| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 3 | 60 | 840 | $350 | $641.2K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 5 | 160 | 5,820 | $40 | $416.1K |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | 8 | 10 | 630 | $130 | $152.5K |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | 7 | 10 | 270 | $50 | $151.8K |
| E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips | 8 | 20 | 300 | $30 | $121.1K |
| E0601 | Continuous positive airway pressure (CPAP) device | 4 | 160 | 1,680 | $30 | $96.3K |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 15 | 40 | 150 | $30 | $56.4K |
| A7031 | Face mask interface, replacement for full face mask, each | 1 | 120 | 1,110 | $20 | $55.9K |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive… | 8 | 70 | 440 | $70 | $53.9K |
| 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 | 20 | 80 | $120 | $53.2K |