Medication Charges Part 15

MORPHINE RANGED DOSE 4-10 0641-6127-01 10 mg mg 0.231 mg 10 mg $171.06
MORPHINE RANGED DOSE 4-10 0641-6127-25 10 mg mg 0.231 mg 10 mg $171.06
MORPHINE RANGED DOSE 4-10 76045-008-10 10 mg mg 0.243 mg 10 mg $171.18
MORPHINE RANGED DOSE 4-10 0641-6073-25 5 mg mg 0.884 mg 5 mg $173.17
MORPHINE RANGED DOSE 4-10 76045-005-01 1 mL mg 19.4 mL 1 mL $188.15
MORPINE 10 MG/ML INJ SYRINGE (ANESTHESIA) UHCS-ANES-20 1 Syringe Syringe Syringe 1 Syringe $0.00
MOXIFLOXACIN 0.5 % OPHT DROPS 65862-840-03 3 mL DROP BTL 10.303 mL 3 mL $91.66
MOXIFLOXACIN-SOD.CHLORIDE(ISO) 400 MG/250 ML IV IVPB 67457-323-25 250 mL Bag 0.109 mL 250 mL $196.00
MULTIVITAMIN STRESS FORMULA ORAL TAB 904026252 60 each each 0.037 each 1 each $12.19
MULTIVITAMIN-IRON-FOLIC ACID 18-400 MG-MCG ORAL TAB 536344238 130 each each 0.029 each 1 each $12.18
MULTIVIT-MIN-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID UHCS-0004-27 60 mL Bottle 0.029 mL 60 mL $50.34
MULTIVIT-MIN-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID 5434462 236 mL Bottle 0.029 mL 236 mL $55.44
MUPIROCIN 2 % TP OINTMENT 68462-180-22 22 g Tube 0.202 g 22 g $58.44
MUPIROCIN CALCIUM 2 % TP CREAM 16714-055-01 15 g Tube 8.098 g 15 g $175.47
MUPIROCIN CALCIUM 2 % TP CREAM 51672-1370-1 15 g Tube 12.078 g 15 g $235.17
MVI ADULT (VIAL 1 FOR COMPOUND) 54643-5649-9 50 mL Vial 0 Vial 50 mL $168.75
MVI ADULT NO.4 WITH VIT K 3300 UNIT- 150 MCG/10 ML IV SOLUTION 54643-5649-1 10 mL Vial 0.754 mL 10 mL $176.29
MVI PED (VIAL 2 FOR COMPOUND) UHCS-0003-30 10 mL Vial 0 Vial 10 mL $168.75
MVI PEDI NO.1 WITH VIT K 80 MG-400 UNIT- 200 MCG/5 ML IV SOLUTION 54643-5646-1 5 mL Vial 0.139 mL 5 mL $169.45
"MVI, PEDIATRIC VIAL" 61703-421-53 1 each each 8.132 each 1 each $176.88
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL RECON. SUSP. 66689-307-08 160 mL Bottle 2.046 mL 160 mL $375.96
MYCOPHENOLATE MOFETIL 250 MG ORAL CAP 51079-721-20 100 each each 0.329 each 1 each $12.48
MYCOPHENOLATE MOFETIL 500 MG ORAL TAB 60687-438-01 100 each each 0.533 each 1 each $12.68
NABUMETONE 500 MG ORAL TAB 50228-465-01 100 each each 0.083 each 1 each $12.23
NABUMETONE 500 MG ORAL TAB 60687-374-01 100 each each 1.092 each 1 each $13.24
NADOLOL 40 MG ORAL TAB 60687-313-25 30 each each 3.303 each 1 each $15.45
NAFCILLIN 1 G INJ VIAL 25021-139-10 1 each each 3.219 each 1 each $171.97
NAFCILLIN 1 G INJ VIAL 70860-116-26 1 each each 4.129 each 1 each $172.88
NAFCILLIN 2 G INJ VIAL 55150-123-16 1 each each 5.376 each 1 each $174.13
NAFCILLIN 2 G INJ VIAL 55150-123-15 1 each each 5.376 each 1 each $174.13
NAFCILLIN 2 G INJ VIAL 44567-222-10 1 each each 6.447 each 1 each $175.20
NAFCILLIN IM 167MG/ML (NICU) UHCS-0000-16 1 each each 10.794 each 1 each $179.54
NAFCILLIN IV 100MG/ML (NICU) UHCS-0000-15 1 each each 10.794 each 1 each $179.54
NALBUPHINE 20 MG/ML INJ SOLUTION 0409-1465-01 1 mL AMPUL 5.006 mL 1 mL $173.76
NALOXONE (NARCAN) 0.4 MG/ML 1 ML FOR BULK CHARGE UHCS-0002-20 1 mL Vial 5.95 mL 1 mL $174.70
NALOXONE (NARCAN) 0.4 MG/ML 10 ML FOR BULK CHARGE UHCS-0002-21 10 mL Vial 1.847 mL 10 mL $268.22
NALOXONE 0.4 MG/ML INJ SOLUTION 0641-6132-01 1 mL Vial 3.233 mL 1 mL $171.98
NALOXONE 0.4 MG/ML INJ SOLUTION 0641-6132-25 1 mL Vial 3.233 mL 1 mL $171.98
NALOXONE 0.4 MG/ML INJ SOLUTION 55150-328-01 10 mL Vial 3.395 mL 10 mL $202.70
NALOXONE 0.4 MG/ML INJ SOLUTION 67457-987-10 10 mL Vial 3.686 mL 10 mL $205.61
NALOXONE 0.4 MG/ML INJ SOLUTION 67457-292-02 1 mL Vial 4.211 mL 1 mL $432.40
NAPHAZOLINE-GLYCERIN 0.012-0.25 % OPHT DROPS 7811225419 30 mL DROP BTL 0.129 mL 30 mL $64.62
NAPHAZOLINE-GLYCERIN 0.012-0.25 % OPHT DROPS 00074-2541-09 30 mL DROP BTL 0.129 mL 30 mL $64.62
NAPROXEN 250 MG ORAL TAB 50268-594-15 50 each each 0.157 each 1 each $12.31
NAPROXEN 250 MG ORAL TAB 50268-594-11 1 each each 0.157 each 1 each $12.31
NATALIZUMAB 300 MG/15 ML IV SOLUTION 64406-008-01 15 mL Vial 547.29 mL 15 mL "$16,521.32"
NATEGLINIDE 120 MG ORAL TAB 55111-329-90 90 each each 0.439 each 1 each $12.59
NEBIVOLOL 2.5 MG ORAL TAB 59651-137-30 30 each each 0.214 each 1 each $12.36
NEBIVOLOL 2.5 MG ORAL TAB 0456-1402-30 30 each each 5.36 each 1 each $17.51
NEBIVOLOL 5 MG ORAL TAB 0904-7189-04 30 each each 1.66 each 1 each $13.81
NEBIVOLOL 5 MG ORAL TAB 0456-1405-11 10 each each 5.46 each 1 each $17.61
NEBIVOLOL 5 MG ORAL TAB 0456-1405-63 100 each each 5.46 each 1 each $17.61
NEOMYCIN 500 MG ORAL TAB 39822-0310-5 100 each each 1.254 each 1 each $13.40
NEOMYCIN SULFATE (BULK) MISC POWDER UHCS-0001-85 2.5 g Bottle 0.55 g 2.5 g $55.38
NEOMYCIN SULFATE (BULK) MISC POWDER 38779-0348-1 10 g Jar 1.091 g 10 g $64.91
NEOMYCIN SULFATE (BULK) MISC POWDER 51552-0969-5 100 g Jar 0.494 g 100 g $103.40
NEOMYCIN SULFATE (BULK) MISC POWDER 24643-0357-5 100 g Jar 1.64 g 100 g $218.00
"NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-10,000 MG-UNIT-UNIT/G OPHT OINTMENT" 24208-780-55 3.5 g Tube 12.026 g 3.5 g $102.84
NEOMYCIN-BACITRACNZN-POLYMYXIN 3.5-400-5000 MG-UNIT-UNIT/G TOP OINTMENT 51672-2120-2 28.4 g Tube 0.049 g 28.4 g $55.39
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TP OINT. PACK" 45802-143-70 144 each each 0.105 each 1 each $24.41
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TP OINT. PACK" 0904-6680-67 144 each each 0.122 each 1 each $24.42
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TP OINT. PACK" 58232-4002-1 1 each each 0.173 each 1 each $24.47
NEOMYCIN-POLYMYXIN B GU 40-200000 MG-UNIT/ML IRRIGATION SOLUTION 39822-1201-2 1 mL AMPUL 10.089 mL 1 mL $178.84
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 MG/ML-UNIT/ML-% OPHT DROPS. 61314-630-06 5 mL DROP BTL 2.136 mL 5 mL $71.43
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 MG-UNIT/G-% OPHT OINTMENT 61314-631-36 3.5 g Tube 3.623 g 3.5 g $73.43
"NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75 MG-10,000 UNIT-0.025MG/ML OPHT DROPS" 24208-790-62 10 mL DROP BTL 3.437 mL 10 mL $95.12
NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 MG-UNIT/ML-% OTIC DROPS. 24208-635-62 10 mL DROP BTL 5.72 mL 10 mL $117.95
NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 MG-UNIT/ML-% OTIC DROPS. 61314-645-11 10 mL DROP BTL 5.936 mL 10 mL $120.11
NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 MG-UNIT/ML-% OTIC SOLUTION 24208-631-10 10 mL Bottle 7.75 mL 10 mL $138.25
NEOMYCIN-POLYMYXIN-HC 3.5-10000-10 MG-UNIT-MG/ML OPHT DROPS. 61314-641-75 7.5 mL DROP BTL 12.075 mL 7.5 mL $151.31
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLUTION 43598-529-36 10 mL Vial 0.323 mL 10 mL $171.98
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLUTION 43598-529-11 10 mL Vial 0.473 mL 10 mL $173.48
NEOSTIGMINE METHYLSULFATE 4 MG/4 ML (1 MG/ML) IV SYRINGE UHCS-0004-89 4 mL Syringe 0.205 mL 4 mL $169.57
NERATINIB 40 MG ORAL TAB 70437-240-18 180 each each 1 Bottle 1 each $499.51
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION 65862-057-24 240 mL Bottle 0.406 mL 240 mL $146.04
NIACIN 100 MG ORAL TAB 5026858215 50 each each 0.255 each 1 each $12.41
NIACIN 250 MG ORAL CPER 1000670020 100 each each 0.055 each 1 each $12.21
NIACIN 500 MG ORAL TB24 59651-018-90 90 each each 0.254 each 1 each $12.40
NIACIN 500 MG ORAL TB24 68084-756-35 60 each each 4.24 each 1 each $16.39
NICARDIPINE 20 MG ORAL CAP 42806-501-09 90 each each 11.447 each 1 each $23.60
NICARDIPINE 25 MG/10 ML IV SOLUTION 55150-183-01 10 mL Vial 1.075 mL 10 mL $179.50
NICARDIPINE 25 MG/10 ML IV SOLUTION 55150-183-10 10 mL Vial 1.075 mL 10 mL $179.50
NICARDIPINE 25 MG/10 ML IV SOLUTION 0143-9593-01 10 mL Vial 1.861 mL 10 mL $187.36
NICARDIPINE 25 MG/10 ML IV SOLUTION 0143-9593-10 10 mL Vial 1.861 mL 10 mL $187.36
NICARDIPINE 25 MG/10 ML IV SOLUTION 0517-0735-01 10 mL Vial 2.43 mL 10 mL $193.05
NICARDIPINE 30 MG ORAL CAP 24658-751-90 90 each each 1.736 each 1 each $13.89
NICOTINE 7 MG/24 HR TD 24HR PATCH 43598-446-74 14 each each 1.135 each 1 each $25.44
NICOTINE 7 MG/24 HR TD 24HR PATCH 43598-446-71 1 each each 1.583 each 1 each $25.88
NICOTINE (POLACRILEX) 2 MG BUCL GUM 49348-573-08 50 each BLIST PACK 0.228 each 1 each $60.00
NICOTINE 14 MG/24 HR TD 24HR PATCH 43598-447-74 14 each each 1.047 each 1 each $25.35
NICOTINE 14 MG/24 HR TD 24HR PATCH 43598-447-71 1 each each 1.583 each 1 each $25.88
NICOTINE 14 MG/24 HR TD 24HR PATCH 60505-7062-0 1 each each 1.713 each 1 each $26.01
NICOTINE 21 MG/24 HR TD 24HR PATCH 43598-448-28 28 each each 0.904 each 1 each $25.20
NICOTINE 21 MG/24 HR TD 24HR PATCH 8113118739 7 each each 1.11 each 1 each $25.41
NICOTINE 21 MG/24 HR TD 24HR PATCH 43598-448-71 1 each each 1.584 each 1 each $25.88
NICU FAT EMULSION 20% (S-M-O-F) IV SYRINGE UHCS-0005-56 30 mL Syringe 0.084 mL 30 mL $130.77
NICU FAT EMULSION 20% (S-M-O-F) IV SYRINGE UHCS-0005-57 60 mL Syringe 0.084 mL 60 mL $133.29
NICU FAT EMULSION 20% IV SYRINGE UHCS-0002-99 30 mL Syringe 0.066 mL 30 mL $130.23
NICU FAT EMULSION 20% IV SYRINGE UHCS-0003-00 60 mL Syringe 0.066 mL 60 mL $132.21
NIFEDIPINE (BULK) MISC POWDER 51552-0720-2 5 g Jar 6.3 g 5 g $31.50
NIFEDIPINE 10 MG ORAL CAP 23155-194-01 100 each each 0.278 each 1 each $12.43
NIFEDIPINE 10 MG ORAL CAP 50268-600-15 50 each each 1.382 each 1 each $13.53
NIFEDIPINE 30 MG ORAL 24HR. TAB 50268-597-11 1 each each 0.742 each 1 each $12.89
NIFEDIPINE 30 MG ORAL 24HR. TAB 50268-597-15 50 each each 0.742 each 1 each $12.89
NIFEDIPINE 60 MG ORAL 24HR. TAB 50268-598-15 50 each each 1.279 each 1 each $13.43
NIFEDIPINE 90 MG ORAL 24HR. TAB 68084-603-21 30 each each 2.049 each 1 each $14.20
NIMODIPINE 30 MG ORAL CAP 23155-512-30 30 each each 1.108 each 1 each $13.26
NIRAPARIB 100 MG ORAL CAP 69656-103-30 30 each each 288.155 each 1 each $300.31
NISOLDIPINE 8.5 MG ORAL TB24 66993-472-02 100 each each 2.699 each 1 each $14.85
NITAZOXANIDE 500 MG ORAL TAB 67546-111-14 12 each each 133.831 each 1 each $145.98
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP 68084-446-01 100 each each 2.716 each 1 each $14.87
NITROGLYCERIN 0.1 MG/HR TD 24HR PATCH 0378-9102-93 30 each each 0.383 each 1 each $24.68
NITROGLYCERIN 0.1MG/ML VIAL UHCS-0001-61 10 mL Vial 0.051 mL 10 mL $169.26
NITROGLYCERIN 0.2 MG/HR TD 24HR PATCH 0378-9104-93 30 each each 0.317 each 1 each $24.62
NITROGLYCERIN 0.2 MG/HR TD 24HR PATCH 0378-9104-16 1 each each 0.317 each 1 each $24.62
NITROGLYCERIN 0.2%/LIDOCAINE 1% 30 GM OINTMENT UHCS-0005-18 30 g Jar 36.048 Jar 30 g $96.80
NITROGLYCERIN 0.4 MG SL SL TABLET 68462-639-45 25 each Bottle 0.249 each 1 each $54.83
NITROGLYCERIN 0.4 MG SL SL TABLET 0071-0418-13 25 each Bottle 1.422 each 1 each $84.15
NITROGLYCERIN 0.4 MG SL SL TABLET (SINGLE TABLET) UHCS-0001-74 1 each each 0.249 each 1 each $12.40
NITROGLYCERIN 0.4 MG/HR TD 24HR PATCH 0378-9112-93 30 each each 0.364 each 1 each $24.66
NITROGLYCERIN 0.6 MG/HR TD 24HR PATCH 0378-9116-93 30 each each 0.42 each 1 each $24.72
NITROGLYCERIN 2 % TD OINTMENT 0281-0326-08 1 g Packet 1.852 g 1 g $14.00
NITROGLYCERIN 2 % TD OINTMENT 0281-0326-30 30 g Tube 0.954 g 30 g $82.62
NITROGLYCERIN 6.5 MG ORAL CPER 49483-222-10 100 each each 0.355 each 1 each $12.51
NITROGLYCERIN BOLUS UHCS-ANES-33 1 mL Vial Vial 1 mL $0.00
NITROGLYCERIN IN 5 % DEXTROSE 100 MG/250 ML (400 MCG/ML) IV SOLUTION 0338-1051-02 250 mL Bottle 0.058 mL 250 mL $153.55
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLUTION 0338-1047-02 250 mL Bottle 0.051 mL 250 mL $151.80
NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLUTION 0338-1049-02 250 mL Bottle 0.055 mL 250 mL $152.80
NITROPRUSSIDE 100 MCG/ML SYRINGE (FOR INTRACORONARY) UHCS-0004-10 500 mL Bottle 2.406 mL 500 mL "$2,421.04"
NITROPRUSSIDE IN 0.9 % NACL 50 MG/100 ML (0.5 MG/ML) IV SOLUTION 51754-1006-1 100 mL Vial 0.416 mL 100 mL $210.35
NIVOLUMAB 100 MG/10 ML IV SOLUTION 0003-3774-12 10 mL Vial 299.762 mL 10 mL "$6,032.71"
NIVOLUMAB 240 MG/24 ML IV SOLUTION 0003-3734-13 24 mL Vial 299.762 mL 24 mL "$14,478.51"
NIVOLUMAB 40 MG/4 ML IV SOLUTION 0003-3772-11 4 mL Vial 299.763 mL 4 mL "$2,413.09"
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLUTION 0409-3375-04 4 mL Vial 0.702 mL 4 mL $171.56
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLUTION 0143-9318-10 4 mL Vial 0.808 mL 4 mL $171.98
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLUTION 47335-615-44 4 mL Vial 0.97 mL 4 mL $172.63
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLUTION 47335-615-40 4 mL Vial 0.97 mL 4 mL $172.63
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLUTION 63323-940-04 4 mL Vial 1.159 mL 4 mL $173.39
NOREPINEPHRINE BITARTRATE-NACL 8 MG/250 ML (32 MCG/ML) IV SOLUTION UHCS-0005-72 250 mL Bag 0.028 mL 250 mL $175.75
NOREPINEPHRINE BITARTRATE-NACL 8 MG/250 ML (32 MCG/ML) IV SOLUTION 69374-316-25 250 mL Bottle 18.5 Bottle 250 mL $187.25
NOREPINEPHRINE BOLUS UHCS-ANES-30 1 mL Vial Vial 1 mL $0.00
NORETHINDRONE ACETATE 5 MG ORAL TAB 68462-304-50 50 each each 0.434 each 1 each $12.58
NORETHINDRONE ACETATE 5 MG ORAL TAB 50742-267-50 50 each each 0.554 each 1 each $12.70
NORTRIPTYLINE 10 MG ORAL CAP 60687-281-01 100 each each 0.257 each 1 each $12.41
NORTRIPTYLINE 25 MG ORAL CAP 50268-604-15 50 each each 0.3 each 1 each $12.45
NOZIN NASAL SANITIZER UHCS-0004-83 1 each Bottle 0 each 1 each $0.00
NOZIN NASAL SANITIZER 85692-3001-21 1 each Bottle 0 each 1 each $0.00
NYSTATIN 100000 UNIT/GRAM TP CREAM 45802-059-35 15 g Tube 0.21 g 15 g $57.15
NYSTATIN 100000 UNIT/GRAM TP OINTMENT 45802-048-35 15 g Tube 0.381 g 15 g $59.72
NYSTATIN 100000 UNITS/ML ORAL SUSPENSION 0121-0868-50 5 mL Cup 0.126 mL 5 mL $12.78

See Part 16