| 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… | 4 | 10 | 930 | $600 | $865.3K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 3 | 10 | 1,350 | $580 | $827K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2 | 10 | 430 | $400 | $356.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 3 | 20 | 1,020 | $90 | $319.7K |
| 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,… | 4 | 10 | 1,970 | $150 | $293.2K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 5 | 10 | 620 | $230 | $219.6K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 18 | 70 | 2,480 | $30 | $143.7K |
| A4606 | Oxygen probe for use with oximeter device, replacement | 1 | 10 | 2,320 | $70 | $137.6K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 1 | 10 | 580 | $180 | $132.3K |
| B9002 | Enteral nutrition infusion pump, any type | 2 | 10 | 1,380 | $90 | $122.2K |