| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 13 | 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 | 4 | 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 | 3 | 10 | 800 | $630 | $475.9K |
| E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other | 4 | 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… | 5 | 10 | 350 | $190 | $133.7K |
| K0825 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds | 2 | 10 | 610 | $170 | $101.1K |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | 4 | 10 | 220 | $90 | $79K |
| E0601 | Continuous positive airway pressure (CPAP) device | 5 | 60 | 1,500 | $40 | $71K |
| E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing | 1 | 80 | 3,150 | $10 | $55.4K |
| A7030 | Full face mask used with positive airway pressure device, each | 4 | 50 | 560 | $60 | $52.8K |