| L3809 | Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type | 2 | 10 | 970 | $130 | $265.4K |
| L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf | 1 | 10 | 380 | $40 | $256.9K |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 2 | 30 | 260 | $180 | $167.2K |
| L0172 | Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf | 1 | 10 | 2,530 | $70 | $166.7K |
| L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf | 1 | 10 | 1,760 | $90 | $157.9K |
| L0625 | Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps,… | 1 | 10 | 4,350 | $30 | $111.2K |
| L1830 | Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf | 1 | 10 | 20 | $50 | $102.8K |
| E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips | 1 | 30 | 170 | $30 | $69.6K |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | 1 | 20 | 70 | $50 | $65.6K |
| E0143 | Walker, folding, wheeled, adjustable or fixed height | 1 | 20 | 620 | $30 | $58.8K |