| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 1 | 10 | 160 | $30,850 | $4.4M |
| E0603 | Breast pump, electric (ac and/or dc), any type | 11 | 30 | 2,290 | $150 | $1.8M |
| 90378 | Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial… | 6 | 10 | 720 | $2,350 | $1.8M |
| 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… | 3 | 30 | 3,220 | $390 | $1.5M |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each | 5 | 10 | 1,300 | $330 | $911.8K |
| 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,… | 2 | 40 | 2,610 | $120 | $677.4K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4 | 50 | 4,010 | $80 | $640.4K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 3 | 20 | 2,890 | $80 | $601.5K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 3 | 20 | 1,070 | $260 | $575K |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each | 11 | 30 | 760 | $100 | $480.6K |