| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 31,440 | $40 | $1.2M |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 2,350 | $260 | $602.1K |
| 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… | 1,710 | $300 | $509.9K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 2,800 | $180 | $503.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4,200 | $60 | $235K |
| 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,… | 1,650 | $120 | $194.7K |
| E0430 | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing | 4,860 | $30 | $155.4K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 480 | $290 | $139.8K |
| E0600 | Respiratory suction pump, home model, portable or stationary, electric | 5,110 | $30 | $132.9K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 330 | $390 | $128.8K |