CPT A4722 — Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis (26 hospitals, — samples)
CPT A4723 — INJ, PERITONEAL DIALYSATE DEXTROSE 2.5%, PER BAG (31 hospitals, — samples)
CPT A5057 — 1 pc ost pou w built-in conv (55 hospitals, — samples)
CPT A5063 — HH Hol Ho18133 Drain Pouch Without Filter (From Dme) (56 hospitals, — samples)
CPT A5113 — Latex leg strap (55 hospitals, — samples)
CPT A5114 — LEG STRAP FOAM/FABRIC REPLAC ONLY PER SET (56 hospitals, — samples)