| B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding… | 5 | 20 | 1,760 | $240 | $807.1K |
| 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,… | 5 | 30 | 1,100 | $100 | $553.7K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 14 | 30 | 490 | $320 | $304.5K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 7 | 100 | 4,570 | $30 | $261.1K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 5 | 10 | 480 | $80 | $245.2K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 5 | 10 | 590 | $180 | $196.6K |
| 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… | 6 | 30 | 920 | $70 | $194K |
| 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… | 2 | 20 | 660 | $60 | $183.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4 | 40 | 570 | $60 | $171.5K |
| E0601 | Continuous positive airway pressure (CPAP) device | 25 | 110 | 1,470 | $30 | $85.3K |