Medication Charges Part 5

Our Commitment to Quality

Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.

NOTE: When reviewing the pricing for Lab or Pathology tests, if the section below a test is blank, the test is repeated again and these are additional charges (for example - Glucose four-hour tolerance test will have the test repeated one hour, two hours and then three hours after the initial blood work is collected for a total of four hours. Each test is charged separately). If your lab work is a panel, then several tests may be performed from one blood sample. You may be charged for each test separately.

• CEFEPIME   1 G INJ VIAL 60505-6144-4 1 each each 2.328 each 1 each $171.08
• CEFEPIME   1 G INJ VIAL 60505-6144-0 1 each each 2.328 each 1 each $171.08
• CEFEPIME   2 G INJ VIAL 60505-6145-4 1 each each 4.369 each 1 each $173.12
• CEFEPIME   2 G INJ VIAL 60505-6145-0 1 each each 4.369 each 1 each $173.12
• CEFEPIME (MAXIPIME) IV 100 MG/ML (NICU) UHCS-0000-80 1 each each 4.035 each 1 each $172.79
• CEFEPIME 1 G INJ VIAL FOR PUSH 60505-6146-4 1 each each 2.328 each 1 each $171.08
• CEFEPIME 1 G INJ VIAL FOR PUSH 60505-6146-0 1 each each 2.33 each 1 each $171.08
• CEFEPIME 2 G INJ VIAL FOR PUSH 60505-6145-0 1 each each 4.369 each 1 each $173.12
• CEFEPIME 2 G INJ VIAL FOR PUSH 60505-6145-4 1 each each 4.369 each 1 each $173.12
• CEFIDEROCOL 1 G IV VIAL 59630-266-10 1 each each 193.196 each 1 each $388.81
• CEFIDEROCOL 1 G IV VIAL 59630-266-01 1 each each 193.196 each 1 each $388.81
• CEFOXITIN   1 G IV VIAL 25021-109-10 1 each each 3.602 each 1 each $172.35
• CEFOXITIN   2 G IV VIAL 25021-110-20 1 each each 7.02 each 1 each $175.77
• CEFOXITIN 1 G IV VIAL FOR PUSH 44567-245-25 1 each each 2.771 each 1 each $171.52
• CEFOXITIN 1 G IV VIAL FOR PUSH 44567-245-85 1 each each 2.773 each 1 each $171.52
• CEFOXITIN 1 G IV VIAL FOR PUSH 25021-109-10 1 each each 3.602 each 1 each $172.35
• CEFOXITIN 1 G IV VIAL FOR PUSH 60505-0759-1 1 each each 6.535 each 1 each $175.29
• CEFOXITIN 2 G IV VIAL FOR PUSH 25021-110-20 1 each each 7.02 each 1 each $175.77
• CEFPROZIL 250 MG/5 ML ORAL RECON. SUSP. 16714-397-03 100 mL Bottle 0.112 mL 100 mL $59.80
• CEFTAROLINE FOSAMIL 600 MG IV VIAL 0456-0600-10 1 each Vial 172.565 each 1 each $347.29
• CEFTAZIDIME   1 G INJ VIAL 44567-235-25 1 each each 2.965 each 1 each $171.72
• CEFTAZIDIME   2 G INJ VIAL 44567-236-10 1 each each 5.413 each 1 each $174.16
• CEFTAZIDIME (FORTAZ) EYE INJECTION 22.5 MG/ML 1ML UHCS-0004-75 1 mL Syringe 3.34 mL 1 mL $172.09
• CEFTAZIDIME (FORTAZ) IV 100 MG/ML (NICU) UHCS-0000-77 1 each each 3.083 each 1 each $171.83
• CEFTAZIDIME (FORTAZ) IV 40 MG/ML (PEDS) UHCS-0002-01 1 each each 3.048 each 1 each $171.80
• CEFTAZIDIME 1 G INJ VIAL FOR PUSH 44567-235-25 1 each each 2.965 each 1 each $171.72
• CEFTAZIDIME 2 G INJ VIAL FOR PUSH 44567-236-10 1 each each 5.413 each 1 each $174.16
• CEFTAZIDIME-AVIBACTAM 2.5 G IV VIAL 0456-2700-01 1 each each 331.267 each 1 each $666.68
• CEFTRIAXONE   1 G INJ VIAL 0143-9857-25 1 each each 0.85 each 1 each $169.60
• CEFTRIAXONE   1 G INJ VIAL 0143-9857-01 1 each each 0.85 each 1 each $169.60
• CEFTRIAXONE   1 G INJ VIAL 0409-7332-20 1 each each 1.185 each 1 each $169.94
• CEFTRIAXONE   2 G INJ VIAL 0409-7335-20 1 each each 2.234 each 1 each $170.98
• CEFTRIAXONE   2 G INJ VIAL 0409-7335-21 1 each each 2.234 each 1 each $170.98
• CEFTRIAXONE   2 G IV VIAL 0409-7336-04 1 each each 4.908 each 1 each $173.66
• CEFTRIAXONE (ROCEPHIN) IM 250 MG/ML (NICU) UHCS-0000-76 1 each each 0.757 each 1 each $169.51
• CEFTRIAXONE (ROCEPHIN) IV 40 MG/ML (PEDS) UHCS-0002-02 1 each each 10.172 each 1 each $178.92
• CEFTRIAXONE (ROCPHIN) IV 100 MG/ML (NICU) UHCS-0000-75 1 each each 0.757 each 1 each $169.51
• CEFTRIAXONE 1 G INJ VIAL FOR PUSH 0409-7332-20 1 each each 1.185 each 1 each $169.94
• CEFTRIAXONE 2 G INJ VIAL FOR PUSH 0409-7335-20 1 each each 2.234 each 1 each $170.98
• CEFTRIAXONE 2 G INJ VIAL FOR PUSH 0409-7335-21 1 each each 2.234 each 1 each $170.98
• CEFTRIAXONE 250 MG INJ VIAL 0409-7337-20 1 each each 0.508 each 1 each $169.26
• CEFTRIAXONE 500 MG INJ VIAL 0409-7338-20 1 each each 0.628 each 1 each $169.38
• CEFUROXIME (ZINACEF) IV 100 MG/ML (NICU) UHCS-0000-74 1 each each 1.774 each 1 each $170.52
• CEFUROXIME 750 MG FOR ORTHO SOLUTION 0143-9979-22 1 each Vial 1.774 each 1 each $170.52
• CEFUROXIME AXETIL 250 MG ORAL TAB 60687-272-94 20 each each 2.47 each 1 each $14.62
• CEFUROXIME AXETIL 500 MG ORAL TAB 57237-059-20 20 each each 1.848 each 1 each $14.00
• CEFUROXIME SODIUM   1.5 G IV VIAL 0143-9567-25 1 each each 3.769 each 1 each $172.52
• CEFUROXIME SODIUM   1.5 G IV VIAL 0143-9567-01 1 each each 3.769 each 1 each $172.52
• CEFUROXIME SODIUM 1.5 G IV VIAL FOR PUSH 0143-9567-01 1 each each 3.769 each 1 each $172.52
• CEFUROXIME SODIUM 1.5 G IV VIAL FOR PUSH 0143-9567-25 1 each each 3.769 each 1 each $172.52
• CEFUROXIME SODIUM 750 MG INJ VIAL 0143-9568-25 1 each each 1.774 each 1 each $170.52
• CEFUROXIME SODIUM 750 MG INJ VIAL FOR PUSH 0143-9568-25 1 each each 1.774 each 1 each $170.52
• CELECOXIB 100 MG ORAL CAP 0904-6502-61 100 each each 0.677 each 1 each $12.83
• CELECOXIB 200 MG ORAL CAP 0904-6503-61 100 each each 1.155 each 1 each $13.31
• "CELLULOSE OXIDIZED (INTERCEED) 3 X 4 "" MISC PAD" UHCS-0001-69 1 each each 370.713 each 1 each $424.71
• "CELLULOSE OXIDIZED 2 X 1/2 "" MISC MISC" 63713-019-55 24 each each 15.108 each 1 each $17.36
• "CELLULOSE OXIDIZED 3 X 4 "" MISC PADS" UHCS-0001-65 1 each each 48.211 each 1 each $102.21
• "CELLULOSE OXIDIZED 4 X 8 "" MISC PAD" UHCS-0001-68 24 each each 56.688 each 1 each $110.69
• CEPHALEXIN 125 MG/5 ML ORAL RECON. SUSP. 0093-4175-73 100 mL Bottle 0.076 mL 100 mL $56.20
• CEPHALEXIN 250 MG ORAL CAP 60687-152-01 100 each each 0.234 each 1 each $12.38
• CEPHALEXIN 250 MG/5 ML ORAL RECON. SUSP. 68180-441-01 100 mL Bottle 0.096 mL 100 mL $58.20
• CEPHALEXIN 250 MG/5 ML ORAL RECON. SUSP. 0093-4177-73 100 mL Bottle 0.213 mL 100 mL $69.90
• CEPHALEXIN 500 MG ORAL CAP 60687-163-01 100 each each 0.195 each 1 each $12.35
• CETIRIZINE 10 MG ORAL TAB 0904-6717-61 100 each each 0.073 each 1 each $12.22
• CETUXIMAB 100 MG/50 ML IV SOLUTION 66733-948-23 50 mL Vial 14.557 mL 50 mL "$1,464.80"
• CETUXIMAB 200 MG/100 ML IV SOLUTION 66733-958-23 100 mL Vial 14.557 mL 100 mL "$2,929.60"
• CHERRY FLAVOR (BULK) ORAL LIQUID 395266216 473 mL Bottle 0.028 mL 473 mL $61.84
• CHLORDIAZEPOXIDE HCL   5 MG ORAL CAP 51079-374-20 100 each each 0.594 each 1 each $16.79
• CHLORDIAZEPOXIDE HCL  10 MG ORAL CAP 51079-375-20 100 each each 0.455 each 1 each $16.66
• CHLORDIAZEPOXIDE HCL  25 MG ORAL CAP 51079-141-20 100 each each 0.49 each 1 each $16.69
• CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG ORAL CAP 51293-696-01 100 each each 8.358 each 1 each $24.56
• CHLORHEXIDINE GLUCONATE  4 % TOP FOAM 0234-0575-16 473 mL Bottle 0.013 mL 473 mL $0.00
• CHLORHEXIDINE GLUCONATE 0.12 % MM MOUTHWASH 0116-2001-16 473 mL Bottle 0.003 mL 473 mL $50.02
• CHLORHEXIDINE GLUCONATE 4 % TP LIQUID 0116-1061-04 118 mL Bottle 0.016 mL 118 mL $0.00
• CHLORHEXIDINE GLUCONATE 4 % TP LIQUID 0234-0575-41 118 mL Bottle Bottle 118 mL $0.00
• CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJ SOLUTION 0143-9210-10 20 mL Vial 0.93 mL 20 mL $187.35
• CHLOROTHIAZIDE (DIURIL) IV 25 MG/ML (NICU) UHCS-0000-73 1 each each 39.26 each 1 each $208.01
• CHLOROTHIAZIDE (DIURIL) PO 50 MG/ML (NICU) UHCS-0000-72 237 mL Bottle 0.269 mL 237 mL $85.35
• CHLOROTHIAZIDE SODIUM 500 MG IV VIAL 47335-330-40 1 each each 29.1 each 1 each $197.85
• CHLOROTHIAZIDE SODIUM 500 MG IV VIAL 25021-305-66 1 each each 29.2 each 1 each $197.95
• CHLORPROMAZINE  10 MG ORAL TAB 63304-185-01 100 each each 0.509 each 1 each $12.66
• CHLORPROMAZINE  10 MG ORAL TAB 50268-162-15 50 each each 2.555 each 1 each $14.71
• CHLORPROMAZINE  25 MG ORAL TAB 0904-7130-61 100 each each 3.72 each 1 each $15.87
• CHLORPROMAZINE  25 MG/ML INJ SOLUTION 0641-1397-35 1 mL AMPUL 21.989 mL 1 mL $190.74
• CHLORTHALIDONE  25 MG ORAL TAB 51079-058-20 100 each each 1.371 each 1 each $13.52
• CHOLECALCIFEROL (VITAMIN D3)  400 UNITS ORAL TAB 7733394810 100 each each 0.177 each 1 each $12.33
• CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS 5483800650 50 mL DROP BTL 0.094 mL 50 mL $18.20
• CHOLECALCIFEROL (VITAMIN D3) 1000 UNITS ORAL TAB 2055503300 100 each each 0.028 each 1 each $12.18
• CHOLECALCIFEROL (VITAMIN D3) 1000 UNITS ORAL TAB 1000670033 100 each each 0.036 each 1 each $12.19
• CHOLECALCIFEROL (VITAMIN D3) 1000 UNITS ORAL TAB 761009840 200 each each 0.212 each 1 each $12.36
• CHOLECALCIFEROL (VITAMIN D3) 1000 UNITS ORAL TAB 0761-0098-40 200 each each 1 each 1 each $13.15
• "CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) ORAL CAP" 5319124401 100 each each 0.034 each 1 each $12.18
• "CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) ORAL CAP" 5026886811 1 each each 0.18 each 1 each $12.33
• "CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) ORAL CAP" 179805701 100 each each 1 Bottle 1 each $12.16
• CHOLECALCIFEROL (VITAMIN D3) 5000 UNITS ORAL TAB 54629-7941-01 100 each each 0.053 each 1 each $12.20
• CHOLECALCIFEROL (VITAMIN D3) 5000 UNITS ORAL TAB 5026886615 50 each each 0.165 each 1 each $12.32
• CHOLESTYRAMINE-ASPARTAME 4 G ORAL POWDER PACK 0245-0036-60 60 each each 1.06 each 1 each $13.21
• CHOLESTYRAMINE-ASPARTAME 4 G ORAL POWDER PACK 0245-0036-89 1 each each 1.06 each 1 each $13.21
• CHONDROITIN SULF-SOD HYALURON 3 %-4 %(0.35ML) 1 % (0.4 ML) IO SYRINGE 8065183135 0.75 mL mL 291 mL .75 mL $242.55
• CHONDROITIN SULF-SOD HYALURON 4-3 % (40-30 MG/ML) IO SYRINGE 8065183905 0.5 mL Syringe 332.18 mL .5 mL $190.39
• CHROMIUM CHLORIDE 4 MCG/ML IV SOLUTION 0409-4093-01 10 mL Vial 1.689 mL 10 mL $185.64
• CHROMIUM PICOLINATE  200 MCG ORAL TAB 8068101200 100 each each 0.026 each 1 each $12.18
• CHROMIUM PICOLINATE  200 MCG ORAL TAB 904431460 100 each each 0.028 each 1 each $12.18
• CIDOFOVIR 75 MG/ML IV SOLUTION 23155-216-31 5 mL Vial 101.608 mL 5 mL "$1,022.43"
• CIDOFOVIR 75 MG/ML IV SOLUTION 67457-210-05 5 mL Vial 182.654 mL 5 mL "$1,837.96"
• CILOSTAZOL  50 MG ORAL TAB 50268-176-15 50 each each 0.61 each 1 each $12.76
• CILOSTAZOL 100 MG ORAL TAB 50268-177-15 50 each each 0.597 each 1 each $12.75
• CILOSTAZOL 100 MG ORAL TAB 50268-177-11 1 each each 0.597 each 1 each $12.75
• CINACALCET 30 MG ORAL TAB 69097-410-02 30 each each 0.462 each 1 each $12.61
• CIPROFLOXACIN (CIPRO) IV 2MG/ML (NICU) UHCS-0000-70 100 mL Bag 0.018 mL 100 mL $170.55
• CIPROFLOXACIN (CIPRO) PO 50MG/ML (NICU) UHCS-0000-71 100 mL Bottle 0.6 Bottle 100 mL $22.20
• CIPROFLOXACIN 6 % (6 MG/0.1 ML) ITYM SUSPENSION 69251-201-01 1 mL Vial 168.22 mL 1 mL $228.97
• CIPROFLOXACIN HCL 250 MG ORAL TAB 68084-069-01 100 each each 0.209 each 1 each $12.36
• CIPROFLOXACIN HCL 500 MG ORAL TAB 68084-070-01 100 each each 0.237 each 1 each $12.39
• CIPROFLOXACIN HCL 750 MG ORAL TAB 68084-071-01 100 each each 0.421 each 1 each $12.57
• CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV IVPB 0409-4777-23 100 mL Bag 0.018 mL 100 mL $170.55
• CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV IVPB 0409-4777-02 200 mL Bag 0.011 mL 200 mL $170.95
• CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DROPS. 43598-326-75 7.5 mL DROP BTL 21.553 mL 7.5 mL $222.40
• CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DROPS. 0065-8533-02 7.5 mL DROP BTL 30.691 mL 7.5 mL $290.93
• CISATRACURIUM 2 MG/ML IV SOLUTION 0074-4380-10 10 mL Vial 2.54 mL 10 mL $194.15
• CISPLATIN 1 MG/ML IV SOLUTION 63323-103-51 50 mL Vial 0.176 mL 50 mL $508.30
• CISPLATIN 1 MG/ML IV SOLUTION 0703-5747-11 50 mL Vial 0.24 mL 50 mL $511.50
• CITALOPRAM 10 MG ORAL TAB 0904-6084-61 100 each each 0.048 each 1 each $12.20
• CITALOPRAM 20 MG ORAL TAB 0904-6085-61 100 each each 0.04 each 1 each $12.19
• CITRATE DEXTROSE SOLUTION MISC SOLUTION 0942-0641-04 1000 mL Flex Cont 8.311 Flex Cont 1000 mL $147.36
• CLADRIBINE 10 MG/10 ML IV SOLUTION 63323-140-10 10 mL Vial 9.976 mL 10 mL $599.26
• CLARITHROMYCIN 125 MG/5 ML ORAL RECON. SUSP. 0781-6022-46 100 mL Bottle 0.627 mL 100 mL $111.30
• CLARITHROMYCIN 250 MG/5 ML ORAL RECON. SUSP. 0781-6023-46 100 mL Bottle 0.966 mL 100 mL $145.20
• CLARITHROMYCIN 500 MG ORAL TAB 50268-179-13 30 each each 3.245 each 1 each $15.40
• "CLEANSER, DEEP CLEAN CREAM (PHISODERM)" UHCS-0001-77 180 mL Bottle 2.79 Bottle 180 mL $56.79
• CLEVIDIPINE 25 MG/50 ML IV EMULSION 10122-610-10 50 mL Vial 1.504 mL 50 mL $243.95
• CLINDAMYCIN (CLEOCIN) 18 MG/ML IV (PEDS) UHCS-0002-03 50 mL Bag 0.784 mL 50 mL $207.95
• CLINDAMYCIN (CLEOCIN) IV 10MG/ML (NICU) UHCS-0000-69 15 mL Vial 0.784 mL 15 mL $180.51
• CLINDAMYCIN HCL 150 MG ORAL CAP 0904-5959-61 100 each each 0.16 each 1 each $12.31
• CLINDAMYCIN HCL 150 MG ORAL CAP 63739-059-10 100 each each 0.522 each 1 each $12.67
• CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV IVPB 0338-3612-50 50 mL Bag 0.074 mL 50 mL $172.45
• CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV IVPB 0338-3612-24 50 mL Bag 0.074 mL 50 mL $172.45
• CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV IVPB 0338-3814-24 50 mL Bag 0.091 mL 50 mL $173.30
• CLINDAMYCIN PALMITATE HCL 75 MG/5 ML ORAL VIAL 16714-483-01 100 mL Bottle 0.159 mL 100 mL $64.50
• CLINDAMYCIN PALMITATE HCL 75 MG/5 ML ORAL VIAL 59762-0016-1 100 mL Bottle 0.382 mL 100 mL $86.80
• CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLUTION 0009-3051-01 2 mL Vial 0.784 mL 2 mL $170.32
• CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLUTION 0009-3051-02 2 mL Vial 0.784 mL 2 mL $170.32
• CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLUTION 67457-814-00 2 mL Vial 0.977 mL 2 mL $170.70
• CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLUTION 67457-814-02 2 mL Vial 0.977 mL 2 mL $170.70
• CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLUTION 25021-115-02 2 mL Vial 1.372 mL 2 mL $171.49
• CLINDAMYCIN PHOSPHATE 2 % VAGL CREAM 59762-5009-1 40 g TUBE/KIT 2.006 g 40 g $134.24

See Part 6