| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 8 | 10 | 2,610 | $310 | $912.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 20 | 530 | $140 | $543.1K |
| 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,… | 7 | 10 | 1,870 | $150 | $413.2K |
| E0603 | Breast pump, electric (ac and/or dc), any type | 5 | 20 | 540 | $140 | $316.8K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 19 | 70 | 4,670 | $40 | $311K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 8 | 10 | 2,720 | $60 | $291.8K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 8 | 20 | 870 | $240 | $248K |
| 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… | 14 | 10 | 350 | $110 | $177.7K |
| A7030 | Full face mask used with positive airway pressure device, each | 15 | 80 | 1,250 | $80 | $169.7K |
| 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… | 12 | 20 | 340 | $120 | $159.9K |