| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 8 | 20 | 1,990 | $210 | $1.1M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 3 | 70 | 4,460 | $60 | $538K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 8 | 20 | 440 | $270 | $305.6K |
| E0601 | Continuous positive airway pressure (CPAP) device | 42 | 80 | 2,470 | $70 | $281K |
| B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100… | 7 | 10 | 790 | $110 | $256.1K |
| B4152 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include… | 9 | 10 | 1,040 | $120 | $254.8K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 11 | 10 | 1,290 | $90 | $231.8K |
| A7030 | Full face mask used with positive airway pressure device, each | 26 | 80 | 1,560 | $90 | $192.7K |
| B9002 | Enteral nutrition infusion pump, any type | 8 | 10 | 770 | $70 | $139.1K |
| A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | 37 | 80 | 1,440 | $60 | $130.3K |