Precision Field Patient Pay - Final

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Patient Name

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Patient Date of Birth

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Choose Product

Circul8 Pro - Adam Veri Product Image

Circul8 Pro - Adam Veri

$150.00

Circul8 Pro - PMP Product Image

Circul8 Pro - PMP

$129.00

Circul8 Pro - Sara Schwartzman Product Image

Circul8 Pro - Sara Schwartzman

$120.00

Cryo ROM Knee. Cold Therapy Knee brace

Cryo ROM Knee

Cold Therapy Knee brace

$95.00

Cryo Hip Brace. Cold Therapy Hip Brace

Cryo Hip Brace

Cold Therapy Hip Brace

$200.00

Cryo Ankle Brace. Cold Therapy Ankle Brace

Cryo Ankle Brace

Cold Therapy Ankle Brace

$50.00

Cryo Shoulder Brace. Cold Therapy Shoulder Brace

Cryo Shoulder Brace

Cold Therapy Shoulder Brace

$75.00

NMES Stimulator Device. Electrical Stimulator

NMES Stimulator Device

Electrical Stimulator

$90.00

Breg Polar Wave. Cold Therapy Machine

Breg Polar Wave

Cold Therapy Machine

$450.00

Breg Polar Cube. Cold Therapy Unit

Breg Polar Cube

Cold Therapy Unit

$250.00

Vascutherm. Daily Rental

Vascutherm

Daily Rental

$50.00 Quantity

Circul8 Extender. DVT Device Extender

Circul8 Extender

DVT Device Extender

$15.00 Quantity

Cryo Back Brace. GForce

Cryo Back Brace

GForce

$150.00 Quantity

Ossur Cold Rush. Includes Wrap

Ossur Cold Rush

Includes Wrap

$225.00 Quantity

Ossur Cold Rush Compact. Includes Wrap

Ossur Cold Rush Compact

Includes Wrap

$125.00 Quantity

Aspen Multipost Collar. Cervical Collar

Aspen Multipost Collar

Cervical Collar

$160.00 Quantity

Trend Pro. Unloader Brace

Trend Pro

Unloader Brace

$229.00 Quantity

Shoulder Sling. Ossur Shoulder Sling Form Fit

Shoulder Sling

Ossur Shoulder Sling Form Fit

$125.00 Quantity

Standard Crutches. Adult

Standard Crutches

Adult

$49.00 Quantity

Ossur Cold Rush - Sara Schwartzman. Includes Wrap

Ossur Cold Rush - Sara Schwartzman

Includes Wrap

$150.00 Quantity

Total

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