| 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… | 1 | 10 | 930 | $600 | $865.3K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1 | 10 | 430 | $400 | $356.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 20 | 1,020 | $90 | $319.7K |
| 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,… | 1 | 10 | 1,970 | $150 | $293.2K |
| B9002 | Enteral nutrition infusion pump, any type | 1 | 10 | 1,380 | $90 | $122.2K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 3 | 10 | 210 | $130 | $90.3K |
| 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… | 3 | 10 | 830 | $70 | $85.6K |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 3 | 10 | 260 | $50 | $79.4K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 2 | 10 | 1,350 | $40 | $69.1K |
| B9998 | Noc for enteral supplies | 1 | 10 | 1,200 | $60 | $59.7K |