| 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… | 6 | 10 | 4,070 | $520 | $2.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 6 | 10 | 2,840 | $410 | $1.5M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 6 | 20 | 920 | $230 | $1.4M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 3 | 10 | 1,020 | $800 | $1.3M |
| A9999 | Miscellaneous dme supply or accessory, not otherwise specified | 4 | 10 | 410 | $230 | $1M |
| E0482 | Cough stimulating device, alternating positive and negative airway pressure | 2 | 10 | 2,350 | $330 | $722.6K |
| E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive… | 1 | 10 | 1,270 | $380 | $485.6K |
| B9002 | Enteral nutrition infusion pump, any type | 5 | 10 | 1,040 | $90 | $393.1K |
| A4605 | Tracheal suction catheter, closed system, each | 2 | 10 | 1,040 | $320 | $386.3K |
| 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,… | 7 | 10 | 2,520 | $140 | $357K |