| 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… | 11 | 10 | 1,020 | $540 | $2.7M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 17 | 20 | 6,040 | $210 | $2.1M |
| 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,… | 10 | 10 | 2,060 | $120 | $716.9K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 4 | 80 | 4,270 | $50 | $417K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 13 | 20 | 760 | $290 | $389K |
| E0601 | Continuous positive airway pressure (CPAP) device | 26 | 90 | 1,970 | $70 | $242.5K |
| 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… | 18 | 20 | 230 | $290 | $143.2K |
| A7030 | Full face mask used with positive airway pressure device, each | 7 | 80 | 1,050 | $80 | $125.7K |
| E0562 | Humidifier, heated, used with positive airway pressure device | 5 | 80 | 540 | $100 | $103.4K |
| A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | 9 | 90 | 1,070 | $50 | $94.1K |