| 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… | 10 | 10 | 2,820 | $540 | $2.9M |
| 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… | 1 | 10 | 3,640 | $140 | $2M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 5 | 10 | 1,050 | $470 | $1.1M |
| S9500 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and… | 5 | 10 | 1,110 | $260 | $1.1M |
| 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,… | 15 | 20 | 2,160 | $160 | $1M |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 14 | 20 | 1,890 | $330 | $830.4K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 25 | 40 | 2,460 | $50 | $518.1K |
| S9343 | Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits… | 5 | 10 | 1,420 | $150 | $378.4K |
| A4927 | Gloves, non-sterile, per 100 | 30 | 40 | 2,580 | $30 | $338.5K |
| S9501 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and… | 4 | 10 | 570 | $290 | $324.6K |