Medication Charges Part 14

METOCLOPRAMIDE HCL 10 MG ORAL TAB 60687-631-01 100 each each 0.392 each 1 each $12.54
METOCLOPRAMIDE HCL 10 MG ORAL TAB 60687-631-11 1 each each 0.392 each 1 each $12.54
METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLUTION 0121-1576-10 10 mL Cup 0.189 mL 10 mL $14.04
METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLUTION 62559-190-16 473 mL Bottle 0.028 mL 473 mL $25.39
METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLUTION UHCS-0001-45 60 mL Bottle 0.036 mL 60 mL $50.76
METOLAZONE 2.5 MG ORAL TAB 51079-023-20 100 each each 1.937 each 1 each $14.09
METOLAZONE 5 MG ORAL TAB 51079-024-20 100 each each 2.224 each 1 each $14.37
METOLAZONE (ZAROXOLYN) PO 1 MG/ML (NICU)) UHCS-0000-17 5 mL Bottle 0.5 Bottle 5 mL $22.10
METOPROLOL ORAL SUSPENSION UHCS-0001-94 100 mL Bottle 1.64 Bottle 100 mL $62.39
METOPROLOL SUCCINATE 25 MG ORAL TB24 0904-6322-06 50 each each 0.35 each 1 each $12.50
METOPROLOL SUCCINATE 25 MG ORAL TB24 0904-6322-61 100 each each 0.388 each 1 each $12.54
METOPROLOL SUCCINATE 50 MG ORAL TB24 0904-6323-61 100 each each 0.643 each 1 each $12.79
METOPROLOL SUCCINATE 100 MG ORAL TB24 0904-6324-61 100 each each 0.705 each 1 each $12.86
METOPROLOL TARTRATE 25 MG ORAL TAB 0904-6340-61 100 each each 0.047 each 1 each $12.20
METOPROLOL TARTRATE 25 MG ORAL TAB 51079-255-01 1 each each 0.047 each 1 each $12.20
METOPROLOL TARTRATE 50 MG ORAL TAB 51079-801-20 100 each each 0.056 each 1 each $12.21
METOPROLOL TARTRATE 50 MG ORAL TAB 62584-266-01 100 each each 0.077 each 1 each $12.23
METOPROLOL TARTRATE 100 MG ORAL TAB 62584-267-01 100 each each 0.116 each 1 each $12.27
METOPROLOL TARTRATE 100 MG ORAL TAB 62584-267-11 100 each each 0.116 each 1 each $12.27
METOPROLOL TARTRATE 12.5 MG ORAL TAB UHCS-0004-36 1 each each 0.025 each 1 each $12.18
METOPROLOL TARTRATE 5 MG/5 ML IV SOLUTION 72611-740-01 5 mL Vial 0.1 mL 5 mL $169.25
METOPROLOL TARTRATE 5 MG/5 ML IV SOLUTION 72611-740-10 5 mL Vial 0.1 mL 5 mL $169.25
METOPROLOL TARTRATE 5 MG/5 ML IV SOLUTION 0409-1778-15 5 mL Vial 0.108 mL 5 mL $169.29
METOPROLOL TARTRATE 5 MG/5 ML IV SOLUTION 47781-587-20 5 mL Vial 0.181 mL 5 mL $169.66
METOPROLOL TARTRATE 5 MG/5 ML IV SOLUTION 47781-587-17 5 mL Vial 0.181 mL 5 mL $169.66
METRONIDAZOLE (FLAGYL) IV 5 MG/ML (NICU) UHCS-0001-03 100 mL Bag 0.017 mL 100 mL $170.45
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL 45802-139-70 70 g Tube 1.681 g 70 g $171.67
METRONIDAZOLE 0.75 % TP GEL 0713-0637-37 45 g Tube 0.687 g 45 g $84.92
METRONIDAZOLE 250 MG ORAL TAB 0904-1453-61 100 each each 0.372 each 1 each $12.52
METRONIDAZOLE 500 MG ORAL TAB 60687-550-01 100 each each 0.391 each 1 each $12.54
METRONIDAZOLE 500 MG ORAL TAB 60687-550-11 1 each each 0.391 each 1 each $12.54
METRONIDAZOLE 500 MG ORAL TAB 60687-424-01 100 each each 0.693 each 1 each $12.84
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV IVPB 0409-0152-01 100 mL Bag 0.015 mL 100 mL $170.25
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV IVPB 0409-0152-24 100 mL Bag 0.015 mL 100 mL $170.25
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV IVPB 0338-1055-48 100 mL Bag 0.018 mL 100 mL $170.55
MEXILETINE 10 MG/ML PO SUSPENSION UHCS-0005-04 240 mL Bottle 0.88 Bottle 240 mL $61.63
MEXILETINE 150 MG ORAL CAP 62559-820-01 100 each each 0.607 each 1 each $12.76
MEXILETINE 150 MG ORAL CAP 0093-8739-01 100 each each 0.764 each 1 each $12.91
MICAFUNGIN 100 MG IV VIAL 0143-9362-01 1 each each 30.48 each 1 each $199.23
MICAFUNGIN 100 MG IV VIAL 63323-729-10 1 each each 31.406 each 1 each $200.16
MICAFUNGIN 100 MG IV VIAL 42023-230-01 1 each each 31.406 each 1 each $200.16
MICAFUNGIN 100 MG IV VIAL 42023-230-10 1 each each 31.406 each 1 each $200.16
MICAFUNGIN 100 MG IV VIAL 0469-3211-10 1 each each 172.69 each 1 each $347.54
MICONAZOLE NITRATE 100 MG VAGL SUPPOSITORY 49348-833-61 7 each each 1.157 each 1 each $62.10
MICONAZOLE NITRATE 2 % TP CREAM 61269-735-56 28 g Tube 0.061 g 28 g $55.71
MICONAZOLE NITRATE 2 % TP CREAM 0472-0735-56 28 g Tube 0.079 g 28 g $56.21
MICONAZOLE NITRATE 2 % TP POWDER 5042833528 71 g Bottle 0 g 71 g $54.00
MICONAZOLE NITRATE 2 % VAGL CREAM 51672-2035-6 45 g TUBE/KIT 0.06 g 45 g $56.70
MICROFIBRIL. COLLAGEN HEMOSTAT 2 X 4 IN TOP SHEE UHCS-0001-66 1 each each 93.47 each 1 each $147.47
MICROFIBRIL. COLLAGEN HEMOSTAT 70 X 35 MM TP SHEET 53276-1010-09 1 each each 142.342 each 1 each $196.34
MIDAZOLAM 1 MG/ML INFUSION PF (WRAPPER) 69374-314-10 100 mL Bottle 22 Bottle 100 mL $244.75
MIDAZOLAM 1 MG/ML INFUSION PF (WRAPPER) 44567-611-10 100 mL Bag 0.231 mL 100 mL $245.85
MIDAZOLAM 1 MG/ML INFUSION PF (WRAPPER) 44567-611-01 100 mL Bag 0.231 mL 100 mL $245.85
MIDAZOLAM 1 MG/ML INJ SOLUTION 0641-6057-01 2 mL Vial 0.144 mL 2 mL $169.04
MIDAZOLAM 1 MG/ML INJ SOLUTION 23155-600-41 2 mL Vial 0.178 mL 2 mL $169.11
MIDAZOLAM 1 MG/ML INJ SOLUTION 23155-600-31 2 mL Vial 0.178 mL 2 mL $169.11
MIDAZOLAM 1 MG/ML INJ SOLUTION 0641-6059-10 5 mL Vial 0.093 mL 5 mL $169.22
MIDAZOLAM 1 MG/ML INJ SOLUTION 0641-6059-01 5 mL Vial 0.093 mL 5 mL $169.22
MIDAZOLAM 1 MG/ML INJ SOLUTION (ANESTHESIA) UHCS-ANES-14 1 mL mL Vial 1 mL $0.00
MIDAZOLAM 2 MG/ML ORAL SYRUP UHCS-0000-21 5 mL Syringe 0.437 mL 5 mL $18.39
MIDAZOLAM 2 MG/ML ORAL SYRUP 68094-764-59 5 mL Cup 1.129 mL 5 mL $21.85
MIDAZOLAM 2 MG/ML ORAL SYRUP 68094-764-62 5 mL Cup 1.129 mL 5 mL $21.85
MIDAZOLAM 2 MG/ML ORAL SYRUP 0054-3566-99 118 mL Bottle 0.437 mL 118 mL $67.77
MIDAZOLAM 2 MG/ML ORAL SYRUP (NICU) UHCS-0004-43 5 mL Syringe 0.955 Syringe 5 mL $169.71
MIDAZOLAM 5 MG/ML INJ SOLUTION 0409-2596-05 10 mL Vial 0.668 mL 10 mL $175.43
MIDODRINE 5 MG ORAL TAB 51079-453-20 100 each each 0.825 each 1 each $12.98
MIDODRINE 5 MG ORAL TAB 0245-0212-89 1 each each 2.784 each 1 each $14.93
MIDODRINE 10 MG ORAL TAB 60687-409-95 1 each each 0.654 each 1 each $12.80
MIDODRINE 10 MG ORAL TAB 60687-409-25 30 each each 0.654 each 1 each $12.80
MIDODRINE 10 MG ORAL TAB 0904-6819-07 30 each each 0.992 each 1 each $13.14
MILNACIPRAN 25 MG ORAL TAB 0456-1525-60 60 each each 7.146 each 1 each $19.30
MILRINONE (PRIMACOR) IV 0.2 MG/ML (NICU) UHCS-0001-05 30 mL Vial 0.159 mL 30 mL $173.52
MILRINONE 1 MG/ML IV SOLUTION 0409-0212-10 10 mL Vial 0.379 mL 10 mL $172.54
MILRINONE IN 5 % DEXTROSE 20 MG/100 ML (200 MCG/ML) IV IVPB 55150-287-10 100 mL Bag 0.052 mL 100 mL $144.25
MILRINONE IN 5 % DEXTROSE 20 MG/100 ML (200 MCG/ML) IV IVPB 55150-287-01 100 mL Bag 0.052 mL 100 mL $144.25
MILRINONE IN 5 % DEXTROSE 20 MG/100 ML (200 MCG/ML) IV IVPB 0143-9719-10 100 mL Bag 0.087 mL 100 mL $147.75
MINERAL OIL ORAL OIL 48433-202-30 30 mL Cup 0.046 mL 30 mL $13.53
MINERAL OIL TP OIL 54162-185-16 472 mL Bottle 0.005 mL 472 mL $56.36
"MINERAL OIL, LIGHT STERILE MISC OIL" 6332325410 10 mL Vial 1.407 mL 10 mL $257.07
MINERAL OIL-HYDROPHIL PETROLAT TP OINTMENT 61924-184-04 106 g Tube 0.029 g 106 g $57.07
MINOCYCLINE 100 MG IV VIAL 70842-160-10 1 each each 209.865 each 1 each $422.35
MINOCYCLINE 100 MG ORAL CAP 60687-336-65 50 each each 0.784 each 1 each $12.93
MINOXIDIL 2.5 MG ORAL TAB 68084-204-01 100 each each 0.377 each 1 each $12.53
MINOXIDIL 10 MG ORAL TAB 68084-205-01 100 each each 0.434 each 1 each $12.58
MIRTAZAPINE 15 MG ORAL TAB 63739-098-10 100 each each 0.095 each 1 each $12.25
MIRTAZAPINE 15 MG ORAL TAB 68084-119-01 100 each each 0.222 each 1 each $12.37
MISOPROSTOL (CYTOTEC) 25 MCG TABLET UHCS-0003-21 1 each Package 0.259 each 1 each $12.41
MISOPROSTOL 100 MCG ORAL TAB 68084-040-01 100 each each 1.37 each 1 each $13.52
MISOPROSTOL 200 MCG ORAL TAB 68084-041-01 100 each each 1.485 each 1 each $13.64
MITOMYCIN 0.2 MG OPHT KIT 49771-002-01 1 each KIT 359 each 1 each $858.50
MITOMYCIN 5 MG IV VIAL 67457-518-05 1 each each 45.35 each 1 each $544.85
MITOMYCIN 5 MG IV VIAL 16729-246-05 1 each each 224.66 each 1 each $724.16
MITOMYCIN 0.02 % 1 ML SYRINGE UHCS-0001-12 1 mL Syringe 33.38 mL 1 mL $532.88
MITOMYCIN 20 MG IV VIAL 0143-9279-01 1 each each 50.8 each 1 each $550.30
MITOMYCIN 20 MG IV VIAL 16729-108-11 1 each each 153.15 each 1 each $652.65
MITOMYCIN 20 MG IV VIAL 16729-247-11 1 each each 583.63 each 1 each "$1,174.56"
MITOXANTRONE 2 MG/ML IV CONCENTRATE 63323-132-10 10 mL Vial 8.983 mL 10 mL $589.33
MITOXANTRONE 2 MG/ML IV CONCENTRATE 0703-4680-01 12.5 mL Vial 9.248 mL 12.5 mL $615.10
MODAFINIL 100 MG ORAL TAB 65862-601-30 30 each each 0.289 each 1 each $16.49
MODIFIED LANOLIN 100 % TP CREAM 4467710202 7 g Tube 0.292 g 7 g $56.04
MOMETASONE 220 MCG/ ACTUATION (14) INHL AERO.POWDER 0085-1341-06 1 each CANISTER 68.32 each 1 each $142.57
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFA INHALER 0085-7206-07 8.8 g AER W/ADAP 22.132 g 8.8 g $269.01
MOMETASONE-FORMOTEROL 200-5 MCG/ACTUATION INHL HFA INHALER 0085-4610-05 8.8 g AER W/ADAP 22.132 g 8.8 g $269.01
MONTELUKAST 5 MG ORAL CHEW TAB 42291-623-30 30 each each 0.2 each 1 each $12.35
MONTELUKAST 10 MG ORAL TAB 68084-875-11 1 each each 0.3 each 1 each $12.45
MONTELUKAST 10 MG ORAL TAB 50268-575-15 50 each each 0.384 each 1 each $12.53
MONTELUKAST 10 MG ORAL TAB 50268-575-11 1 each each 0.384 each 1 each $12.53
MORPHINE 10 MG/5 ML ORAL SOLUTION 68094-001-62 5 mL Cup 0.251 mL 5 mL $17.46
MORPHINE 15 MG ORAL TBER 0406-8315-62 100 each each 0.415 each 1 each $15.27
MORPHINE 2 MG/ML INJ SOLUTION 63323-452-01 2 mg Vial 0.693 mg 2 mg $170.14
MORPHINE 2 MG/ML INJ SYRINGE 76045-004-10 2 mg Syringe 0.647 mg 2 mg $170.04
MORPHINE 2 MG/ML IV SYRINGE 0409-1890-03 2 mg Cartridge 0.665 mg 2 mg $170.08
MORPHINE 2 MG/ML IV SYRINGE 0409-1890-01 2 mg Cartridge 0.665 mg 2 mg $170.08
MORPHINE 30 MG ORAL TBER 0406-8330-62 100 each each 0.862 each 1 each $15.71
MORPHINE 4 MG/ML INJ SYRINGE 76045-005-10 4 mg Syringe 0.347 mg 4 mg $170.14
MORPHINE 4 MG/ML INJ SYRINGE 76045-005-01 1 mL Syringe 19.4 mL 1 mL $470.38
MORPHINE 4 MG/ML IV SOLUTION 0641-6125-01 4 mg Vial 0.548 mg 4 mg $170.94
MORPHINE 4 MG/ML IV SYRINGE 0409-1891-03 4 mg Cartridge 0.333 mg 4 mg $170.08
MORPHINE 4 MG/ML IV SYRINGE 0409-1891-01 4 mg Cartridge 0.333 mg 4 mg $170.08
MORPHINE 5 MG/ML INJ SYRINGE 76045-006-10 5 mg Syringe 0.296 mg 5 mg $340.46
MORPHINE 60 MG ORAL TBER 0406-8380-62 100 each each 1.298 each 1 each $16.15
MORPHINE (PF) 0.5 MG/ML INJ SOLUTION 0409-3814-12 10 mL Vial 0.63 mL 10 mL $175.05
MORPHINE (PF) 0.5 MG/ML INJ SOLUTION (ANESTHESIA) UHCS-ANES-17 1 ampule ampule Ampule 1 ampule $0.00
MORPHINE (PF) 10 MG/ML INJ SOLUTION 0641-6039-01 20 mL AMPUL 9.51 mL 20 mL $382.78
MORPHINE (PF) IN 0.9 % SOD CHL 1 MG/ML IV SOLUTION 70092-1380-36 100 mL Bag 0.117 mL 100 mL $234.45
MORPHINE 10 MG/ML INJ SYRINGE 76045-008-10 10 mg Syringe 0.243 mg 10 mg $171.18
MORPHINE 10 MG/ML IV SOLUTION 0641-6127-01 10 mg Vial 0.231 mg 10 mg $171.06
MORPHINE 10 MG/ML IV SOLUTION 0641-6127-25 10 mg Vial 0.231 mg 10 mg $171.06
MORPHINE 10 MG/ML IV SYRINGE 0409-1893-01 10 mg Syringe 0.133 mg 10 mg $170.08
MORPHINE 100 MG ORAL TBER 0406-8390-62 100 each each 2.302 each 1 each $18.50
MORPHINE 2 MG/ML INJ SYRINGE (ANESTHESIA) UHCS-ANES-06 1 Syringe Syringe Syringe 1 Syringe $0.00
MORPHINE 4 MG/ML INJ SYRINGE (ANESTHESIA) UHCS-ANES-07 1 Syringe Syringe Syringe 1 Syringe $0.00
MORPHINE 5 MG/ML INJ SYRINGE (ANESTHESIA) UHCS-ANES-29 1 mL Syringe Syringe 1 mL $0.00
MORPHINE 5 MG/ML INJ SYRINGE (ORTHO INJ COA) 76045-006-10 5 mg Syringe 0.296 mg 5 mg $340.46
MORPHINE 50 MG/ML IV SOLUTION 0409-1134-03 20 mL Vial 0.597 mL 20 mL $261.69
MORPHINE 50 MG/ML IV SOLUTION 0409-1134-05 50 mL Vial 0.507 mL 50 mL $275.10
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION 0054-0517-41 15 mL Bottle 0.395 mL 15 mL $73.43
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION 0406-8003-15 15 mL Bottle 0.554 mL 15 mL $75.81
MORPHINE DRIP (MIXED IN IV ROOM) $208.74
MORPHINE DRIP NON-TITRATABLE (MIXED IN IV ROOM) $208.74
MORPHINE IN 0.9 % SODIUM CHLOR 50 MG/50 ML (1 MG/ML) IV PCA SYRINGE 70092-1128-50 50 mL Syringe 0.207 mL 50 mL $233.10
MORPHINE IN DEXTROSE 5 % 100 MG/50 ML (2 MG/ML) INJ PCA SYRINGE 61553-187-75 50 mL Syringe 10.866 Syringe 50 mL $233.62
MORPHINE INFUSION (NON-TITRATABLE) 70092-1380-36 100 mL Bag 0.117 mL 100 mL $234.45
MORPHINE IV 0.1MG/ML (NICU) UHCS-0000-57 20 mL Vial 0.067 mL 20 mL $170.09
MORPHINE IV 0.5MG/ML (NICU) UHCS-0000-58 10 mL Vial 2.541 mL 10 mL $194.16
MORPHINE PCA IN D5W (MIXED IN IV ROOM) 2 MG/ML $208.74
MORPHINE PO 0.5MG/ML (NICU) UHCS-0003-47 10 mL Syringe 2.541 mL 10 mL $47.01
MORPHINE RANGED DOSE 1-10 0409-1890-03 2 mg mg 0.665 mg 2 mg $170.08
MORPHINE RANGED DOSE 1-10 0409-1890-01 2 mg mg 0.665 mg 2 mg $170.08
MORPHINE RANGED DOSE 1-10 0409-1891-03 4 mg mg 0.333 mg 4 mg $170.08
MORPHINE RANGED DOSE 1-10 0409-1891-01 4 mg mg 0.333 mg 4 mg $170.08
MORPHINE RANGED DOSE 1-10 0409-1890-10 2 mg mg 0.762 mg 2 mg $170.27
MORPHINE RANGED DOSE 1-10 0641-6125-01 4 mg mg 0.548 mg 4 mg $170.94
MORPHINE RANGED DOSE 1-10 0641-6125-25 4 mg mg 0.548 mg 4 mg $170.94

See Part 15