Medication Charges Part 22

TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSPENSION 70121-1049-1 1 mL Vial 3.21 mL 1 mL $171.96
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL TAB 68084-750-25 30 each each 0.643 each 1 each $12.79
TRIHEXYPHENIDYL 5 MG ORAL TAB 0591-5337-01 100 each each 0.28 each 1 each $12.43
TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM) 0.64MG/ML IV NICU UHCS-0000-03 25 mL Vial 0.731 mL 25 mL $187.03
TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM) PO 8MG/ML (NICU) UHCS-0000-52 30 mL Bottle 0.135 mL 30 mL $25.65
TROLAMINE SALICYLATE 10 % TP CREAM 4116773003 85 g Tube 0.039 g 85 g $57.32
TROPICAMIDE 1 % OPHT DROPS 17478-102-12 15 mL DROP BTL 0.343 mL 15 mL $29.45
TROPICAMIDE 1 % OPHT DROPS 61314-355-01 3 mL DROP BTL 3.14 mL 3 mL $33.72
TRYPAN BLUE 0.06 % IO SYRINGE 68803-612-10 0.5 mL Syringe 71.9 Syringe .5 mL $96.20
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML IDRM SOLUTION 49281-752-22 5 mL Vial 65.936 mL 5 mL $498.43
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML IM SYRINGE 49281-790-51 0.5 mL Syringe 225.3 mL .5 mL $281.40
UMECLIDINIUM-VILANTEROL 62.5-25 MCG/ACTUATION INHL DISKUS 0173-0869-06 14 each BLIST PACK 4.158 each 1 each $132.46
UREA (BULK) 100 % MISC BEADS 51552-0057-5 500 g Jar 0.039 g 500 g "$6,094.50"
UREA (BULK) 100 % MISC POWDER 38779-0101-9 1000 g Jar 0.045 g 1000 g $99.00
URSODIOL (ACTIGAL)25MG/ML PO SYRINGE (NICU) UHCS-0000-02 60 mL Bottle 2.4 Bottle 60 mL $63.15
URSODIOL 300 MG ORAL CAP 0904-7168-61 100 each each 2.303 each 1 each $14.45
VALACYCLOVIR 500 MG ORAL TAB 63739-525-10 100 each each 3.567 each 1 each $15.72
VALGANCICLOVIR (VALCYTE) PO 50 MG/ML (NICU) UHCS-0005-25 88 mL Bottle 8.4 mL 88 mL $760.80
VALGANCICLOVIR 450 MG ORAL TAB 16714-765-01 60 each each 12.909 each 1 each $25.06
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLUTION 0143-9637-10 5 mL Vial 0.443 mL 5 mL $170.97
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION UHCS-0001-56 60 mL Bottle 0.026 mL 60 mL $50.16
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION 60432-621-16 473 mL Bottle 0.026 mL 473 mL $60.90
VALSARTAN 80 MG ORAL TAB 60687-623-01 100 each each 0.774 each 1 each $12.92
VALSARTAN 80 MG ORAL TAB 60687-128-11 1 each each 0.932 each 1 each $13.08
VALSARTAN 80 MG ORAL TAB 60687-128-01 100 each each 0.932 each 1 each $13.08
VALSARTAN 160 MG ORAL TAB 59746-362-90 90 each each 0.236 each 1 each $12.39
VALSARTAN 160 MG ORAL TAB 55111-733-90 90 each each 0.236 each 1 each $12.39
VANCOMYCIN 5 G IV VIAL 0409-6509-01 5 g Vial 3.232 g 5 g $859.91
VANCOMYCIN 125 MG ORAL CAP 47781-729-02 20 each each 1.883 each 1 each $14.03
VANCOMYCIN 500 MG IV VIAL 0409-4332-01 1 each each 2.171 each 1 each $170.92
VANCOMYCIN 500 MG IV VIAL 0409-4332-11 1 each each 2.171 each 1 each $170.92
VANCOMYCIN 750 MG IV VIAL 0409-6531-02 1 each each 6.9 each 1 each $175.65
VANCOMYCIN (VANCOCIN) IV 5 MG/ML IN NS (PEDS) UHCS-0003-14 1 each each 3.331 each 1 each $172.08
VANCOMYCIN (VANCOCIN) IV 5MG/ML (NICU) UHCS-0000-51 1 each each 3.331 each 1 each $172.08
VANCOMYCIN 1 GRAM VIAL FOR DAY SURGERY UHCS-0002-54 1 each Vial 1.949 each 1 each $170.70
VANCOMYCIN 10 MG/ML EYE INJECTION UHCS-0004-74 1 mL Syringe 3.06 mL 1 mL $171.81
VANCOMYCIN 1000 MG IV VIAL 67457-340-01 1 each each 2.369 each 1 each $171.12
VANCOMYCIN 1000 MG IV VIAL 67457-340-00 1 each each 2.369 each 1 each $171.12
VANCOMYCIN 1000 MG IV VIAL 72611-765-01 1 each each 5.533 each 1 each $174.28
VANCOMYCIN 5 GRAM IV VIAL (NO ROUNDING) 0409-6509-01 5 g Vial 3.232 g 5 g $859.91
VANCOMYCIN 500 MG IV FOR ORTHO SOLUTION 0409-4332-01 1 each each 2.171 each 1 each $170.92
VANCOMYCIN COMMUNICATION TO DRAW PEAK LEVEL UHCS-0005-29 1 each each 0 each 1 each $0.00
VANCOMYCIN COMMUNICATION TO DRAW RANDOM LEVEL UHCS-0005-30 1 each each 0 each 1 each $0.00
VANCOMYCIN COMMUNICATION TO DRAW TROUGH LEVEL UHCS-0005-28 1 each each 0 each 1 each $0.00
VANCOMYCIN FOR INHALATION UHCS-0001-92 2.5 each each 1.999 each 1 each $173.75
VANCOMYCIN ORAL SOLUTION 125MG/2.5ML UHCS-0003-41 2.5 mL Syringe 1.25 Syringe 2.5 mL $17.45
VANCOMYCIN ORAL SOLUTION 250MG/5ML 60ML UHCS-0001-93 60 mL Bottle 17.5 Bottle 60 mL $33.70
VANCOMYCIN ORAL SOLUTION 500MG/10ML UHCS-0003-50 10 mL Syringe 1.09 Syringe 10 mL $17.29
VANCOMYCIN PULSE DOSE MONITORING UHCS-CON0-01 1 each N/A N/A 1 each $0.00
VANCOMYCIN-NS 1.25 GRAM/250 ML IVPB UHCS-0005-38 250 mL Bag 4.24 Bag 250 mL $172.99
VANCOMYCIN-NS 1.5 GRAM/500 ML IVPB UHCS-0005-40 500 mL Bag 7.31 Bag 500 mL $176.06
VARENICLINE 0.5 MG ORAL TAB 60505-4765-5 56 each each 5.181 each 1 each $17.33
VARENICLINE 0.5 MG ORAL TAB 0069-0468-56 56 each each 7.745 each 1 each $19.90
VARENICLINE 1 MG ORAL TAB 60505-4766-6 56 each each 4.633 each 1 each $16.78
VARENICLINE 1 MG ORAL TAB 0069-0469-56 56 each each 7.745 each 1 each $19.90
VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBQ RECON. SUSP. 0006-4827-00 1 each each 152.029 each 1 each $320.78
VASOPRESSIN 20 UNITS/ML IV SOLUTION 42367-570-87 1 mL Vial 21.245 mL 1 mL $190.00
VASOPRESSIN 20 UNITS/ML IV SOLUTION 0517-1020-25 1 mL Vial 23.074 mL 1 mL $191.82
VASOPRESSIN 20 UNITS/ML IV SOLUTION 0517-1020-01 1 mL Vial 23.074 mL 1 mL $191.82
VASOPRESSIN 20 UNITS/ML IV SOLUTION 70121-1642-5 1 mL Vial 36.948 mL 1 mL $205.70
VASOPRESSIN 20 UNITS/ML IV SOLUTION 42023-164-10 1 mL Vial 73.896 mL 1 mL $242.65
VASOPRESSIN INFUSION 20 UNITS/100 ML (PREMIX) 42023-237-01 100 mL Vial 0.739 mL 100 mL $212.95
VASOPRESSIN INFUSION 20 UNITS/100 ML (PREMIX) 42023-237-10 100 mL Vial 0.739 mL 100 mL $212.95
VECURONIUM 100MG/100ML BOLUS 0409-1632-01 1 each each 6.655 each 1 each $0.00
VECURONIUM BROMIDE 10 MG IV VIAL 55150-235-01 1 each each 2.24 each 1 each $170.99
VECURONIUM BROMIDE 10 MG IV VIAL 0703-2914-03 1 each each 5.348 each 1 each $174.10
VEDOLIZUMAB 300 MG IV VIAL 64764-300-20 1 each each 8176.02 each 1 each "$16,454.24"
VEMURAFENIB 240 MG ORAL TAB 50242-090-01 120 each each 1 Bottle 1 each $12.16
VENLAFAXINE 37.5 MG ORAL CP24 0904-6468-61 100 each each 0.379 each 1 each $12.53
VENLAFAXINE 37.5 MG ORAL TAB 51079-480-20 100 each each 0.565 each 1 each $12.72
VENLAFAXINE 75 MG ORAL CP24 0093-7385-05 500 each each 0.251 each 1 each $12.40
VENLAFAXINE 75 MG ORAL CP24 0904-6469-61 100 each each 0.386 each 1 each $12.54
VERAPAMIL 40 MG ORAL TAB 0591-0404-01 100 each each 0.1 each 1 each $12.25
VERAPAMIL 80 MG ORAL TAB 0904-2920-61 100 each each 0.074 each 1 each $12.22
VERAPAMIL 120 MG ORAL TBER 51079-894-20 100 each each 1.792 each 1 each $13.94
VERAPAMIL 180 MG ORAL TBER 75834-158-01 100 each each 0.135 each 1 each $12.29
VERAPAMIL 180 MG ORAL TBER 68462-293-01 100 each each 0.298 each 1 each $12.45
VERAPAMIL 2.5 MG/ML IV SOLUTION 43066-031-25 2 mL Vial 2.044 mL 2 mL $172.84
VERAPAMIL 2.5 MG/ML IV SOLUTION 43066-031-01 2 mL Vial 2.044 mL 2 mL $172.84
VERAPAMIL 2.5 MG/ML IV SOLUTION 0409-1144-10 2 mL Vial 2.046 mL 2 mL $172.84
VERAPAMIL 2.5 MG/ML IV SOLUTION 72485-108-25 2 mL Vial 2.198 mL 2 mL $173.15
VERAPAMIL 2.5 MG/ML IV SOLUTION 70121-1585-5 2 mL Vial 2.275 mL 2 mL $173.30
VERAPAMIL 2.5 MG/ML IV SOLUTION 70710-1643-7 2 mL Vial 4.618 mL 2 mL $177.99
VERAPAMIL 240 MG ORAL TBER 68462-260-01 100 each each 0.286 each 1 each $12.44
VERICIGUAT 2.5 MG ORAL TAB 0006-5028-01 14 each each 19.782 each 1 each $31.93
VERICIGUAT 5 MG ORAL TAB 0006-5029-02 30 each each 19.784 each 1 each $31.93
VIAL2BAG ADVANCED 20MM ADAPTER UHCS-0005-81 1 each each 1.924 Package 1 each $0.00
VIAL-MATE ADAPTER UHCS-0000-19 1 each each 2.39 each 1 each $0.00
VICTOR TRIAL DOBUTAMINE 500 MG/250 ML (200 0409-2347-32 250 mL Bag 0.039 mL 250 mL $148.80
VINBLASTINE 1 MG/ML IV SOLUTION 63323-278-10 10 mL Vial 3.676 mL 10 mL $536.26
VINCRISTINE 1 MG/ML IV SOLUTION 61703-309-26 1 mL Vial 4.97 mL 1 mL $504.47
VINORELBINE 10 MG/ML IV SOLUTION 25021-204-01 1 mL Vial 7.67 mL 1 mL $507.17
VINORELBINE 50 MG/5 ML IV SOLUTION 25021-204-05 5 mL Vial 6.374 mL 5 mL $531.37
VIT B COMP-C-FA-COPPER-ZINC 5-1.5-25 MG ORAL TAB 5199152890 90 each each 0.392 each 1 each $12.54
VITAMIN A (AQUASOL A) IM (NICU) 61703-418-18 1 each each 110.89 each 1 each $279.64
VITAMIN A 10000 UNITS ORAL CAP 904208560 100 each each 0.025 each 1 each $12.18
VITAMIN A PALMITATE 50000 UNITS/ML IM SOLUTION 61703-418-18 1 each each 110.89 each 1 each $279.64
VITAMIN E (DL ACETATE) 400 UNIT ORAL CAP 536479901 100 each each 0.059 each 1 each $12.21
"VITAMIN E (DL, ACETATE) 45 MG (100 UNIT) ORAL CAP" 8068113400 100 each each 0.015 each 1 each $12.17
VITS A AND D-WHITE PET-LANOLIN TP OINT. PACK 0168-0035-45 5 g BLIST PACK 0.041 g 5 g $270.21
VITS A AND D-WHITE PET-LANOLIN TP OINTMENT 0168-0035-01 56.7 g Tube 0.044 g 56.7 g $56.50
VODKA UHCS-0002-45 30 mL Package 0 mL 30 mL $0.00
VORICONAZOLE 200 MG IV VIAL 0049-3190-01 1 each each 15.93 each 1 each $184.68
VORICONAZOLE 200 MG IV VIAL 47781-466-71 1 each each 112.76 each 1 each $281.51
VORICONAZOLE 200 MG ORAL TAB 63629-8734-1 30 each each 2.37 each 1 each $14.52
WARFARIN 1 MG ORAL TAB 0832-1211-01 100 each each 0.119 each 1 each $12.27
WARFARIN 2 MG ORAL TAB 0832-1212-01 100 each each 0.119 each 1 each $12.27
WARFARIN 2.5 MG ORAL TAB 0832-1213-01 100 each each 0.119 each 1 each $12.27
WARFARIN 5 MG ORAL TAB 0832-1216-01 100 each each 0.119 each 1 each $12.27
WARFARIN 7.5 MG ORAL TAB 0832-1218-01 100 each each 0.163 each 1 each $12.31
WARFARIN (COUMADIN) COUNSELING PULSE DOSE UHCS-CON0-05 1 each N/A N/A 1 each $0.00
WARFARIN 0.5 MG ORAL TAB UHCS-0003-51 1 each each 0.069 each 1 each $12.22
WARFARIN 1.25 MG ORAL TAB UHCS-0004-06 1 each each 0.069 each 1 each $12.22
"WATER FOR INJECT, BACTERIOSTAT INJ SOLUTION" 0409-3977-03 30 mL Vial 0.05 mL 30 mL $23.44
WATER FOR INJECTION 10 ML FOR BULK CHARGE UHCS-0002-22 10 mL Vial 0.082 mL 10 mL $22.76
WATER FOR INJECTION 100 ML FOR BULK CHARGE UHCS-0002-25 100 mL Vial 0.037 mL 100 mL $172.45
WATER FOR INJECTION 20 ML FOR BULK CHARGE UHCS-0002-23 20 mL Vial 0.054 mL 20 mL $23.02
WATER FOR INJECTION 50 ML FOR BULK CHARGE UHCS-0002-24 50 mL Vial 0.039 mL 50 mL $23.89
WATER FOR INJECTION STERILE INJ SOLUTION 0409-4887-20 20 mL Vial 0.054 mL 20 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION 0409-4887-50 50 mL Vial 0.039 mL 50 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION 0409-4887-99 100 mL Vial 0.037 mL 100 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION 63323-185-10 10 mL Vial 0.352 mL 10 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION UHCS-0004-81 10 mL Syringe 0 Syringe 10 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION 63323-185-09 50 mL Vial 0.119 mL 50 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION FOR USE WITH MED MIXTURES 0409-4887-20 20 mL Vial 0.054 mL 20 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION FOR USE WITH MED MIXTURES 0409-4887-50 50 mL Vial 0.039 mL 50 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION FOR USE WITH MED MIXTURES 0409-4887-99 100 mL Vial 0.037 mL 100 mL $0.00
WATER FOR INJECTION STERILE INJ SOLUTION FOR USE WITH MED MIXTURES 63323-185-10 10 mL Vial 0.352 mL 10 mL $0.00
WATER FOR INJECTION STERILE IV BAG 0264-7850-10 500 mL Bag 0.007 mL 500 mL $142.55
WATER FOR INJECTION STERILE IV BAG 0990-7990-09 1000 mL Flex Cont 0.005 mL 1000 mL $144.05
WATER FOR INJECTION STERILE IV BAG 0338-0013-04 1000 mL Bag 6.691 Bag 1000 mL $145.74
WATER FOR IRRIGATION STERILE IRRIGATION BAG 0338-0003-44 1000 mL Flex Cont 5.664 Flex Cont 1000 mL $77.21
WATER FOR IRRIGATION STERILE IRRIGATION SOLUTION 0338-0004-04 1000 mL Bottle 3.122 Bottle 1000 mL $74.67
WATER FOR IRRIGATION STERILE IRRIGATION SOLUTION 0338-0004-03 500 mL Bottle 3.357 Bottle 500 mL $74.91
WATER FOR IRRIGATION STERILE IRRIGATION SOLUTION 0338-0004-02 250 mL Bottle 3.482 Bottle 250 mL $75.03
WATER FOR IRRIGATION STERILE IRRIGATION SOLUTION 0338-0004-05 1500 mL Bottle 4.971 Bottle 1500 mL $76.52
WHISKEY UHCS-0002-43 30 mL Package 0 mL 30 mL $0.00
WHITE PETROLATUM 41 % TP OINTMENT 7214003147 396 g Jar 0.025 g 396 g $63.90
WHITE PETROLATUM 42 % TP OINTMENT 0536-1143-98 454 g Jar 0.021 g 454 g $63.53
WHITE PETROLATUM TP GEL 0904-5731-82 368 g Jar 0.008 g 368 g $56.94
WHITE PETROLATUM-MINERAL OIL 80-20 % OPHT OINTMENT 1011902239 3.5 g Tube 1.8 g 3.5 g $67.05
WHITE PETROLATUM-MINERAL OIL 83-15 % OPHT OINTMENT 0904-6488-38 3.5 g Tube 0.831 g 3.5 g $63.66
WHITE PETROLATUM-MINERAL OIL 83-15 % OPHT OINTMENT 17478-062-35 3.5 g Tube 1.846 g 3.5 g $67.21
WINE UHCS-0002-44 180 mL Package 0 mL 180 mL $0.00
WOUND DRESSINGS TP PASTE 1170103132 170 g Tube 0.087 g 170 g $0.00
ZAFIRLUKAST 20 MG ORAL TAB 55111-626-60 60 each each 0.853 each 1 each $13.00
ZIDOVUDINE (RETROVIR) PO 10MG/ML (NICU) UHCS-0000-50 60 mL Bottle 0.139 mL 60 mL $29.94
ZIDOVUDINE 10 MG/ML IV SOLUTION 49702-213-26 20 mL Vial 1.416 mL 20 mL $197.07
ZIDOVUDINE 10 MG/ML ORAL SYRUP UHCS-0001-57 30 mL Bottle 0.262 mL 30 mL $56.46
ZIDOVUDINE 10 MG/ML ORAL SYRUP 65862-048-24 240 mL Bottle 0.139 mL 240 mL $81.96
ZIDOVUDINE 300 MG ORAL TAB 31722-509-60 60 each each 0.288 each 1 each $12.44

See Part 23