| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10 | 20 | 1,990 | $210 | $1.1M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 7 | 10 | 1,710 | $520 | $915.3K |
| 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 | 790 | $150 | $638.5K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 1 | 70 | 4,460 | $60 | $538K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 2 | 20 | 440 | $270 | $305.6K |
| E0601 | Continuous positive airway pressure (CPAP) device | 10 | 80 | 2,470 | $70 | $281K |
| E1399 | Durable medical equipment, miscellaneous | 8 | 10 | 340 | $280 | $272K |
| 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… | 11 | 10 | 1,040 | $120 | $254.8K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 8 | 10 | 1,290 | $90 | $231.8K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 9 | 10 | 770 | $100 | $221.1K |