| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 850 | $300 | $1M |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 3 | 10 | 630 | $220 | $557.2K |
| 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… | 2 | 10 | 240 | $540 | $555.1K |
| 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,… | 6 | 10 | 650 | $180 | $533.1K |
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | 3 | 10 | 970 | $260 | $223.7K |
| B9002 | Enteral nutrition infusion pump, any type | 4 | 10 | 70 | $130 | $213K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 4 | 10 | 40 | $110 | $207.8K |
| 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… | 5 | 10 | 1,080 | $150 | $151.9K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 6 | 10 | 120 | $170 | $138.1K |
| 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… | 14 | 20 | 280 | $110 | $133.5K |