| 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… | 9 | 30 | 3,090 | $330 | $1.5M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 11 | 20 | 1,770 | $320 | $954.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 50 | 3,660 | $140 | $902.9K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 21 | 40 | 1,020 | $150 | $584.2K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 28 | 160 | 6,970 | $40 | $504.9K |
| 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,… | 21 | 50 | 1,180 | $100 | $407.9K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 62 | 70 | 610 | $130 | $243.7K |
| B4155 | Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium… | 17 | 20 | 1,160 | $110 | $229.7K |
| 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… | 54 | 100 | 900 | $90 | $204.5K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 9 | 20 | 650 | $130 | $184.1K |