| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 740 | $180 | $1.3M |
| 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… | 2 | 10 | 860 | $310 | $1.1M |
| B9002 | Enteral nutrition infusion pump, any type | 2 | 10 | 5,350 | $30 | $983.8K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 6,400 | $150 | $927.5K |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) | 3 | 10 | 3,850 | $170 | $899.7K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2 | 10 | 880 | $240 | $588.4K |
| 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,… | 3 | 10 | 990 | $110 | $419.9K |
| 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… | 2 | 10 | 1,750 | $140 | $336.2K |
| B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100… | 4 | 10 | 1,430 | $110 | $318.9K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 4 | 10 | 240 | $60 | $132K |