| 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 | 1,270 | $1,150 | $2M |
| 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 | 1,100 | $260 | $547K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 1,560 | $130 | $516.7K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 6 | 20 | 630 | $410 | $392.3K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 1 | 10 | 640 | $570 | $367.2K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 14 | 30 | 3,430 | $40 | $326.4K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 4 | 10 | 1,120 | $180 | $198.5K |
| 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… | 2 | 10 | 250 | $70 | $171.8K |
| A4305 | Disposable drug delivery system, flow rate of 50 ml or greater per hour | 2 | 10 | 1,210 | $130 | $158.5K |
| 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… | 2 | 10 | 1,850 | $70 | $122.1K |