| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 2 | 20 | 1,290 | $750 | $2M |
| 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… | 7 | 30 | 3,090 | $330 | $1.5M |
| E1399 | Durable medical equipment, miscellaneous | 3 | 20 | 470 | $480 | $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… | 5 | 20 | 1,770 | $320 | $954.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 9 | 50 | 3,660 | $140 | $902.9K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 21 | 60 | 1,000 | $350 | $612.2K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 3 | 40 | 1,020 | $150 | $584.2K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 58 | 160 | 6,970 | $40 | $504.9K |
| 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,… | 15 | 50 | 1,180 | $100 | $407.9K |
| A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation | 2 | 10 | 100 | $250 | $392.4K |