| 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… | 6 | 10 | 1,030 | $450 | $1.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 4 | 10 | 2,760 | $360 | $1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 5 | 30 | 1,500 | $150 | $899.7K |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 1 | 10 | 320 | $2,310 | $740.3K |
| 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… | 3 | 10 | 2,550 | $150 | $644.6K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1 | 10 | 90 | $2,630 | $449K |
| 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 | 20 | 1,040 | $160 | $444.8K |
| 99601 | The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit. | 3 | 10 | 2,310 | $80 | $371K |
| 99602 | The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for each additional hour of the visit after the first two hours. | 3 | 10 | 3,280 | $100 | $365.6K |
| 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… | 1 | 10 | 1,250 | $200 | $258.2K |