| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 27,960 | $50 | $1.4M |
| 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… | 1,500 | $810 | $1.2M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2,870 | $410 | $1.2M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 3,400 | $210 | $724.4K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 2,330 | $130 | $293.3K |
| K0001 | Standard wheelchair | 11,860 | $20 | $261K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2,530 | $100 | $260.8K |
| E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips | 5,240 | $50 | $246.1K |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 1,280 | $180 | $234.1K |
| E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress | 7,190 | $30 | $222.8K |