| 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… | 2,280 | $270 | $610.2K |
| 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,… | 4,290 | $120 | $501.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7,180 | $60 | $430.6K |
| 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… | 2,260 | $110 | $251.1K |
| B4100 | Food thickener, administered orally, per ounce | 2,320 | $100 | $234.3K |
| 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… | 2,190 | $100 | $227.3K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 890 | $260 | $226.6K |
| B9998 | Noc for enteral supplies | 3,520 | $20 | $80.9K |
| A4213 | Syringe, sterile, 20 cc or greater, each | 560 | $120 | $67.3K |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) | 5,290 | $10 | $52.9K |