| 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… | 2 | 10 | 1,070 | $1,900 | $1.5M |
| 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… | 5 | 10 | 250 | $930 | $905.7K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 1 | 10 | 1,390 | $370 | $849.7K |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 2 | 10 | 350 | $2,450 | $844.1K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 10 | 3,440 | $180 | $673K |
| A4231 | Infusion set for external insulin pump, needle type | 1 | 10 | 5,140 | $130 | $663.4K |
| T4541 | Incontinence product, disposable underpad, large, each | 21 | 30 | 1,460 | $30 | $266K |
| K0552 | Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each | 1 | 10 | 3,410 | $70 | $238.4K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 27 | 30 | 990 | $70 | $238.1K |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 1 | 10 | 380 | $550 | $209K |