| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 18 | 30 | 2,590 | $110 | $1.4M |
| 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,… | 14 | 20 | 2,110 | $220 | $915.7K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 17 | 40 | 860 | $450 | $660.3K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 9 | 200 | 1,950 | $90 | $492K |
| 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… | 16 | 30 | 1,310 | $110 | $298K |
| 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… | 20 | 30 | 1,020 | $80 | $291.3K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 16 | 20 | 1,350 | $110 | $260.3K |
| E0601 | Continuous positive airway pressure (CPAP) device | 17 | 140 | 2,000 | $50 | $209.5K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 12 | 20 | 880 | $60 | $129.6K |
| B9002 | Enteral nutrition infusion pump, any type | 17 | 20 | 1,020 | $70 | $125.9K |