| 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… | 4 | 30 | 3,090 | $330 | $1.5M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 3 | 20 | 1,770 | $320 | $954.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 3 | 50 | 3,660 | $140 | $902.9K |
| B4189 | Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix | 2 | 10 | 600 | $750 | $590.9K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 26 | 160 | 6,970 | $40 | $504.9K |
| S9494 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and… | 5 | 20 | 3,060 | $100 | $461.7K |
| 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 | 50 | 1,180 | $100 | $407.9K |
| B4185 | Parenteral nutrition solution, not otherwise specified, 10 grams lipids | 3 | 10 | 740 | $110 | $325K |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1 | 10 | 410 | $480 | $304.9K |
| B4224 | Parenteral nutrition administration kit, per day | 3 | 10 | 3,530 | $60 | $256.4K |