| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 6 | 30 | 1,020 | $310 | $547.3K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 82 | 80 | 5,550 | $60 | $504.2K |
| K0861 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | 2 | 10 | 800 | $630 | $475.9K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 3 | 10 | 510 | $720 | $457K |
| L1832 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to… | 2 | 10 | 770 | $390 | $296.7K |
| E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other | 2 | 10 | 1,950 | $100 | $196.2K |
| L4360 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a… | 1 | 10 | 350 | $190 | $133.7K |
| E2611 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware | 1 | 10 | 2,100 | $60 | $132.5K |
| K0825 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds | 1 | 10 | 610 | $170 | $101.1K |
| E0955 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each | 2 | 10 | 1,560 | $80 | $83.4K |