| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 10 | 30 | 990 | $310 | $1.4M |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 19 | 20 | 1,990 | $160 | $525.8K |
| E0601 | Continuous positive airway pressure (CPAP) device | 8 | 80 | 2,450 | $60 | $338.6K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 3 | 80 | 3,570 | $40 | $316K |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 2 | 10 | 2,530 | $50 | $245.1K |
| A7030 | Full face mask used with positive airway pressure device, each | 12 | 60 | 1,260 | $80 | $197.2K |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 2 | 10 | 500 | $70 | $161.2K |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive… | 11 | 40 | 470 | $140 | $143.6K |
| A7031 | Face mask interface, replacement for full face mask, each | 23 | 60 | 1,840 | $30 | $114.2K |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | 3 | 10 | 640 | $80 | $113.9K |