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888-770-0044 .. .. fax: 724-694-5081
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reimbursement codes for BetterBinder:
L0621, L0500, L0600
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BetterBinder for back pain, pregnancy and post-partum support, post-op security, bariatic comfort,
breast wrap, help with lymphedema, rib stabilizer--etc.
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Waist circumference for sizes: S: 20-29 inches, M: 30-39 inches, L: 40-55 inches,.XL: 56-75 inches. Pregnant women should measure their fullest circumference.
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A
minimum order of 3 BetterBinders is
required S____
M____ L____: $33.00
XL____ $37.00
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...ORDER TOTAL = $______
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.CIRCLE preferred shipping: Standard Parcel
Post: 6-10 days...Priority Mail: 2-3 days... or OVERNIGHT
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PO #______________ Credit Card#
___________________________________________ expires_______________
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Name on card: _________________________________________________________________________________
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FACILITY NAME:_______________________________________________________________________________
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CONTACT PERSON:
_______________________________ PHONE: (_______)____________________________
Make sure we can reach reception in
your department
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SHIPPING ADDRESS:
__________________________________________________________________________
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BILLING ADDRESS if
different: ___________________________________________________________________
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