| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 5 | 10 | 1,810 | $310 | $1.2M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 1 | 20 | 440 | $140 | $543.9K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 6 | 10 | 1,130 | $200 | $279.4K |
| B4036 | Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 5 | 10 | 1,860 | $90 | $199.9K |
| 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,… | 5 | 10 | 640 | $120 | $199.7K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 6 | 10 | 1,340 | $150 | $196.8K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 1,780 | $50 | $146.6K |
| B9002 | Enteral nutrition infusion pump, any type | 6 | 10 | 1,680 | $80 | $120.7K |
| B4152 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include… | 3 | 10 | 800 | $70 | $89.2K |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) | 4 | 10 | 1,460 | $20 | $58.2K |