| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 6 | 10 | 1,150 | $630 | $1.5M |
| 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… | 8 | 10 | 500 | $320 | $1.1M |
| E1399 | Durable medical equipment, miscellaneous | 13 | 30 | 170 | $600 | $996.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 11 | 20 | 2,220 | $120 | $530.7K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 14 | 160 | 5,820 | $40 | $416.1K |
| 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,… | 9 | 10 | 830 | $110 | $314.9K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 4 | 10 | 740 | $120 | $196K |
| 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… | 13 | 20 | 860 | $60 | $164.9K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 8 | 10 | 340 | $90 | $130.1K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 4 | 10 | 550 | $90 | $124.7K |