| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 1 | 10 | 990 | $650 | $1.7M |
| 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… | 1 | 10 | 1,030 | $450 | $1.1M |
| S8189 | Tracheostomy supply, not otherwise classified | 1 | 10 | 4,540 | $70 | $1.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1 | 10 | 2,760 | $360 | $1M |
| A4353 | Intermittent urinary catheter, with insertion supplies | 2 | 10 | 760 | $860 | $980.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 1 | 30 | 1,500 | $150 | $899.7K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 1 | 10 | 1,090 | $330 | $897K |
| 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… | 1 | 10 | 1,130 | $580 | $868.6K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 14 | 40 | 2,410 | $140 | $800.1K |
| A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation | 1 | 10 | 5,760 | $120 | $704.9K |