| L3010 | Foot, insert, removable, molded to patient model, longitudinal arch support, each | 1 | 10 | 1,110 | $190 | $213.5K |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 9 | 20 | 140 | $160 | $155.3K |
| L1820 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific… | 3 | 10 | 190 | $80 | $79.9K |
| 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… | 2 | 10 | 300 | $150 | $47.6K |
| A4670 | Automatic blood pressure monitor | 15 | 50 | 240 | $50 | $46.2K |
| L3221 | Orthopedic footwear, mens shoe, depth inlay, each | 1 | 10 | 220 | $130 | $43K |
| 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 | 4 | 10 | 150 | $50 | $38.4K |
| 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 | 1,090 | $30 | $38.1K |
| A6533 | Gradient compression stocking, thigh length, 18-30 mmhg, each | 5 | 10 | 100 | $60 | $36.6K |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 5 | 30 | 120 | $40 | $34.9K |