| 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 | 10 | 2,820 | $540 | $2.9M |
| A4353 | Intermittent urinary catheter, with insertion supplies | 7 | 10 | 950 | $680 | $2.5M |
| S9342 | Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits… | 6 | 10 | 3,640 | $140 | $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,… | 2 | 20 | 2,160 | $160 | $1M |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 1 | 10 | 2,800 | $140 | $915.5K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 1 | 20 | 3,430 | $80 | $650K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 1 | 20 | 2,730 | $80 | $633.1K |
| T4523 | Adult sized disposable incontinence product, brief/diaper, large, each | 1 | 20 | 1,320 | $110 | $594.7K |
| 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… | 1 | 30 | 2,430 | $110 | $592.1K |
| T4530 | Pediatric sized disposable incontinence product, brief/diaper, large size, each | 2 | 10 | 1,390 | $120 | $547.2K |