| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10 | 20 | 6,040 | $210 | $2.1M |
| B4087 | Gastrostomy/jejunostomy tube, standard, any material, any type, each | 12 | 10 | 3,320 | $130 | $965.1K |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 8 | 10 | 1,140 | $450 | $561.4K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 2 | 80 | 4,270 | $50 | $417K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 4 | 20 | 760 | $290 | $389K |
| 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… | 9 | 20 | 1,760 | $100 | $281.3K |
| 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… | 8 | 20 | 1,150 | $130 | $274.3K |
| B9002 | Enteral nutrition infusion pump, any type | 10 | 20 | 1,140 | $100 | $250.3K |
| E0601 | Continuous positive airway pressure (CPAP) device | 44 | 90 | 1,970 | $70 | $242.5K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 7 | 10 | 1,330 | $220 | $242.4K |