Enteral Nutrients, Equipment and Supplies

Transcription

1 DMEPOS Competitive Bidding Program Bid Preparation Worksheet Round 2 Estimated Capacity & Bid Amount Calculations Enteral Nutrients, Equipment and Supplies ***Please read the important information provided on page 4 before proceeding to the page(s) for a specific competitive bidding area.*** Akron, OH 4 Albany-Schenectady-Troy, NY 5 Albuquerque, NM 5 Allentown-Bethlehem-Easton, PA-NJ 6 Asheville, NC 6 Atlanta-Sandy Springs-Marietta, GA 7 Augusta-Richmond County, GA-SC 7 Austin-Round Rock-San Marcos, TX 8 Bakersfield-Delano, CA 9 Baltimore-Towson, MD 9 Baton Rouge, LA 10 Beaumont-Port Arthur, TX 10 Birmingham-Hoover, AL 11 Boise City-Nampa, ID 11 Boston-Cambridge-Quincy, MA-NH 12 Bridgeport-Stamford-Norwalk, CT 13 Bronx-Manhattan NY CBA 13 Buffalo-Niagara Falls, NY 14 Cape Coral-Fort Myers, FL 14 Central-Chicago Metro CBA 15 Charleston-North Charleston-Summerville, SC 15 Chattanooga, TN-GA 16 Colorado Springs, CO 17 Columbia, SC 17 Columbus, OH 18 Dayton, OH 18 Deltona-Daytona Beach-Ormond Beach, FL 19 Denver-Aurora-Broomfield, CO 19 Detroit-Warren-Livonia, MI 20 El Paso, TX 21 Flint, MI 21

2 Fresno, CA 22 Grand Rapids-Wyoming, MI 22 Greensboro-High Point, NC 23 Greenville-Mauldin-Easley, SC 23 Hartford-West Hartford-East Hartford, CT 24 Honolulu, HI 25 Houston-Sugar Land-Baytown, TX 25 Huntington-Ashland, WV-KY-OH 26 Indiana-Chicago Metro CBA 26 Indianapolis-Carmel, IN 27 Jackson, MS 27 Jacksonville, FL 28 Knoxville, TN 29 Lakeland-Winter Haven, FL 29 Las Vegas-Paradise, NV 30 Little Rock-North Little Rock-Conway, AR 30 Los Angeles County CBA 31 Louisville/Jefferson County, KY-IN 31 McAllen-Edinburg-Mission, TX 32 Memphis, TN-MS-AR 33 Milwaukee-Waukesha-West Allis, WI 33 Minneapolis-St. Paul-Bloomington, MN-WI 34 Nashville-Davidson--Murfreesboro--Franklin, TN 34 Nassau-Brooklyn-Queens-Richmond County Metro CBA 35 New Haven-Milford, CT 35 New Orleans-Metairie-Kenner, LA 36 North East NY CBA Metro 37 North Port-Bradenton-Sarasota, FL 37 Northern NJ Metro CBA 38 Northern-Chicago Metro CBA 38 Ocala, FL 39 Oklahoma City, OK 39 Omaha-Council Bluffs, NE-IA 40 Orange County CBA 41 Oxnard-Thousand Oaks-Ventura, CA 41 Palm Bay-Melbourne-Titusville, FL 42 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 42 Phoenix-Mesa-Glendale, AZ 43

3 Portland-Vancouver-Hillsboro, OR-WA 43 Poughkeepsie-Newburgh-Middletown, NY 44 Providence-New Bedford-Fall River, RI-MA 45 Raleigh-Cary, NC 45 Richmond, VA 46 Rochester, NY 46 Sacramento--Arden-Arcade--Roseville, CA 47 Salt Lake City, UT 47 San Antonio-New Braunfels, TX 48 San Diego-Carlsbad-San Marcos, CA 49 San Francisco-Oakland-Fremont, CA 49 San Jose-Sunnyvale-Santa Clara, CA 50 Scranton--Wilkes-Barre, PA 50 Seattle-Tacoma-Bellevue, WA 51 South-West-Chicago-Metro CBA 51 Southern NY Metro CBA 52 Springfield, MA 53 St. Louis, MO-IL 53 Stockton, CA 54 Suffolk County CBA 54 Syracuse, NY 55 Tampa-St. Petersburg-Clearwater, FL 55 Toledo, OH 56 Tucson, AZ 57 Tulsa, OK 57 Virginia Beach-Norfolk-Newport News, VA-NC 58 Visalia-Porterville, CA 58 Washington-Arlington-Alexandria, DC-VA-MD-WV 59 Wichita, KS 59 Worcester, MA 60 Youngstown-Warren-Boardman, OH-PA 61

4 DMEPOS Competitive Bidding Bid Preparation Worksheet - Round 2 Estimated Capacity & Bid Amount Calculations This worksheet is provided to assist you with determining your bid amount and estimated capacity for each item in the product category. This information will be entered in DBidS, the online bidding system, on Form B. capacity is the estimated number of units that you believe you can provide in the competitive bidding area in a calendar year. All bid amounts must be bona fide (rational and feasible for you to furnish at the bid price). You must not submit a bid for an item at a loss in order to improve your chances of winning a contract. It is important for you to consider and include your cost to purchase the item, overhead, and profit when determining a bid amount for a unit. CMS will evaluate bids to verify that they are bona fide and may ask you to submit additional information, including a rationale and invoices or other documents, to validate the bid amount. Save a copy of your completed worksheet to use if CMS requests documentation to support your bid amount. Please review the Request for Bids (RFB) instructions and fact sheets for assistance with completing your bid sheet (Form B). General Notes * The bidding units defined in this worksheet are for bidding purposes ONLY. Please carefully review the definition of a bidding unit for each HCPCS (Healthcare Common Procedure Coding System) code and make sure you submit your bid amount correctly. Do NOT submit a rental bid amount when the definition of the bidding unit is for the purchase of a new item. The definition of a bidding unit (purchase or rental) is not necessarily an indication that this is how payment will be made for the item under the competitive bidding program. * In all situations where a competitive bidding area (CBA) covers more than one state, the fee schedule amount for the state with the highest allowed charges (the Medicare approved amount paid for an item) for items subject to competitive bidding is used as the bid limit. * 2010 Beneficiary Count may exceed 2010 Allowed Units because the beneficiary used the item for less than 10 months. (For bidding purposes, 10 months of rental are calculated as one unit) * Items that are currently paid on a monthly rental basis will continue to be paid on a monthly rental basis under the competitive bidding program How Purchase Bids Will Be Converted to Rental Payments * Capped Rental Durable Medical Equipment (DME) except power wheelchairs - single payment amount for rental months 1-3 based on 10 percent of purchase bids and single payment amount for rental months 4-13 based on 7.5 percent of purchase bids * Power Wheelchairs - single payment amount for rental months 1-3 based on 15 percent of purchase bids and single payment amount for rental months 4-13 based on 6 percent of purchase bids * Enteral Nutrition Equipment - single payment amount for rental months 1-3 based on 10 percent of purchase bids and single payment amount for rental months 4-15 based on 7.5 percent of purchase bid * Inexpensive or Routinely Purchased (IRP) DME - single payment amount for rental based on 10 percent of purchase of bids The order in which HCPCS codes are presented in this worksheet is NOT NECESSARILY the order in which they will appear in Form B in DBidS. It is important that you CAREFULLY REVIEW THE DATA YOU ENTER IN DBIDS FOR ACCURACY. Product Category: Enteral Nutrients, Equipment and Supplies Reference Data for Background Informational Purposes Only Reference Data for Background Informational Purposes Only Bidder Data (You will enter your estimated capacity and bid amount information in DBidS on Form B) Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH B4150 B4152 B4154 B4035 B4153 B4034 B4155 B4036 B4149 HCPCS Code Akron, OH E0776BA IV Pole: Item w PEN Services HCPCS Code Description Definition of a Bidding Unit Weight (The relative market importance of the item in the product category based on utilization) 2010 Beneficiary Count (Number of unique Medicare beneficiaries in the CBA that received the product in CY 2010) 2010 Allowed Units for the CBA and HCPCS code paid by Medicare in CY 2010) Bid Limit (2012 Fee Schedule: Bid amount must be at or below this amount) Feeding Tube, 100 Calories = 1 Unit new unit ,460 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Akron, OH B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each Akron, OH B9002 Enteral Nutrition Infusion Pump - With Alarm Akron, OH B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each Akron, OH B4082 Nasogastric Tubing Without Stylet new unit ,950 $0.55 new unit ,325 $1.21 new unit ,136 $11.56 new unit ,041 $1.89 new unit ,335 $6.06 new unit ,918 $0.94 new unit ,599 $7.94 new unit $1.56 new unit $ new unit $35.39 new unit $1, new unit $35.39 new unit $15.94 Cost to Purchase One (1) Unit (Should be less than your bid amount) Bid Amount (To provide one [1] unit as described in Definition of a Bidding Unit; should include cost to buy unit, overhead and profit) Estimated Capacity (Number of units you can furnish in the CBA for one [1] year)

5 2010 Bid Beneficiary 2010 Allowed Cost Amount Akron, OH B4081 Nasogastric Tubing With Stylet new unit $21.44 Akron, OH B4083 Stomach Tube - Levine Type new unit $2.45 Akron, OH B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Albany-Schenectady-Troy, NY B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,046 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Albany-Schenectady-Troy, NY B4152 = 1 Unit new unit ,347 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Albany-Schenectady-Troy, NY B4154 Tube, 100 Calories = 1 Unit new unit ,335 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Albany-Schenectady-Troy, NY B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,357 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Albany-Schenectady-Troy, NY B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,841 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Albany-Schenectady-Troy, NY B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,916 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Albany-Schenectady-Troy, NY B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,034 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Albany-Schenectady-Troy, NY B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,148 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Albany-Schenectady-Troy, NY B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Albany-Schenectady-Troy, NY E0776BA IV Pole: Item w PEN Services new unit $ Albany-Schenectady-Troy, NY B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Albany-Schenectady-Troy, NY B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Albany-Schenectady-Troy, NY B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Albany-Schenectady-Troy, NY B4082 Nasogastric Tubing Without Stylet new unit $15.94 Albany-Schenectady-Troy, NY B4081 Nasogastric Tubing With Stylet new unit $21.44 Albany-Schenectady-Troy, NY B4083 Stomach Tube - Levine Type new unit $2.45 Albany-Schenectady-Troy, NY B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Albuquerque, NM B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,454 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Albuquerque, NM B4152 = 1 Unit new unit ,171 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Albuquerque, NM B4154 Tube, 100 Calories = 1 Unit new unit ,243 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Albuquerque, NM B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,927 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Albuquerque, NM B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,112 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Albuquerque, NM B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,352 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Albuquerque, NM B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,442 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Albuquerque, NM B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,723 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Albuquerque, NM B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,615 $1.56

6 2010 Bid Beneficiary 2010 Allowed Cost Amount Albuquerque, NM E0776BA IV Pole: Item w PEN Services new unit $ Albuquerque, NM B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Albuquerque, NM B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Albuquerque, NM B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Albuquerque, NM B4082 Nasogastric Tubing Without Stylet new unit $15.94 Albuquerque, NM B4081 Nasogastric Tubing With Stylet new unit $21.44 Albuquerque, NM B4083 Stomach Tube - Levine Type new unit $2.45 Albuquerque, NM B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Allentown-Bethlehem-Easton, PA-NJ B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,362 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Allentown-Bethlehem-Easton, PA-NJ B4152 = 1 Unit new unit ,696 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Allentown-Bethlehem-Easton, PA-NJ B4154 Tube, 100 Calories = 1 Unit new unit ,490 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Allentown-Bethlehem-Easton, PA-NJ B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,498 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Allentown-Bethlehem-Easton, PA-NJ B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,738 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Allentown-Bethlehem-Easton, PA-NJ B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,874 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Allentown-Bethlehem-Easton, PA-NJ B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,700 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Allentown-Bethlehem-Easton, PA-NJ B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,716 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Allentown-Bethlehem-Easton, PA-NJ B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Allentown-Bethlehem-Easton, PA-NJ E0776BA IV Pole: Item w PEN Services new unit $ Allentown-Bethlehem-Easton, PA-NJ B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Allentown-Bethlehem-Easton, PA-NJ B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Allentown-Bethlehem-Easton, PA-NJ B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Allentown-Bethlehem-Easton, PA-NJ B4082 Nasogastric Tubing Without Stylet new unit $15.94 Allentown-Bethlehem-Easton, PA-NJ B4081 Nasogastric Tubing With Stylet new unit $21.44 Allentown-Bethlehem-Easton, PA-NJ B4083 Stomach Tube - Levine Type new unit $2.45 Allentown-Bethlehem-Easton, PA-NJ B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Asheville, NC B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,342 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Asheville, NC B4152 = 1 Unit new unit ,072 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Asheville, NC B4154 Tube, 100 Calories = 1 Unit new unit ,535 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Asheville, NC B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,347 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Asheville, NC B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,030 $1.89

7 Asheville, NC Asheville, NC Asheville, NC Asheville, NC B4034 B4155 B4036 B4149 HCPCS Code HCPCS Code Description Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Definition of a Bidding Unit Weight (The relative market importance of the item in the product category based on utilization) 2010 Beneficiary Count (Number of unique Medicare beneficiaries in the CBA that received the product in CY 2010) 2010 Allowed Units for the CBA and HCPCS code paid by Medicare in CY 2010) Bid Limit (2012 Fee Schedule: Bid amount must be at or below this amount) new unit ,529 $6.06 new unit ,562 $0.94 new unit ,078 $7.94 new unit $1.56 Asheville, NC E0776BA IV Pole: Item w PEN Services new unit $ Asheville, NC B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Asheville, NC B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Asheville, NC B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Asheville, NC B4082 Nasogastric Tubing Without Stylet new unit $15.94 Asheville, NC B4081 Nasogastric Tubing With Stylet new unit $21.44 Asheville, NC B4083 Stomach Tube - Levine Type new unit $2.45 Asheville, NC B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Atlanta-Sandy Springs-Marietta, GA B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,476,817 $0.67 Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA B4152 B4154 B4035 B4153 B4034 B4155 B4036 B4149 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,054,818 $0.55 new unit ,097,859 $1.21 new unit ,684 $11.56 new unit ,263 $1.89 new unit ,738 $6.06 new unit ,750 $0.94 new unit ,369 $7.94 new unit ,641 $1.56 Atlanta-Sandy Springs-Marietta, GA E0776BA IV Pole: Item w PEN Services new unit $ Atlanta-Sandy Springs-Marietta, GA B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Atlanta-Sandy Springs-Marietta, GA B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Atlanta-Sandy Springs-Marietta, GA B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Atlanta-Sandy Springs-Marietta, GA B4082 Nasogastric Tubing Without Stylet new unit $15.94 Atlanta-Sandy Springs-Marietta, GA B4081 Nasogastric Tubing With Stylet new unit $21.44 Atlanta-Sandy Springs-Marietta, GA B4083 Stomach Tube - Levine Type new unit $2.45 Atlanta-Sandy Springs-Marietta, GA B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Augusta-Richmond County, GA-SC B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,282 $0.67 Cost to Purchase One (1) Unit (Should be less than your bid amount) Bid Amount (To provide one [1] unit as described in Definition of a Bidding Unit; should include cost to buy unit, overhead and profit) Estimated Capacity (Number of units you can furnish in the CBA for one [1] year)

8 2010 Bid Beneficiary 2010 Allowed Cost Amount Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Augusta-Richmond County, GA-SC B4152 = 1 Unit new unit ,224 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Augusta-Richmond County, GA-SC B4154 Tube, 100 Calories = 1 Unit new unit ,312 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Augusta-Richmond County, GA-SC B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,251 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Augusta-Richmond County, GA-SC B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,650 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Augusta-Richmond County, GA-SC B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,541 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Augusta-Richmond County, GA-SC B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,127 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Augusta-Richmond County, GA-SC B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,054 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Augusta-Richmond County, GA-SC B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Augusta-Richmond County, GA-SC E0776BA IV Pole: Item w PEN Services new unit $ Augusta-Richmond County, GA-SC B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Augusta-Richmond County, GA-SC B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Augusta-Richmond County, GA-SC B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Augusta-Richmond County, GA-SC B4082 Nasogastric Tubing Without Stylet new unit $15.94 Augusta-Richmond County, GA-SC B4081 Nasogastric Tubing With Stylet new unit $21.44 Augusta-Richmond County, GA-SC B4083 Stomach Tube - Levine Type new unit $2.45 Augusta-Richmond County, GA-SC B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Austin-Round Rock-San Marcos, TX B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,961 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Austin-Round Rock-San Marcos, TX B4152 = 1 Unit new unit ,203 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Austin-Round Rock-San Marcos, TX B4154 Tube, 100 Calories = 1 Unit new unit ,896 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Austin-Round Rock-San Marcos, TX B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,820 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Austin-Round Rock-San Marcos, TX B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,179 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Austin-Round Rock-San Marcos, TX B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,598 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Austin-Round Rock-San Marcos, TX B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,844 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Austin-Round Rock-San Marcos, TX B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,209 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Austin-Round Rock-San Marcos, TX B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,230 $1.56 Austin-Round Rock-San Marcos, TX E0776BA IV Pole: Item w PEN Services new unit $ Austin-Round Rock-San Marcos, TX B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Austin-Round Rock-San Marcos, TX B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Austin-Round Rock-San Marcos, TX B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39

9 2010 Bid Beneficiary 2010 Allowed Cost Amount Austin-Round Rock-San Marcos, TX B4082 Nasogastric Tubing Without Stylet new unit $15.94 Austin-Round Rock-San Marcos, TX B4081 Nasogastric Tubing With Stylet new unit $21.44 Austin-Round Rock-San Marcos, TX B4083 Stomach Tube - Levine Type new unit $2.45 Austin-Round Rock-San Marcos, TX B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Bakersfield-Delano, CA B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,521 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Bakersfield-Delano, CA B4152 = 1 Unit new unit ,030 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Bakersfield-Delano, CA B4154 Tube, 100 Calories = 1 Unit new unit ,731 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Bakersfield-Delano, CA B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,116 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Bakersfield-Delano, CA B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,662 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Bakersfield-Delano, CA B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,597 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Bakersfield-Delano, CA B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,128 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Bakersfield-Delano, CA B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Bakersfield-Delano, CA B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Bakersfield-Delano, CA E0776BA IV Pole: Item w PEN Services new unit $ Bakersfield-Delano, CA B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Bakersfield-Delano, CA B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Bakersfield-Delano, CA B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Bakersfield-Delano, CA B4082 Nasogastric Tubing Without Stylet new unit $15.94 Bakersfield-Delano, CA B4081 Nasogastric Tubing With Stylet new unit $21.44 Bakersfield-Delano, CA B4083 Stomach Tube - Levine Type new unit $2.45 Bakersfield-Delano, CA B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Baltimore-Towson, MD B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,100,450 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Baltimore-Towson, MD B4152 = 1 Unit new unit ,486,585 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Baltimore-Towson, MD B4154 Tube, 100 Calories = 1 Unit new unit ,622 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Baltimore-Towson, MD B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,999 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Baltimore-Towson, MD B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,012 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Baltimore-Towson, MD B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,133 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Baltimore-Towson, MD B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,412 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Baltimore-Towson, MD B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,551 $7.94

10 2010 Bid Beneficiary 2010 Allowed Cost Amount Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Baltimore-Towson, MD B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,166 $1.56 Baltimore-Towson, MD E0776BA IV Pole: Item w PEN Services new unit $ Baltimore-Towson, MD B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Baltimore-Towson, MD B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Baltimore-Towson, MD B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Baltimore-Towson, MD B4082 Nasogastric Tubing Without Stylet new unit $15.94 Baltimore-Towson, MD B4081 Nasogastric Tubing With Stylet new unit $21.44 Baltimore-Towson, MD B4083 Stomach Tube - Levine Type new unit $2.45 Baltimore-Towson, MD B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Baton Rouge, LA B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,432 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Baton Rouge, LA B4152 = 1 Unit new unit ,808 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Baton Rouge, LA B4154 Tube, 100 Calories = 1 Unit new unit ,686 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Baton Rouge, LA B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,092 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Baton Rouge, LA B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,974 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Baton Rouge, LA B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,772 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Baton Rouge, LA B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,547 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Baton Rouge, LA B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,918 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Baton Rouge, LA B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Baton Rouge, LA E0776BA IV Pole: Item w PEN Services new unit $ Baton Rouge, LA B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Baton Rouge, LA B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Baton Rouge, LA B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Baton Rouge, LA B4082 Nasogastric Tubing Without Stylet new unit $15.94 Baton Rouge, LA B4081 Nasogastric Tubing With Stylet new unit $21.44 Baton Rouge, LA B4083 Stomach Tube - Levine Type new unit $2.45 Baton Rouge, LA B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Beaumont-Port Arthur, TX B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,500 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Beaumont-Port Arthur, TX B4152 = 1 Unit new unit ,804 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Beaumont-Port Arthur, TX B4154 Tube, 100 Calories = 1 Unit new unit ,759 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Beaumont-Port Arthur, TX B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,399 $11.56

11 2010 Bid Beneficiary 2010 Allowed Cost Amount Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Beaumont-Port Arthur, TX B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,344 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Beaumont-Port Arthur, TX B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,721 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Beaumont-Port Arthur, TX B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,871 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Beaumont-Port Arthur, TX B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,021 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Beaumont-Port Arthur, TX B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Beaumont-Port Arthur, TX E0776BA IV Pole: Item w PEN Services new unit $ Beaumont-Port Arthur, TX B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Beaumont-Port Arthur, TX B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Beaumont-Port Arthur, TX B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Beaumont-Port Arthur, TX B4082 Nasogastric Tubing Without Stylet new unit $15.94 Beaumont-Port Arthur, TX B4081 Nasogastric Tubing With Stylet new unit $21.44 Beaumont-Port Arthur, TX B4083 Stomach Tube - Levine Type new unit $2.45 Beaumont-Port Arthur, TX B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Birmingham-Hoover, AL B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,204 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Birmingham-Hoover, AL B4152 = 1 Unit new unit ,761 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Birmingham-Hoover, AL B4154 Tube, 100 Calories = 1 Unit new unit ,636 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Birmingham-Hoover, AL B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,525 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Birmingham-Hoover, AL B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,854 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Birmingham-Hoover, AL B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,045 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Birmingham-Hoover, AL B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,302 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Birmingham-Hoover, AL B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,217 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Birmingham-Hoover, AL B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit $1.56 Birmingham-Hoover, AL E0776BA IV Pole: Item w PEN Services new unit $ Birmingham-Hoover, AL B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Birmingham-Hoover, AL B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Birmingham-Hoover, AL B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Birmingham-Hoover, AL B4082 Nasogastric Tubing Without Stylet new unit $15.94 Birmingham-Hoover, AL B4081 Nasogastric Tubing With Stylet new unit $21.44 Birmingham-Hoover, AL B4083 Stomach Tube - Levine Type new unit $2.45 Birmingham-Hoover, AL B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Boise City-Nampa, ID B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,074 $0.67

12 2010 Bid Beneficiary 2010 Allowed Cost Amount Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Boise City-Nampa, ID B4152 = 1 Unit new unit ,119 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Boise City-Nampa, ID B4154 Tube, 100 Calories = 1 Unit new unit ,258 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Boise City-Nampa, ID B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,347 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Boise City-Nampa, ID B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,775 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Boise City-Nampa, ID B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,353 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Boise City-Nampa, ID B4155 Feeding Tube, 100 Calories = 1 Unit new unit $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Boise City-Nampa, ID B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,906 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Boise City-Nampa, ID B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,816 $1.56 Boise City-Nampa, ID E0776BA IV Pole: Item w PEN Services new unit $ Boise City-Nampa, ID B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Boise City-Nampa, ID B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Boise City-Nampa, ID B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Boise City-Nampa, ID B4082 Nasogastric Tubing Without Stylet new unit $15.94 Boise City-Nampa, ID B4081 Nasogastric Tubing With Stylet new unit $21.44 Boise City-Nampa, ID B4083 Stomach Tube - Levine Type new unit $2.45 Boise City-Nampa, ID B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Boston-Cambridge-Quincy, MA-NH B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,946,813 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Boston-Cambridge-Quincy, MA-NH B4152 = 1 Unit new unit ,473,691 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Boston-Cambridge-Quincy, MA-NH B4154 Tube, 100 Calories = 1 Unit new unit ,834 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Boston-Cambridge-Quincy, MA-NH B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,452 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Boston-Cambridge-Quincy, MA-NH B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,104 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Boston-Cambridge-Quincy, MA-NH B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,029 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Boston-Cambridge-Quincy, MA-NH B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,322 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Boston-Cambridge-Quincy, MA-NH B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,879 $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Boston-Cambridge-Quincy, MA-NH B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,431 $1.56 Boston-Cambridge-Quincy, MA-NH E0776BA IV Pole: Item w PEN Services new unit $ Boston-Cambridge-Quincy, MA-NH B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Boston-Cambridge-Quincy, MA-NH B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Boston-Cambridge-Quincy, MA-NH B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39

13 2010 Bid Beneficiary 2010 Allowed Cost Amount Boston-Cambridge-Quincy, MA-NH B4082 Nasogastric Tubing Without Stylet new unit $15.94 Boston-Cambridge-Quincy, MA-NH B4081 Nasogastric Tubing With Stylet new unit $21.44 Boston-Cambridge-Quincy, MA-NH B4083 Stomach Tube - Levine Type new unit $2.45 Boston-Cambridge-Quincy, MA-NH B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Bridgeport-Stamford-Norwalk, CT B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,733 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Bridgeport-Stamford-Norwalk, CT B4152 = 1 Unit new unit ,407 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Bridgeport-Stamford-Norwalk, CT B4154 Tube, 100 Calories = 1 Unit new unit ,036 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Bridgeport-Stamford-Norwalk, CT B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,809 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Bridgeport-Stamford-Norwalk, CT B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,174 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Bridgeport-Stamford-Norwalk, CT B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,651 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Bridgeport-Stamford-Norwalk, CT B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,919 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Bridgeport-Stamford-Norwalk, CT B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit $7.94 Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Bridgeport-Stamford-Norwalk, CT B4149 Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,208 $1.56 Bridgeport-Stamford-Norwalk, CT E0776BA IV Pole: Item w PEN Services new unit $ Bridgeport-Stamford-Norwalk, CT B4087 Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each new unit $35.39 Bridgeport-Stamford-Norwalk, CT B9002 Enteral Nutrition Infusion Pump - With Alarm new unit $1, Bridgeport-Stamford-Norwalk, CT B4088 Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each new unit $35.39 Bridgeport-Stamford-Norwalk, CT B4082 Nasogastric Tubing Without Stylet new unit $15.94 Bridgeport-Stamford-Norwalk, CT B4081 Nasogastric Tubing With Stylet new unit $21.44 Bridgeport-Stamford-Norwalk, CT B4083 Stomach Tube - Levine Type new unit $2.45 Bridgeport-Stamford-Norwalk, CT B9000 Enteral Nutrition Infusion Pump - Without Alarm new unit $1, Bronx-Manhattan NY CBA B4150 Feeding Tube, 100 Calories = 1 Unit new unit ,904,528 $0.67 Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories Bronx-Manhattan NY CBA B4152 = 1 Unit new unit ,534,745 $0.55 Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Bronx-Manhattan NY CBA B4154 Tube, 100 Calories = 1 Unit new unit ,780,559 $1.21 Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Bronx-Manhattan NY CBA B4035 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit , ,031 $11.56 Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Bronx-Manhattan NY CBA B4153 Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit new unit ,659 $1.89 Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Bronx-Manhattan NY CBA B4034 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,840 $6.06 Fat (E.G. Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Bronx-Manhattan NY CBA B4155 Feeding Tube, 100 Calories = 1 Unit new unit ,331 $0.94 Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Bronx-Manhattan NY CBA B4036 Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape new unit ,366 $7.94