| 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… | 2 | 10 | 2,190 | $710 | $6.2M |
| E2402 | Negative pressure wound therapy electrical pump, stationary or portable | 1 | 10 | 4,010 | $160 | $3.3M |
| E0604 | Breast pump, hospital grade, electric (ac and / or dc), any type | 1 | 10 | 90,100 | $30 | $2.7M |
| 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,… | 2 | 10 | 3,250 | $210 | $2.5M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 1 | 10 | 2,200 | $760 | $2.1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 20 | 2,850 | $160 | $1.5M |
| 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 | 520 | $310 | $1.5M |
| E1399 | Durable medical equipment, miscellaneous | 4 | 20 | 660 | $450 | $1.2M |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2 | 10 | 660 | $460 | $1.2M |
| E0652 | Pneumatic compressor, segmental home model with calibrated gradient pressure | 1 | 10 | 1,980 | $520 | $1M |