| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 7 | 20 | 2,040 | $590 | $2.1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 17 | 50 | 4,010 | $80 | $640.4K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 112 | 190 | 6,790 | $40 | $579.6K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 41 | 80 | 1,240 | $70 | $295.8K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 39 | 90 | 780 | $80 | $277.8K |
| 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… | 19 | 60 | 900 | $80 | $275.5K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 27 | 100 | 810 | $70 | $275.1K |
| T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | 37 | 90 | 1,860 | $30 | $255.3K |
| 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… | 33 | 80 | 1,420 | $70 | $242.4K |
| T4542 | Incontinence product, disposable underpad, small size, each | 23 | 30 | 1,580 | $30 | $117.5K |