               $189.00




                                                                                   Page 6 of 70
                                                                                                                                                                                      Maximum
  HCPCS                                                                                                                                                        MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                            Amount

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035999         Petite ComfortGel with Headgear plus Petite Gel/Silicone Cushions         $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1036000         Small ComfortGel with Headgear plus Small Gel/Silicone Cushions           $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1036800         OptiLife Mask with Headgear and Petite, Small, Medium and Large Pillows   $219.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1040768         ComfortFusion with Headgear FitPack , Small & Medium                      $184.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1040769         ComfortFusion with Headgear, Small                                        $174.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1040770         ComfortFusion with Headgear, Medium                                       $174.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050000         EasyLife nasal mask with headgear, petite                                 $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050001         EasyLife nasal mask with headgear, small                                  $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050002         EasyLife nasal mask with headgear, med                                    $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050003         EasyLife nasal mask with headgear, med wide                               $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050004         EasyLife nasal mask with headgear, large                                  $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050005         P/P EASYLIFE DUOPACK W/HGR                                                $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050006         EasyLife DuoPack with headgear, small                                     $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050007         EasyLife DuoPack with headgear, med                                       $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050008         EasyLife DuoPack with headgear, med wide                                  $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050009         EasyLife DuoPack with headgear, large                                     $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050078         EasyLife FitPack with headgear, S and M                                   $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050079         EasyLife FitPack with headgear, MW and L                                  $205.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1070037         ComfortGel Blue Mask with headgear, large                                 $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1070038         ComfortGel Blue Mask with headgear, medium                                $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1070039         ComfortGel Blue Mask with headgear, small                                 $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1070040         ComfortGel Blue Mask with headgear, petite                                $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071800         TrueBlue Mask with headgear, petite                                       $199.00




                                                                                   Page 7 of 70
                                                                                                                                                                         Maximum
  HCPCS                                                                                                                                           MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                               Amount

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071801         TrueBlue Mask with headgear, small                           $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071803         TrueBlue Mask with headgear,medium                           $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071804         TrueBlue Mask with headgear,medium wide                      $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071805         TrueBlue Mask with headgear, large                           $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1073336         GoLife for Men w/headgear                                     $38.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, E7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1073114         GoLife Fitpack: Mask with headgear                           $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, E7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1082577         GoLife For Women Fit pack mask with cushions and hdgr        $195.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302044         Reusable Headgear (Beige)                                     $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302142         Softcap, White Medium                                         $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302215         Softcap, White Large                                          $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302266         Softcap, White                                                $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302285         Bonnet B2                                                     $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302328         SimpleStrap Reusable Headgear                                 $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302439         Softcap, Blue Large                                           $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302441         Softcap, Blue Child                                           $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302442         Softcap, Blue Extra Large                                     $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302449         Softcap, White Extra Large                                    $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302458         Softcap, Blue Medium                                          $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302465         Mesh Softcap, Blue Child                                      $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 302466         Mesh Softcap, Blue Extra Large                                $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 452023         Small Convertible Headgear                                    $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 452027         Medium Convertible Headgear                                   $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 452029         Large Convertible Headgear                                    $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1002064         Mesh Softcap, Blue Medium                                     $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1002065         Mesh Softcap, Blue Large                                      $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1002764         Simplicity Headgear                                           $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1002800         Deluxe Headgear                                               $44.95
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1003052         Total Headgear                                                $43.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1006416         Deluxe Softcap                                                $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1014333         ComfortHeadgear                                               $50.83
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1018755         Small Deluxe Headgear                                         $44.94
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1025117         ComfortLite 2 Halo Headgear with Strap                        $47.50
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1025225         ComfortLite 2 Mask Sub-Assembly with Headgear, no cushions   $134.90
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1033678         Premium headgear, ComfortGel Blue                             $44.94
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1036818         OptiLife Subassembly with Headgear and Chin Support Band     $134.90
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1036850         OptiLife Headgear with Chin Support Band                      $47.50
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1047975         FullLife headgear system                                      $42.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1050095         EasyLife headgear                                             $38.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1060807         FitLife headgear, small                                       $39.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1060808         FitLife headgear, large                                       $39.00




                                                                                   Page 8 of 70
                                                                                                                                                                                            Maximum
  HCPCS                                                                                                                                                              MSRP      Your Price     Bid
  Code(s)   HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                                    Amount
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                 1071874         TrueBlue headgear, reduced size                                                    $38.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                 1071875         TrueBlue headgear                                                                  $38.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                 1082581         GoLife For Women Headgear                                                          $38.00
            CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036       DEVICE                                                  302175         Chin Strap                                                                         $26.98
            CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036       DEVICE                                                  302425         Deluxe Chin Strap                                                                  $68.40
            CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036       DEVICE                                                 1012911         Premium Chin Strap                                                                 $34.20

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE         7212          CPAP Tubing, 10' Gray                                                              $41.47

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE        532316         Lightweight Flexible Tubing 6'                                                     $45.00

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE        622038         Smooth-Bor Tubing 6' Gray                                                          $45.00

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE       1022738         ComfortCurve Tubing System 6'                                                      $47.50

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE       1032907         Reusable Performance Tubing 6ft (1.83m)                                            $45.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7070          INCOMING FILTER 7000,7001 CPAP                                                     $18.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7301            Disposible Filter                                                                 $8.51
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7302          Tranquility Quest/BiLevel/Quest Plus/Auto Disposable Filters, 5 per pack           $30.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7715          Bacteria Filter                                                                     $3.58
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         302064         BiPAP S, S/T, STD Filter, 8 per pack                                               $44.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         622017         Solo, Solo Plus, LX CPAP Ultra-Fine Filter, 6 per pack                             $35.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         622219         Synchrony/Duet LX/BiPAP Pro Ultra-Fine Filter, 6 per pack                          $35.00

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         622221         Synchrony/Duet LX/BiPAP Pro, 2 pollen filters and 6 ultra-fine filters per pack    $65.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1005945           Disposible Filter                                                                $12.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1005964         Pollen Filter, 2 per pack                                                          $35.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1006191         Synchrony/Duet LX/BiPAP Pro Ultra-Fine Filter, 2 per pack                          $12.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1006193         Solo, Solo Plus, LX CPAP Ultra-Fine Filter, 2 per pack                             $12.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1029330           Disposible Filter                                                                $35.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1029331           Disposible Filter                                                                $35.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1035442         M Series Ultra Fine Filter, 2 per pack                                             $12.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1035443                                                                                            $16.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039606           Disposible Filter                                                                 $7.50
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039607           Disposible Filter                                                                 $5.50
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039608           Disposible Filter                                                                $16.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039609           Disposible Filter                                                                 $5.50
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039610           Disposible Filter                                                                 $7.50
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039611           Disposible Filter                                                                $18.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039616           Disposible Filter                                                                $18.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1039617           Disposible Filter                                                                 $7.50
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1063091           Disposible Filter                                                                 $0.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                        1063096           Disposible Filter                                                                 $7.50

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         362521         REMstar Choice/Choice LS/Express Pollen Filter, 1 per pack                         $17.65

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         532247         GP Aria/Virtuoso/ Duet/Quartet Reusable Filter, 2 per pack                         $35.00

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         622018         Solo, Solo Plus, LX CPAP Pollen Filter, 2 per pack                                 $35.00

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         622220         Synchrony/Duet LX/BiPAP Pro Pollen Filter, 2 per pack                              $35.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                        1001389           Disposible Filter                                                                $16.00
            EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
            ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045       REPLACEMENT ONLY                                        302310         PEV Replacement Diaphragm, 5 per pack                                              $80.30
            EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
            ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045       REPLACEMENT ONLY                                        302312         Plateau Exhalation Valve (PEV)                                                     $39.40




                                                                                 Page 9 of 70
                                                                                                                                                                                               Maximum
   HCPCS                                                                                                                                                              MSRP        Your Price     Bid
   Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                                   Amount
                EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
                ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045           REPLACEMENT ONLY                                        332113         Whisper Swivel II                                                                $26.55
                EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
                ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045           REPLACEMENT ONLY                                       1004395         Elbow with Exhalation Port                                                       $26.55
                EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
                ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045           REPLACEMENT ONLY                                       1010646         Diffusion Elbow with Exhalation Port                                             $26.55
                EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
                ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045           REPLACEMENT ONLY                                       1014206         ComfortLite 2 Simple Cushion Elbow, 5 per pack                                   $24.80

                WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE
A7046           AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH              1008619         REMstar Heated Humidifier Chamber (with 2 couplers)                              $14.76
                PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME
                LIQUEFIER USED TO FILL PORTABLE LIQUID OXYGEN
                CONTAINERS, INCLUDES PORTABLE CONTAINERS,
                REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR                           HomeLox Portable Liquid Oxygenerating System
                MASK AND TUBING, WITH OR WITHOUT SUPPLY                                Includes the HomeLox home liquefaction unit and GoLox portable liquid
E0433           RESERVOIR AND CONTENTS GAUGE                           1057020         oxygen device                                                                  $5,850.00

                PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES
                PORTABLE CONTAINER, SUPPLY RESERVOIR, HUMIDIFIER,                      GoLox portable liquid oxygen system
                FLOWMETER, REFILL ADAPTOR, CONTENTS GAUGE,                             Includes GoLox USP device, shoulder strap, cannula and tubing 4' (1.2 M) in
E0434           CANNULA OR MASK, AND TUBING                            1019900         length, and user manual                                                        $1,950.00
E0463 / E0464                                                          1054260         Trilogy100 ventilator                                                         $17,600.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
                WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0470           AIRWAY PRESSURE DEVICE)                                DS650S          System One Bipap with SD Card                                                  $3,495.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
                WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0470           AIRWAY PRESSURE DEVICE)                                DS750S          System one Bipap Auto with SD Card                                             $3,995.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
                WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0470, E0562    AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS650HS         System one Bipap with heated humidifier and SD Card                            $3,986.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
                WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0470, E0562    AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS750HS         System one Bipap Auto with heated humidifier and SD Card                       $4,442.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0471           AIRWAY PRESSURE DEVICE)                                1012885         BiPAP S/T Ventilatory Support System                                           $5,500.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0471           AIRWAY PRESSURE DEVICE)                                1014248         BiPAP S/T Ventilatory Support System Core Package                              $5,800.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0471           AIRWAY PRESSURE DEVICE)                                1042906         BiPAP autoSV Advanced                                                          $8,000.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0471           AIRWAY PRESSURE DEVICE)                                1060485         BiPAP AVAPS, C Series and SD card                                              $5,800.00

                RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
                CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
                NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
                (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
                POSITIVE
E0471           AIRWAY PRESSURE DEVICE)                                1061420         BiPAP S/T, C Series and SD card                                                $5,000.00




                                                                                     Page 10 of 70
                                                                                                                                                                                       Maximum
  HCPCS                                                                                                                                                       MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                            Amount

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                DS950S          SystemOne BiPAP autoSV Advanced                                         $8,000.00

               HUMIDIFIER, NON-HEATED,RESPIRATORY ASSIST DEVICE,
               BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE
               FEATURE, USED WITH NONINVASIVE INTERFACE, E.G.,
               NASAL OR FACIAL MASK (INTERMITTENT ASSIST DEVICE
               WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE);
E0471, E0562   HEATED HUMIDIFIER                                      1042907         BiPAP autoSV Advanced with HH                                           $8,500.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             1061418         BiPAP AVAPS, C Series and SD card w/HH                                  $6,500.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             1061422         BiPAP S/T, C Series and SD card w/HH                                    $5,800.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS950HS         SystemOne BiPAP autoSV Advanced with humidifier                         $8,500.00
               HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY
E0561          PRESSURE DEVICE                                        1006087         REMstar Passover Humidifier                                              $108.00
               HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY
E0562          PRESSURE DEVICE                                        1005792         REMstar Heated Humidifier                                                $335.00
               HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY
E0562          PRESSURE DEVICE                                        1009491         H2 Heated Humidifier                                                     $365.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE               DS510S          REMstar Auto with A-Flex M Series
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE               DS150S          System One REMstar with SD Card                                         $1,109.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE               DS250S          System One REMstar Plus with SD Card                                    $1,833.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE               DS450S          System One REMstar Pro with SD Card                                     $1,917.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE               DS550S          System One REMstar Auto with SD Card                                    $2,650.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             1043237         Sleep Easy CPAP with Heated Humidifier                                  $1,671.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS150HS         System One REMstar with SD Card and Heated Humidifier                   $1,409.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS250HS         System One REMstar Plus with SD Card and Heated Humidifier              $2,273.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS450HS         System One REMstar Pro with AutoIQ with SD Card and Heated Humidifier   $2,348.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS510HS         REMstar Auto with A-Flex M Series Core Package
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS550HS         System One REMstar Auto with SD Card and Heated Humidifier              $3,109.00
               CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE;
E0601, E0562   HEATED HUMIDIFIER                                       SE2010         Sleep Easy CPAP with Cflex and Heated Humidifier                        $1,169.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020000         EverFlo 5 Liter Concentrator                                            $1,852.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020001         EverFlo 5 Liter Concentrator with Oxygen Percentage Indicator           $1,995.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020014         EverFlo Q oxygen concentrator with OPI                                  $2,045.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020015         EverFlo Q oxygen concentrator                                           $1,902.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1039362         EverFlo 120V, transfill                                                 $1,890.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1039363         EverFlo 120V OPI, transfill                                             $1,950.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1039364         EverFlo Q 120V OPI, transfill                                           $2,075.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1039365         EverFlo Q 120V, transfill                                               $2,010.00




                                                                                    Page 11 of 70
                                                                                                                                                                                  Maximum
  HCPCS                                                                                                                                                  MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                      Part Number(s)        Product Description                                                                            Amount
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                              M10600          M10 Concentrator                                                        $2,599.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                             M10600-10        Millennium 120V, transfill                                              $2,654.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                              M10605          M10 Concentrator with Oxygen Percentage Indicator                       $2,749.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                             M10605-10        Millennium 120V OPI, transfill                                          $2,804.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390, E1392   RATE; PORTABLE OXYGEN CONCENTRATOR                900-000         EverGo – Black Case                                                     $4,095.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390, E1392   RATE; PORTABLE OXYGEN CONCENTRATOR               900-000-01       EverGo 1-battery standalone, black case                                 $3,995.00
               PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME
               COMPRESSOR USED TO FILL PORTABLE OXYGEN
               CYLINDERS; INCLUDES PORTABLE CONTAINERS,
               REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR
K0738          MASK, AND TUBING                                  1057101         UltraFill system with 2 cylinders, 2,000 psi and a cylinder bag, 120V   $4,300.00




                                                                               Page 12 of 70
                                                                                                                                                                                     Maximum
  HCPCS                                                                                                                                                       MSRP      Your Price     Bid
  Code(s)   HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                             Amount
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7070          INCOMING FILTER 7000,7001 CPAP                                              $18.00

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE         7212          CPAP Tubing, 10' Gray                                                       $41.47
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7301             Disposible Filter                                                         $8.51
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7302          Tranquility Quest/BiLevel/Quest Plus/Auto Disposable Filters, 5 per pack    $30.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                          7715          Bacteria Filter                                                              $3.58
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302044         Reusable Headgear (Beige)                                                   $40.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         302064         BiPAP S, S/T, STD Filter, 8 per pack                                        $44.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302142         Softcap, White Medium                                                       $40.00
            CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036       DEVICE                                                  302175         Chin Strap                                                                  $26.98
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302180         Reusable Nasal Mask, Size Medium                                           $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302183         Reusable Nasal Mask, Size Medium Wide                                      $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302186         Reusable Nasal Mask, Size Medium Small                                     $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302187         Reusable Nasal Mask, Size Small                                            $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302188         Reusable Nasal Mask, Size Large                                            $120.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302215         Softcap, White Large                                                        $40.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302218         Reusable Nasal Mask, Size Large Narrow                                     $120.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302219         Reusable Nasal Mask, Size Petite                                           $120.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302266         Softcap, White                                                              $40.00
            NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
            POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034       HEAD STRAP                                              302279         Reusable Nasal Mask, Size Small Child                                      $120.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302285         Bonnet B2                                                                   $40.00
            EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
            ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045       REPLACEMENT ONLY                                        302310         PEV Replacement Diaphragm, 5 per pack                                       $80.30
            EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
            ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045       REPLACEMENT ONLY                                        302312         Plateau Exhalation Valve (PEV)                                              $39.40
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302328         SimpleStrap Reusable Headgear                                               $40.00
            CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036       DEVICE                                                  302425         Deluxe Chin Strap                                                           $68.40
            FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030       PRESSURE DEVICE, EACH                                   302433         Total Face Mask with Headgear                                              $249.10
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302439         Softcap, Blue Large                                                         $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302441         Softcap, Blue Child                                                         $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302442         Softcap, Blue Extra Large                                                   $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302449         Softcap, White Extra Large                                                  $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302458         Softcap, Blue Medium                                                        $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302465         Mesh Softcap, Blue Child                                                    $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  302466         Mesh Softcap, Blue Extra Large                                              $40.00
            EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
            ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045       REPLACEMENT ONLY                                        332113         Whisper Swivel II                                                           $26.55

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         362521         REMstar Choice/Choice LS/Express Pollen Filter, 1 per pack                  $17.65
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  452023         Small Convertible Headgear                                                  $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  452027         Medium Convertible Headgear                                                 $40.00
            HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035       DEVICE                                                  452029         Large Convertible Headgear                                                  $40.00

            FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039       PRESSURE DEVICE                                         532247         GP Aria/Virtuoso/ Duet/Quartet Reusable Filter, 2 per pack                  $35.00

A7037       TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE        532316         Lightweight Flexible Tubing 6'                                              $45.00
            FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038       PRESSURE DEVICE                                         622017         Solo, Solo Plus, LX CPAP Ultra-Fine Filter, 6 per pack                      $35.00




                                                                                 Page 13 of 70
                                                                                                                                                                                               Maximum
  HCPCS                                                                                                                                                                 MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                                    Amount

               FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039          PRESSURE DEVICE                                         622018         Solo, Solo Plus, LX CPAP Pollen Filter, 2 per pack                                 $35.00

A7037          TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE        622038         Smooth-Bor Tubing 6' Gray                                                          $45.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                         622219         Synchrony/Duet LX/BiPAP Pro Ultra-Fine Filter, 6 per pack                          $35.00

               FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039          PRESSURE DEVICE                                         622220         Synchrony/Duet LX/BiPAP Pro Pollen Filter, 2 per pack                              $35.00

               FILTER, NON-DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                         622221         Synchrony/Duet LX/BiPAP Pro, 2 pollen filters and 6 ultra-fine filters per pack    $65.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7039          PRESSURE DEVICE                                        1001389            Disposible Filter                                                               $16.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1002064         Mesh Softcap, Blue Medium                                                          $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1002065         Mesh Softcap, Blue Large                                                           $40.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002370         Profile Lite Mask Only, Size Medium Small                                         $171.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002371         Profile Lite Mask Only, Size Medium                                               $171.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002372         Profile Lite Mask Only, Size Medium Wide                                          $171.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002373         Profile Lite Mask Only, Size Large                                                $171.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002374         Profile Lite Mask Only, Size Large Narrow                                         $171.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1002757         Simplicity Mask and Headgear, Size Small                                          $170.49

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1002759         Simplicity Mask and Headgear, Size Medium                                         $170.49
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1002764         Simplicity Headgear                                                                $40.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1002800         Deluxe Headgear                                                                    $44.95
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002849         Profile Lite Mask Only, Size Petite                                               $171.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1002850         Profile Lite Mask Only, Size Small                                                $171.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION             1002854         ComfortGel Full mask DuoPack, small                                               $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION             1002855         ComfortGel Full mask DuoPack, med                                                 $284.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030, A7031   PRESSURE DEVICE, EACH; REPLACEMENT CUSHION             1002856         ComfortGel Full mask DuoPack, large                                               $284.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1003052         Total Headgear                                                                     $43.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1003656         Medium Replacement Cushion, 5 per pack                                            $232.50
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1003657         Small Replacement Cushion, 5 per pack                                             $232.50
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1003658         Small Replacement Cushion, Single                                                  $46.50
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1003659         Medium Replacement Cushion, Single                                                 $45.50

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004086         Profile Lite Mask and Headgear, Size Petite                                       $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004087         Profile Lite Mask and Headgear, Size Small                                        $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004088         Profile Lite Mask and Headgear, Size Medium Small                                 $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004089         Profile Lite Mask and Headgear, Size Medium                                       $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004110         Profile Lite Mask and Headgear, Size Medium Wide                                  $195.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004111         Profile Lite Mask and Headgear, Size Large                                        $195.00




                                                                                    Page 14 of 70
                                                                                                                                                                          Maximum
  HCPCS                                                                                                                                            MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                               Amount

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1004112         Profile Lite Mask and Headgear, Size Large Narrow            $195.00
               EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
               ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045          REPLACEMENT ONLY                                       1004395         Elbow with Exhalation Port                                    $26.55
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1004872         ComfortFull 2 Mask and Headgear, Size Medium                 $249.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1004880         ComfortFull 2 Mask and Headgear, Size Small                  $249.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1004950         ComfortFull 2 Mask and Headgear, Size Large                  $249.00
               HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY
E0562          PRESSURE DEVICE                                        1005792         REMstar Heated Humidifier                                    $335.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1005945            Disposible Filter                                          $12.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1005964         Pollen Filter, 2 per pack                                     $35.00
               HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY
E0561          PRESSURE DEVICE                                        1006087         REMstar Passover Humidifier                                  $108.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1006191         Synchrony/Duet LX/BiPAP Pro Ultra-Fine Filter, 2 per pack     $12.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1006193         Solo, Solo Plus, LX CPAP Ultra-Fine Filter, 2 per pack        $12.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1006416         Deluxe Softcap                                                $40.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1007919         ComfortSelect Mask and Headgear, Size Medium                 $179.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1007930         ComfortSelect Mask and Headgear, Size Small                  $179.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1007931         ComfortSelect Mask and Headgear, Size Small Wide             $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1007932         ComfortSelect Mask Only, Size Medium                         $167.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1007933         ComfortSelect Mask Only, Size Small                          $167.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1007934         ComfortSelect Mask Only, Size Small Wide                     $167.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1007935         ComfortSelect Cushion with Retaining Ring, Size Medium        $57.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1007936         ComfortSelect Cushion with Retaining Ring, Size Small         $57.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1007937         ComfortSelect Cushion with Retaining Ring, Size Small Wide    $57.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1007963         ComfortClassic Mask and Headgear, Size Small                 $159.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1007964         ComfortClassic Mask and Headgear, Size Medium                $159.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1007965         Comfort Classic Mask Only, Size Medium                       $139.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1007966         Comfort Classic Mask Only, Size Small                        $139.00

               WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE
A7046          AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH              1008619         REMstar Heated Humidifier Chamber (with 2 couplers)           $14.76

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1009040         ComfortGel Mask and Headgear, Size Petite                    $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1009041         ComfortGel Mask and Headgear, Size Small                     $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1009042         ComfortGel Mask and Headgear, Size Medium                    $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1009043         ComfortGel Mask and Headgear, Size Large                     $204.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1009048         ComfortGel Cushion, Size Petite                               $41.80
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1009049         ComfortGel Cushion, Size Small                                $41.80




                                                                                    Page 15 of 70
                                                                                                                                                                                             Maximum
  HCPCS                                                                                                                                                             MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                                  Amount
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1009050         ComfortGel Cushion, Size Medium                                                 $41.80
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1009051         ComfortGel Cushion, Size Large                                                  $41.80
               HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY
E0562          PRESSURE DEVICE                                        1009491         H2 Heated Humidifier                                                           $365.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1010518         ComfortGel Mask Only, Size Petite                                              $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1010519         ComfortGel Mask Only, Size Small                                               $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1010640         ComfortGel Mask Only, Size Medium                                              $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1010641         ComfortGel Mask Only, Size Large                                               $190.00
               EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
               ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045          REPLACEMENT ONLY                                       1010646         Diffusion Elbow with Exhalation Port                                            $26.55
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1010868         ComfortFull 2 Mask Only, Size Small                                            $237.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1010869         ComfortFull 2 Mask Only, Size Medium                                           $237.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1010870         ComfortFull 2 Mask Only, Size Large                                            $237.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                1012885         BiPAP S/T Ventilatory Support System                                          $5,500.00
               CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE
A7036          DEVICE                                                 1012911         Premium Chin Strap                                                              $34.20
               EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH
               ACCESSORIES FOR POSITIVE AIRWAY DEVICES,
A7045          REPLACEMENT ONLY                                       1014206         ComfortLite 2 Simple Cushion Elbow, 5 per pack                                  $24.80

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                1014248         BiPAP S/T Ventilatory Support System Core Package                             $5,800.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1014333         ComfortHeadgear                                                                 $50.83

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1018138         Small Simplicity with Deluxe Softcap                                           $170.49
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1018158         Medium Simplicity with Deluxe Softcap                                          $170.49
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1018755         Small Deluxe Headgear                                                           $44.94

               PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES
               PORTABLE CONTAINER, SUPPLY RESERVOIR, HUMIDIFIER,                      GoLox portable liquid oxygen system
               FLOWMETER, REFILL ADAPTOR, CONTENTS GAUGE,                             Includes GoLox USP device, shoulder strap, cannula and tubing 4' (1.2 M) in
E0434          CANNULA OR MASK, AND TUBING                            1019900         length, and user manual                                                       $1,950.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020000         EverFlo 5 Liter Concentrator                                                  $1,852.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020001         EverFlo 5 Liter Concentrator with Oxygen Percentage Indicator                 $1,995.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020014         EverFlo Q oxygen concentrator with OPI                                        $2,045.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   1020015         EverFlo Q oxygen concentrator                                                 $1,902.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1020407         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 4, 5 per pack         $152.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1020408         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 5, 5 per pack         $152.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1020409         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 6, 5 per pack         $152.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1020411         ComfortLite 2 Simple Cushion Pack, Size Large, 5 per pack                      $309.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1020412         ComfortLite 2 Simple Cushion Pack, Size Medium, 5 per pack                     $309.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1020413         ComfortLite 2 Simple Cushion Pack, Size Small, 5 per pack                      $309.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                 1020414         ComfortLite 2 Simple Cushion Pack, Size Petite, 5 per pack                     $309.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1020930         ComfortLite/ComfortLite 2 Direct Seal Cushion Pack, Size 3, 5 per pack         $152.00




                                                                                    Page 16 of 70
                                                                                                                                                                                         Maximum
  HCPCS                                                                                                                                                           MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                               Amount
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021802         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 1, 1 per pack             $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021806         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 2, 1 per pack             $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021807         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 3, 1 per pack             $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021815         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 4, 1 per pack             $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021816         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 5, 1 per pack             $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1021817         ComfortLite/ComfortLite 2 Direct Seal Cushion, Size 6, 1 per pack             $30.40
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1021821         ComfortLite 2 Simple Cushion, Size Large, 1 per pack                          $60.80
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1021823         ComfortLite 2 Simple Cushion, Size Medium, 1 per pack                         $60.80
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1021830         ComfortLite 2 Simple Cushion, Size Small, 1 per pack                          $60.80
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1021835         ComfortLite 2 Simple Cushion, Size Petite, 1 per pack                         $60.80

A7037          TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE      1022738         ComfortCurve Tubing System 6'                                                 $47.50

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025111         ComfortLite 2 mask Combo and Headgear, Size S, M, L Simple Cushions          $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size 4, 5 Direct Seal Cushion, S, M
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025112         Simple Cushion                                                               $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size 5, 6 Direct Seal, M, L Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1025113         Cushion                                                                      $209.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1025117         ComfortLite 2 Halo Headgear with Strap                                        $47.50
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1025120         ComfortLite 2 Mask Combo, Mask Only, Size S, M, L Simple Cushions            $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo, Mask Only, Size 4, 5 Direct Seal Cushion, S, M
A7034          HEAD STRAP                                            1025121         Simple Cushion                                                               $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 mask Combo, Mask Only, Size 5, 6 Direct Seal Cushion, M, L
A7034          HEAD STRAP                                            1025122         Simple Cushion                                                               $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1025123         ComfortLite 2 Mask Combo, Mask Only, Size 4, 5, 6 Direct Seal Cushions       $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1025127         ComfortLite 2 Mask Combo and Headgear, Size 4, 5, 6 Direct Seal Cushions     $209.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1025225         ComfortLite 2 Mask Sub-Assembly with Headgear, no cushions                   $134.90

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortSelect Mask and Headgear with Size Small, Medium and Small Wide
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1026880         Cushions with Retaining Rings                                                $189.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1029330            Disposible Filter                                                          $35.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1029331            Disposible Filter                                                          $35.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030493         ComfortLite 2 Mask Combo and Headgear, Size S, M, L Pillow Cushions          $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size S, M Pillows and Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030494         Cushions                                                                     $209.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo and Headgear, Size M, L Pillows and Simple
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1030495         Cushions                                                                     $209.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      ComfortLite 2 Mask Combo, Mask Only, Size S, M Pillows and Simple
A7034          HEAD STRAP                                            1030496         Cushions                                                                     $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1030497         ComfortLite 2 Mask Combo, Mask Only, Size M, L Pillows and Simple Cushions   $193.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1030498         ComfortLite 2 Mask Combo, Mask Only, S, M, L Pillow Cushions                 $193.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1030502         ComfortLite 2 Pillow Cushions, Size Petite, 1 per pack                        $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1030503         ComfortLite 2 Pillow Cushions, Size Small, 1 per pack                         $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1030504         ComfortLite 2 Pillow Cushions, Size Medium, 1 per pack                        $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1030505         ComfortLite 2 Pillow Cushions, Size Large, 1 per pack                         $30.40
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1031391         ComfortGel Cushion and Silicone Flap, Size Petite                             $47.50
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1031392         ComfortGel Cushion and Silicone Flap, Size Small                              $47.50




                                                                                   Page 17 of 70
                                                                                                                                                                                        Maximum
  HCPCS                                                                                                                                                        MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                                              Amount
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1031403         ComfortGel Cushion and Silicone Flap, Size Medium                           $47.50

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT                      Medium ComfortGel Mask and Headgear with Small Gel Cushion and Silicone
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1031405         Flap                                                                       $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1031406         Medium ComfortGel Mask Only with Small Gel Cushion and Silicone Flap       $200.00

A7037          TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE      1032907         Reusable Performance Tubing 6ft (1.83m)                                     $45.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1033678         Premium headgear, ComfortGel Blue                                           $44.94
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1035442         M Series Ultra Fine Filter, 2 per pack                                      $12.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1035443                                                                                     $16.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035931         Medium ComfortGel with Headgear plus Medium Gel/Silicone Cushions          $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035932         Large ComfortGel with Headgear plus Large Gel/Silicone Cushions            $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035966         Small ComfortSelect with Headgear Plus Small Cushion                       $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035967         Medium ComfortSelect with Headgear Plus Medium Cushion                     $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035968         Small Wide ComfortSelect with Headgear Plus Small Wide Cushion             $189.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1035999         Petite ComfortGel with Headgear plus Petite Gel/Silicone Cushions          $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1036000         Small ComfortGel with Headgear plus Small Gel/Silicone Cushions            $214.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1036800         OptiLife Mask with Headgear and Petite, Small, Medium and Large Pillows    $219.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1036804         OptiLife Mask only with Petite, Small, Medium and Large Pillows            $204.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1036818         OptiLife Subassembly with Headgear and Chin Support Band                   $134.90
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1036838         Petite OptiLife Pillow Replacement                                          $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1036839         Small OptiLife Pillow Replacement                                           $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1036840         Medium OptiLife Pillow Replacement                                          $30.40
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                1036841         Large OptiLife Pillow Replacement                                           $30.40
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                1036850         OptiLife Headgear with Chin Support Band                                    $47.50
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  1039362         EverFlo 120V, transfill                                                   $1,890.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  1039363         EverFlo 120V OPI, transfill                                               $1,950.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  1039364         EverFlo Q 120V OPI, transfill                                             $2,075.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  1039365         EverFlo Q 120V, transfill                                                 $2,010.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039606            Disposible Filter                                                         $7.50
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039607            Disposible Filter                                                         $5.50
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039608            Disposible Filter                                                        $16.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039609            Disposible Filter                                                         $5.50
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039610            Disposible Filter                                                         $7.50
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039611            Disposible Filter                                                        $18.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                       1039616            Disposible Filter                                                        $18.00




                                                                                   Page 18 of 70
                                                                                                                                                                         Maximum
  HCPCS                                                                                                                                         MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                              Amount
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1039617            Disposible Filter                                         $7.50
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1040135         ComfortGel Full mask with premium headgear, small          $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1040136         ComfortGel Full mask with premium headgear, med            $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1040137         ComfortGel Full mask with premium headgear, large          $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1040138         ComfortGel Full premium headgear                            $44.95
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1040568         ComfortGel Full mask without headgear, small               $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1040569         ComfortGel Full mask without headgear, medium              $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1040570         ComfortGel Full mask without headgear, large               $262.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1040768         ComfortFusion with Headgear FitPack , Small & Medium       $184.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1040769         ComfortFusion with Headgear, Small                         $174.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1040770         ComfortFusion with Headgear, Medium                        $174.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1040798         ComfortGel Full cushion, small                              $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1040799         ComfortGel Full cushion, medium                             $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1040800         ComfortGel Full cushion, large                              $83.13
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1040836         ComfortFusion without Headgear FitPack , Small & Medium    $169.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1042205         ComfortFusion without Headgear, Small                      $159.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1042206         ComfortFusion without Headgear, Medium                     $159.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                1042906         BiPAP autoSV Advanced                                     $8,000.00

               HUMIDIFIER, NON-HEATED,RESPIRATORY ASSIST DEVICE,
               BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE
               FEATURE, USED WITH NONINVASIVE INTERFACE, E.G.,
               NASAL OR FACIAL MASK (INTERMITTENT ASSIST DEVICE
               WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE);
E0471, E0562   HEATED HUMIDIFIER                                      1042907         BiPAP autoSV Advanced with HH                             $8,500.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             1043237         Sleep Easy CPAP with Heated Humidifier                    $1,671.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1044861         ComfortGel Full cushion and SST flap, small                $106.88
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1044862         ComfortGel Full cushion and SST flap, medium               $106.88
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1044863         ComfortGel Full cushion and SST flap, large                $106.88
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1047916         FullLife mask with headgear, small                         $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1047917         FullLife mask with headgear, medium                        $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1047918         FullLife mask with headgear, large                         $254.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1047919         FullLife mask FitPack with headgear                        $316.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1047922         FullLife cushion, small                                     $84.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1047923         FullLife cushion, medium                                    $84.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1047924         FullLife cushion, large                                     $84.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1047975         FullLife headgear system                                    $42.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1050000         EasyLife nasal mask with headgear, petite                  $195.00




                                                                                    Page 19 of 70
                                                                                                                                                                        Maximum
   HCPCS                                                                                                                                       MSRP        Your Price     Bid
   Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                             Amount

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050001         EasyLife nasal mask with headgear, small                  $195.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050002         EasyLife nasal mask with headgear, med                    $195.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050003         EasyLife nasal mask with headgear, med wide               $195.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050004         EasyLife nasal mask with headgear, large                  $195.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050005          P/P EASYLIFE DUOPACK W/HGR                               $205.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050006         EasyLife DuoPack with headgear, small                     $205.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050007         EasyLife DuoPack with headgear, med                       $205.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050008         EasyLife DuoPack with headgear, med wide                  $205.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050009         EasyLife DuoPack with headgear, large                     $205.00
                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034           HEAD STRAP                                            1050010         EasyLife without headgear, petite                         $191.00
                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034           HEAD STRAP                                            1050011         EasyLife without headgear, small                          $171.00
                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034           HEAD STRAP                                            1050012         EasyLife without headgear, med                            $171.00
                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034           HEAD STRAP                                            1050013         EasyLife without headgear, med wide                       $171.00
                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034           HEAD STRAP                                            1050014         EasyLife without headgear, large                          $171.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050078         EasyLife FitPack with headgear, S and M                   $205.00

                NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
                POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035    HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1050079         EasyLife FitPack with headgear, MW and L                  $205.00
                CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032           REPLACEMENT ONLY, EACH                                1050090         P EASYLIFE CUSHION SET                                     $42.00
                CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032           REPLACEMENT ONLY, EACH                                1050091         EasyLife cushion, small                                    $42.00
                CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032           REPLACEMENT ONLY, EACH                                1050092         EasyLife cushion, med                                      $42.00
                CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032           REPLACEMENT ONLY, EACH                                1050093         EasyLife cushion, med wide                                 $42.00
                CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032           REPLACEMENT ONLY, EACH                                1050094         EasyLife cushion, large                                    $42.00
                HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035           DEVICE                                                1050095         EasyLife headgear                                          $38.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1051032         ComfortGel Full mask duopack without headgear, small      $272.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1051033         ComfortGel Full mask duopack without headgear, medium     $272.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1051034         ComfortGel Full mask duopack without headgear, large      $272.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
                PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035    DEVICE                                                1052149         FullLife mask DuoPack with headgear, small                $291.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
                PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035    DEVICE                                                1052153         FullLife mask DuoPack with headgear, medium               $291.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
                PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035    DEVICE                                                1052156         FullLife mask DuoPack with headgear, large                $291.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1052158         FullLife mask without headgear, small                     $242.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1052159         FullLife mask without headgear, medium                    $242.00
                FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030           PRESSURE DEVICE, EACH                                 1052160         FullLife mask without headgear, large                      $242.00
E0463 / E0464                                                         1054260         Trilogy100 ventilator                                   $17,600.00




                                                                                    Page 20 of 70
                                                                                                                                                                                       Maximum
  HCPCS                                                                                                                                                       MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                            Amount
               PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME
               LIQUEFIER USED TO FILL PORTABLE LIQUID OXYGEN
               CONTAINERS, INCLUDES PORTABLE CONTAINERS,
               REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR                           HomeLox Portable Liquid Oxygenerating System
               MASK AND TUBING, WITH OR WITHOUT SUPPLY                                Includes the HomeLox home liquefaction unit and GoLox portable liquid
E0433          RESERVOIR AND CONTENTS GAUGE                           1057020         oxygen device                                                           $5,850.00
               PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME
               COMPRESSOR USED TO FILL PORTABLE OXYGEN
               CYLINDERS; INCLUDES PORTABLE CONTAINERS,
               REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR
K0738          MASK, AND TUBING                                       1057101         UltraFill system with 2 cylinders, 2,000 psi and a cylinder bag, 120V   $4,300.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                1060485         BiPAP AVAPS, C Series and SD card                                       $5,800.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1060801         FitLife total full-face mask, small                                      $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1060802         FitLife total full-face mask, large                                      $274.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1060807         FitLife headgear, small                                                   $39.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1060808         FitLife headgear, large                                                   $39.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             1061418         BiPAP AVAPS, C Series and SD card w/HH                                  $6,500.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                1061420         BiPAP S/T, C Series and SD card                                         $5,000.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             1061422         BiPAP S/T, C Series and SD card w/HH                                    $5,800.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1062003         ComfortGel Full mask without headgear, extra large                       $262.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
               PRESSURE DEVICE, EACH; HEADGEAR USED WITH PAP
A7030, A7035   DEVICE                                                 1062004         ComfortGel Full mask with premium headgear, extra large                  $274.00
               FULL FACE MASK USED WITH POSITIVE AIRWAY
A7030          PRESSURE DEVICE, EACH                                  1062005         ComfortGel Full mask DuoPack, extra large                                $284.00
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1062030         ComfortGel Full cushion, extra large                                      $83.13
               CUSHION FOR USE ON FULL FACE MASK INTERFACE,
A7031          REPLACEMENT ONLY, EACH                                 1062032         ComfortGel Full cushion and SST flap, extra large                        $106.88
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1063091            Disposible Filter                                                       $0.00
               FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY
A7038          PRESSURE DEVICE                                        1063096            Disposible Filter                                                       $7.50

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1070037         ComfortGel Blue Mask with headgear, large                                $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1070038         ComfortGel Blue Mask with headgear, medium                               $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1070039         ComfortGel Blue Mask with headgear, small                                $204.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1070040         ComfortGel Blue Mask with headgear, petite                               $204.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1070041         ComfortGel Blue Mask without headgear, large                             $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1070042         ComfortGel Blue Mask without headgear, medium                            $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1070043         ComfortGel Blue Mask without headgear, small                             $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                             1070044         ComfortGel Blue Mask without headgear, petite                            $190.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                        1070049         ComfortGel Blue Mask Duopack, large                                      $214.00




                                                                                    Page 21 of 70
                                                                                                                                                                Maximum
  HCPCS                                                                                                                                  MSRP      Your Price     Bid
  Code(s)      HCPCS Code Description(s)                          Part Number(s)        Product Description                                                      Amount
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070050         ComfortGel Blue Mask Duopack, medium                $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070051         ComfortGel Blue Mask Duopack, small                 $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1070052         ComfortGel Blue Mask Duopack, petite                $214.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1070053         ComfortGel Blue Fitpack, small and medium cushion    $42.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070101         ComfortGel Blue cushion, large                       $42.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070102         ComfortGel Blue cushion, medium                      $42.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070103         ComfortGel Blue cushion, small                       $42.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070104         ComfortGel Blue cushion, petite                      $42.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070105         ComfortGel Blue cushion and flap, large              $48.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070106         ComfortGel Blue cushion and flap, medium             $48.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070107         ComfortGel Blue cushion and flap, small              $48.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1070108         ComfortGel Blue cushion and flap, petite             $48.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071800         TrueBlue Mask with headgear, petite                 $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071801         TrueBlue Mask with headgear, small                  $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071803         TrueBlue Mask with headgear,medium                  $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071804         TrueBlue Mask with headgear,medium wide             $199.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE             1071805         TrueBlue Mask with headgear, large                  $199.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071806         TrueBlue Mask without headgear, petite              $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071807         TrueBlue Mask without headgear, small               $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071808         TrueBlue Mask without headgear, medium              $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071809         TrueBlue Mask without headgear, medium wide         $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071810         TrueBlue Mask without headgear, large               $179.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071816         TrueBlue Mask Fitpack, small and medium             $215.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034          HEAD STRAP                                            1071817         TrueBlue Mask Fitpack, medium wide and large        $215.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071818         TrueBlue Mask Duopack, petite                       $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071819         TrueBlue Mask Duopack, small                        $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071820         TrueBlue Mask Duopack, medium                       $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071821         TrueBlue Mask Duopack, medium wide                  $229.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7032   HEAD STRAP; REPLACEMENT CUSHION                       1071822         TrueBlue Mask Duopack, large                        $229.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1071861         TrueBlue cushion and flap, petite                    $45.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1071862         TrueBlue cushion and flap, small                     $45.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1071863         TrueBlue cushion and flap, medium                    $45.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1071864         TrueBlue cushion and flap, medium wide               $45.00
               CUSHION FOR USE ON NASAL MASK INTERFACE,
A7032          REPLACEMENT ONLY, EACH                                1071865         TrueBlue cushion and flap, large                     $45.00




                                                                                   Page 22 of 70
                                                                                                                                                                                       Maximum
  HCPCS                                                                                                                                                       MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                                            Amount
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1071874         TrueBlue headgear, reduced size                                           $38.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1071875         TrueBlue headgear                                                         $38.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, E7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1073114         GoLife Fitpack: Mask with headgear                                       $195.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                  1073329         GoLife Fitpack: mask only plus petite, small, medium, large cushion      $188.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1073332         GoLIfe Replacement cushion, petite                                        $42.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1073333         GoLife Replacement cushion, small                                         $42.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1073334         GoLife Replacement cushion, medium                                        $42.00
               PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE,
A7033          REPLACEMENT ONLY, PAIR                                 1073335         GoLife Replacement cushion, large                                         $42.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, A7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1073336         GoLife for Men w/headgear                                                 $38.00

               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT
A7034, E7035   HEAD STRAP; HEADGEAR USED WITH PAP DEVICE              1082577         GoLife For Women Fit pack mask with cushions and hdgr                    $195.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                  1082578         GoLife For Women Mask only                                                $81.00
               NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH
               POSITIVE AIRWAY PRESSURE DEVICE, WITHOUT HEAD
A7034          STRAP                                                  1082579         GoLife For Women Fit pack – mask and cushions only                       $188.00
               HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE
A7035          DEVICE                                                 1082581         GoLife For Women Headgear                                                 $38.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390, E1392   RATE; PORTABLE OXYGEN CONCENTRATOR                     900-000         EverGo – Black Case                                                     $4,095.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390, E1392   RATE; PORTABLE OXYGEN CONCENTRATOR                    900-000-01       EverGo 1-battery standalone, black case                                 $3,995.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS150HS         System One REMstar with SD Card and Heated Humidifier                   $1,409.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                DS150S         System One REMstar with SD Card                                         $1,109.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS250HS         System One REMstar Plus with SD Card and Heated Humidifier              $2,273.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                DS250S         System One REMstar Plus with SD Card                                    $1,833.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS450HS         System One REMstar Pro with AutoIQ with SD Card and Heated Humidifier   $2,348.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                DS450S         System One REMstar Pro with SD Card                                     $1,917.00
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS510HS         REMstar Auto with A-Flex M Series Core Package
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                DS510S         REMstar Auto with A-Flex M Series
               CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE; HEATED
E0601, E0562   HUMIDIFIER                                             DS550HS         System One REMstar Auto with SD Card and Heated Humidifier              $3,109.00
E0601          CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                DS550S         System One REMstar Auto with SD Card                                    $2,650.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
               WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0470, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS650HS         System one Bipap with heated humidifier and SD Card                     $3,986.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
               WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0470          AIRWAY PRESSURE DEVICE)                                DS650S          System One Bipap with SD Card                                           $3,495.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
               WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0470, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS750HS         System one Bipap Auto with heated humidifier and SD Card                $4,442.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED
               WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0470          AIRWAY PRESSURE DEVICE)                                DS750S          System one Bipap Auto with SD Card                                      $3,995.00




                                                                                    Page 23 of 70
                                                                                                                                                                   Maximum
  HCPCS                                                                                                                                   MSRP        Your Price     Bid
  Code(s)      HCPCS Code Description(s)                           Part Number(s)        Product Description                                                        Amount

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471, E0562   AIRWAY PRESSURE DEVICE); HEATED HUMIDIFIER             DS950HS         SystemOne BiPAP autoSV Advanced with humidifier     $8,500.00

               RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE
               CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH
               NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK
               (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS
               POSITIVE
E0471          AIRWAY PRESSURE DEVICE)                                DS950S          SystemOne BiPAP autoSV Advanced                     $8,000.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   M10600          M10 Concentrator                                    $2,599.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  M10600-10        Millennium 120V, transfill                          $2,654.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                   M10605          M10 Concentrator with Oxygen Percentage Indicator   $2,749.00
               OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT,
               CAPABLE OF DELIVERING 85 PERCENT OR GREATER
               OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW
E1390          RATE                                                  M10605-10        Millennium 120V OPI, transfill                      $2,804.00
               CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE;
E0601, E0562   HEATED HUMIDIFIER                                       SE2010         Sleep Easy CPAP with Cflex and Heated Humidifier    $1,169.00




                                                                                    Page 24 of 70

				
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