| 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… | 5,950 | $110 | $678.4K |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 4,650 | $140 | $651.1K |
| L3670 | Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf | 9,500 | $50 | $455.8K |
| L3807 | Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | 3,790 | $100 | $387K |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 12,470 | $30 | $349.2K |
| E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips | 14,510 | $20 | $348.2K |
| L0633 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral… | 1,540 | $180 | $272.6K |
| L3809 | Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type | 2,020 | $130 | $255.9K |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | 5,090 | $50 | $229.1K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 670 | $320 | $209.8K |