| 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… | 3,430 | $870 | $3M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10,150 | $220 | $2.3M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 2,800 | $790 | $2.2M |
| E0601 | Continuous positive airway pressure (CPAP) device | 30,410 | $50 | $1.5M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 21,230 | $60 | $1.3M |
| 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,… | 2,720 | $240 | $650.6K |
| A7030 | Full face mask used with positive airway pressure device, each | 8,190 | $80 | $622.2K |
| 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… | 1,110 | $490 | $542.9K |
| E0562 | Humidifier, heated, used with positive airway pressure device | 6,160 | $70 | $419.2K |
| A4554 | Disposable underpads, all sizes | 3,750 | $110 | $397.8K |