| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7,120 | $170 | $1.2M |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1,720 | $690 | $1.2M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 9,350 | $120 | $1.1M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 2,270 | $440 | $1M |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 6,590 | $150 | $955.4K |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | 11,570 | $70 | $844.4K |
| B9002 | Enteral nutrition infusion pump, any type | 8,820 | $60 | $502.7K |
| B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,… | 2,300 | $210 | $471.5K |
| 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… | 1,770 | $230 | $409.5K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 5,490 | $60 | $335.1K |