| 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 | 10 | 2,190 | $710 | $6.2M |
| 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 | 3,250 | $210 | $2.5M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10 | 20 | 2,850 | $160 | $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… | 6 | 10 | 520 | $310 | $1.5M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 89 | 100 | 8,410 | $40 | $728.2K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 6 | 20 | 2,730 | $90 | $643.1K |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 3 | 10 | 1,110 | $130 | $424.1K |
| 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… | 7 | 20 | 2,170 | $100 | $373.3K |
| B9002 | Enteral nutrition infusion pump, any type | 12 | 10 | 2,540 | $60 | $342.5K |
| 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 | 2,560 | $100 | $334.1K |