| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 8 | 10 | 1,300 | $500 | $1.1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 15 | 30 | 3,000 | $90 | $961.2K |
| 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,… | 17 | 20 | 2,850 | $110 | $728.4K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 12 | 150 | 8,400 | $30 | $342.7K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 29 | 50 | 410 | $210 | $248.6K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 19 | 30 | 1,570 | $30 | $161.8K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 8 | 10 | 910 | $90 | $161.4K |
| B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100… | 13 | 20 | 1,280 | $40 | $153.1K |
| 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… | 14 | 30 | 610 | $30 | $143.4K |
| A4629 | Tracheostomy care kit for established tracheostomy | 10 | 20 | 590 | $50 | $103.6K |