| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 5 | 10 | 3,350 | $1,110 | $3.3M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 13 | 20 | 2,840 | $230 | $1.8M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 13 | 10 | 1,400 | $340 | $1.4M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 20 | 140 | 7,200 | $60 | $1.1M |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 27 | 40 | 1,070 | $540 | $919.6K |
| 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 | 40 | 1,190 | $90 | $424.3K |
| 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… | 13 | 30 | 1,100 | $120 | $372.6K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 5 | 10 | 2,090 | $150 | $309.5K |
| B9002 | Enteral nutrition infusion pump, any type | 10 | 10 | 780 | $70 | $239.3K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 9 | 10 | 950 | $110 | $177.6K |