| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 13 | 20 | 730 | $2,870 | $3.5M |
| 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… | 4 | 20 | 1,400 | $80 | $2.7M |
| J3380 | Injection, vedolizumab, intravenous, 1 mg | 14 | 20 | 120 | $5,050 | $1.9M |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 1 | 10 | 1,060 | $810 | $1.9M |
| 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… | 8 | 20 | 590 | $610 | $1.7M |
| S9366 | Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all… | 1 | 10 | 2,140 | $670 | $1.4M |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 9 | 20 | 140 | $2,120 | $1.4M |
| 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… | 2 | 20 | 1,660 | $260 | $897.7K |
| S9365 | Home infusion therapy, total parenteral nutrition (tpn); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment… | 1 | 10 | 1,520 | $530 | $810.5K |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 12 | 20 | 320 | $1,170 | $765.3K |