Medication Charges Part 6

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.

CLINIMIX CYCLIC TPN (SUMMERVILLE) $510.00
CLOBAZAM 10 MG ORAL TAB 51991-900-01 100 each each 0.554 each 1 each $15.40
CLOBETASOL 0.05 % TP CREAM 42291-076-15 15 g Tube 0.132 g 15 g $55.98
CLOBETASOL 0.05 % TP OINTMENT 42291-077-15 15 g Tube 0.161 g 15 g $56.42
CLOBETASOL 0.05 % TP OINTMENT 52565-039-15 15 g Tube 0.711 g 15 g $64.67
CLONAZEPAM 0.5 MG ORAL TAB 63739-263-10 100 each each 0.103 each 1 each $16.30
CLONAZEPAM 0.5 MG ORAL TAB 60687-544-01 100 each each 0.33 each 1 each $16.53
CLONIDINE (CATAPRES) PO 10 MCG/ML (NICU) UHCS-0004-53 1 each each 0.036 each 1 each $21.64
CLONIDINE 0.1 MG/24 HR TD WEEKLY PATCH 51862-453-04 4 each each 9.598 each 1 each $33.90
CLONIDINE 0.1 MG/24 HR TD WEEKLY PATCH 51862-453-01 1 each each 9.598 each 1 each $33.90
CLONIDINE 0.1 MG/24 HR TD WEEKLY PATCH 0378-0871-99 4 each each 11.375 each 1 each $35.68
CLONIDINE 0.2 MG/24 HR TD WEEKLY PATCH 0378-0872-99 4 each each 16.785 each 1 each $41.09
CLONIDINE 0.3 MG/24 HR TD WEEKLY PATCH 0378-0873-99 4 each each 21.375 each 1 each $45.68
CLONIDINE HCL 0.1 MG ORAL TAB 0904-5656-61 100 each each 0.048 each 1 each $12.20
CLONIDINE HCL 0.1 MG ORAL TAB 51079-299-01 1 each each 0.095 each 1 each $12.25
CLONIDINE HCL 0.2 MG ORAL TAB 29300-136-01 100 each each 0.054 each 1 each $12.20
CLONIDINE HCL 0.3 MG ORAL TAB 0904-5658-61 100 each each 0.071 each 1 each $12.22
CLOPIDOGREL 75 MG ORAL TAB 0904-6294-61 100 each each 0.127 each 1 each $12.28
CLOPIDOGREL 300 MG ORAL TAB 55111-671-31 30 each each 15.395 each 1 each $27.55
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TAB 51672-4042-1 100 each each 1.372 each 1 each $17.57
CLOTRIMAZOLE 10 MG MM TROCHE 0054-8146-22 70 each each 2.539 each 1 each $14.69
CLOTRIMAZOLE 1 % TP CREAM 45802-434-11 28 g Tube 0.04 g 28 g $55.12
CLOTRIMAZOLE 1 % VAGL CREAM 51672-2003-6 45 g TUBE/KIT 0.051 g 45 g $56.30
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TP CREAM 16714-496-01 15 g Tube 0.273 g 15 g $58.10
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TP LOTION 51672-1308-3 30 mL Bottle 1.972 mL 30 mL $113.16
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TP LOTION 0168-0370-30 30 mL Bottle 3.813 mL 30 mL $168.39
COAGULATION FACTOR IX 500 (+/-) UNIT IV VIAL 68516-3607-2 1 each each 0.69 each 1 each $169.44
"COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) IV VIAL" 0169-7201-01 1 each each 2159.7 each 1 each "$4,346.40"
"COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) IV VIAL" 0169-7202-01 1 each each 4319.4 each 1 each "$8,692.79"
"COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) IV VIAL" 0169-7205-01 1 each each 10798.5 each 1 each "$21,731.98"
COCAINE 4 % NASL SOLUTION 0527-1971-74 4 mL Bottle 37.655 mL 4 mL $218.12
COCAINE 4 % TP SOLUTION 0527-1728-74 4 mL Bottle 32.32 mL 4 mL $196.78
CODEINE SULFATE 30 MG ORAL TAB 0054-0244-24 100 each each 0.794 each 1 each $15.64
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQUID 50383-087-07 5 mL Cup 0.056 mL 5 mL $16.48
COENZYME Q10 50 MG ORAL CAP 904561646 30 each each 0.131 each 1 each $12.28
COLCHICINE 0.6 MG ORAL TAB 65162-710-09 90 each each 0.494 each 1 each $12.64
COLESEVELAM 625 MG ORAL TAB 67877-506-51 180 each each 0.827 each 1 each $12.98
COLESEVELAM 625 MG ORAL TAB 60687-385-25 30 each each 3.075 each 1 each $15.23
COLESTIPOL 1 G ORAL TAB 59762-0450-1 120 each each 0.558 each 1 each $12.71
COLISTIN (COLISTIMETHATE NA) 150 MG INJ VIAL 70594-023-01 1 each each 8.78 each 1 each $177.53
COLISTIN (COLISTIMETHATE NA) 150 MG INJ VIAL 63323-393-06 1 each each 10.14 each 1 each $178.89
COLLAGENASE CLOSTRIDIUM HISTO. 250 UNIT/GRAM TP OINTMENT 50484-010-30 30 g Tube 7.886 g 30 g $290.58
COMBINED TC99 AND ULTRA TAG KIT UHCS-RAD-027 1 each each 530 each 1 each $530.00
COMPOUNDING VEHICLE SYRUP NO23 ORAL SYRUP 574030416 473 mL Bottle 0.027 mL 473 mL $61.37
CONIVAPTAN IN 5 % DEXTROSE 20 MG/100 ML IV SOLUTION 66220-160-10 100 mL Bag 8.231 mL 100 mL $962.15
CONJUGATED ESTROGENS 1.25 MG ORAL TAB 0046-1104-81 100 each each 6.192 each 1 each $18.34
CONJUGATED ESTROGENS 0.3 MG ORAL TAB 0046-1100-81 100 each each 6.192 each 1 each $18.34
CONJUGATED ESTROGENS 0.625 MG ORAL TAB 0046-1102-81 100 each each 6.192 each 1 each $18.34
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM 0046-0872-21 30 g TUBE/KIT 13.45 g 30 g $457.50
CONJUGATED ESTROGENS 25 MG INJ VIAL 0046-0749-05 1 each each 329.99 each 1 each $664.11
COPPER 380 SQUARE MM IU IUD 59365-5128-1 1 each each 937 each 1 each "$1,885.71"
COPPER CU-64 DOTATATE 148 MBQ/4 ML (4 MCI/4 ML) IV SOLUTION 69945-064-01 1 each each 9240 each 1 each "$9,240.00"
COPPER GLUCONATE 2 MG ORAL TAB 5848702801 100 each each 0.046 each 1 each $12.20
CORN STARCH TP POWDER UHCS-0001-87 120 g Bottle 0.011 g 120 g $14.82
COSYNTROPIN 0.001 MG INJECTION 0781-3440-95 1 each each 16.627 each 1 each $185.38
COSYNTROPIN 0.25 MG INJ VIAL 0781-3440-95 1 each each 16.627 each 1 each $185.38
"COVID-19 VACC,MRNA(MODERNA)-PF 100 MCG/0.5 ML IM SUSPENSION" 80777-273-10 5 mL Vial 0 mL 5 mL $0.00
"COVID-19 VACC,MRNA(MODERNA)-PF 100 MCG/0.5 ML IM SUSPENSION" 80777-273-99 5 mL Vial 0 mL 5 mL $0.00
"COVID-19 VACC,MRNA(PFIZER)(PF) 30 MCG/0.3 ML IM RECON. SUSP." 59267-1000-1 1.8 mL Vial 0 mL 1.8 mL $0.00
CR-51 NA CHROMATE UHCS-RAD-001 1 each each 1248 each 1 each "$1,248.00"
CROMOLYN 5.2 MG/SPRAY (4 %) NASL SPRAY 57782-397-26 26 mL SQUEEZ BTL 0.16 mL 26 mL $78.41
CROTALIDAE POLYVAL IMMUNE FAB INJ VIAL 50633-110-12 1 each each 2953.53 each 1 each "$5,943.98"
CUPRIC CHLORIDE 0.4 MG/ML IV SOLUTION 0409-4092-01 10 mL Vial 2.166 mL 10 mL $190.41
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TAB 7733393710 100 each each 0.1 each 1 each $12.25
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TAB 7733393725 1 each each 0.1 each 1 each $12.25
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TAB 3786491301 100 each each 0.16 each 1 each $12.31
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLUTION 63323-044-01 1 mL Vial 6.381 mL 1 mL $175.13
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLUTION 63323-044-00 1 mL Vial 6.381 mL 1 mL $175.13
CYCLER PERITONEAL DIALYSIS W/1.5% DEXTROSE AND LOW CA++ 0941-0409-06 2000 mL Flex Cont 14.222 Flex Cont 2000 mL $153.27
CYCLER PERITONEAL DIALYSIS W/1.5% DEXTROSE AND LOW CA++ 0941-0409-01 6000 mL Flex Cont 31.26 Flex Cont 6000 mL $170.31
CYCLER PERITONEAL DIALYSIS W/2.5% DEXTROSE AND LOW CA ++ 0941-0457-08 2000 mL Flex Cont 17.037 Flex Cont 2000 mL $156.09
CYCLER PERITONEAL DIALYSIS W/2.5% DEXTROSE AND LOW CA++ 0941-0457-01 6000 mL Flex Cont 31.95 Flex Cont 6000 mL $171.00
CYCLER PERITONEAL DIALYSIS W/4.25% DEXTROSE AND LOW CA++ 0941-0459-08 2000 mL Flex Cont 17.757 Flex Cont 2000 mL $156.81
CYCLER PERITONEAL DIALYSIS W/4.25% DEXTROSE AND LOW CA++ 0941-0459-01 6000 mL Flex Cont 32.83 Flex Cont 6000 mL $171.88
CYCLIC TPN ADULT (CENTRAL) $510.00
CYCLIC TPN ADULT (PERIPHERAL) $510.00
CYCLOBENZAPRINE 10 MG ORAL TAB 63739-531-10 100 each each 0.073 each 1 each $12.22
CYCLOPENTOLATE 1 % OPHT DROPS 24208-735-01 2 mL DROP BTL 4.375 mL 2 mL $33.05
CYCLOPENTOLATE 1 % OPHT DROPS 17478-100-02 2 mL DROP BTL 5.46 mL 2 mL $35.22
CYCLOPENTOLATE 1 % OPHT DROPS 61314-396-01 2 mL DROP BTL 5.52 mL 2 mL $35.34
CYCLOPENTOLATE 2 % OPHT DROPS 17478-097-02 2 mL DROP BTL 10.575 mL 2 mL $45.45
CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OPHT DROPS 0065-0359-02 2 mL DROP BTL 13.635 mL 2 mL $51.57
CYCLOPHOSPHAMIDE 25 MG ORAL CAP 54879-021-01 100 each each 2.441 each 1 each $14.59
CYCLOPHOSPHAMIDE (CYTOXAN) PO 10 MG/ML UHCS-0004-49 50 mL Bottle 4.75 mL 50 mL $249.65
CYCLOPHOSPHAMIDE 1 G IV VIAL 70121-1239-1 1 each each 207.83 each 1 each $707.33
CYCLOPHOSPHAMIDE 1 G IV VIAL 10019-939-01 1 each each 219.8 each 1 each $719.30
CYCLOPHOSPHAMIDE 500 MG IV VIAL 70121-1238-1 1 each each 93.62 each 1 each $593.12
CYCLOPHOSPHAMIDE 500 MG IV VIAL 16714-859-01 1 each each 96.5 each 1 each $596.00
CYCLOPHOSPHAMIDE 500 MG IV VIAL 10019-938-01 1 each each 109.88 each 1 each $609.38
CYCLOSPORINE 25 MG ORAL CAP 68084-879-25 30 each each 3.905 each 1 each $16.06
CYCLOSPORINE MODIFIED 25 MG ORAL CAP 0093-5740-65 30 each each 1.016 each 1 each $52.66
CYCLOSPORINE MODIFIED 100 MG ORAL CAP 0093-5742-65 30 each each 4.063 each 1 each $16.21
CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP UHCS-0001-36 60 mL Bottle 0.053 mL 60 mL $51.78
CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP 64980-504-48 473 mL Bottle 0.053 mL 473 mL $73.67
CYPROHEPTADINE 4 MG ORAL TAB 52817-210-10 100 each each 0.102 each 1 each $12.25
CYSTEINE (L-CYSTEINE) 50 MG/ML IV SOLUTION 0781-8940-95 10 mL Vial 1.714 mL 10 mL $185.89
CYTARABINE (PF) 2 G INJ SOLUTION 61703-319-22 20 mL Vial 0.889 mL 20 mL $517.28
CYTARABINE (PF) 2 G INJ SOLUTION 67457-452-20 20 mL Vial 0.924 mL 20 mL $517.98
CYTOMEGALOVIRUS IMMUNE GLOB 50 MG/ML IV SOLUTION 44206-532-11 50 mL Vial 29.036 mL 50 mL "$2,921.75"
D10 %-0.45 % SODIUM CHLORIDE IV BAG 0264-7622-00 1000 mL Bag 7.355 Bag 1000 mL $146.41
D5 % AND 0.9 % SODIUM CHLORIDE IV BAG 0338-0089-04 1000 mL Bag 3.843 Bag 1000 mL $142.89
D5 %-0.45 % SODIUM CHLORIDE IV BAG 0338-0085-04 1000 mL Bag 3.9 Bag 1000 mL $142.95
D5 %-0.45 % SODIUM CHLORIDE IV BAG 0409-7926-02 250 mL Bag 0.019 mL 250 mL $143.80
DABIGATRAN ETEXILATE 75 MG ORAL CAP 0597-0355-56 60 each each 5.956 each 1 each $18.11
DABIGATRAN ETEXILATE 150 MG ORAL CAP 0597-0360-82 60 each each 5.956 each 1 each $18.11
DACARBAZINE 200 MG IV VIAL 0703-5075-01 1 each each 15.16 each 1 each $514.66
DALBAVANCIN 500 MG IV SOLUTION 57970-100-01 1 each each 1548.27 each 1 each "$3,115.89"
DANTROLENE 20 MG IV VIAL 0143-9297-01 1 each each 50.8 each 1 each $219.55
DANTROLENE 20 MG IV VIAL 27505-003-67 1 each each 61.667 each 1 each $230.42
DANTROLENE 20 MG IV VIAL 78670-003-67 1 each each 61.667 each 1 each $230.42
DANTROLENE 25 MG ORAL CAP 68084-300-21 30 each each 1.503 each 1 each $13.65
DANTROLENE 250 MG IV RECON. SUSP. 42367-540-32 1 each each 2005.83 each 1 each "$4,036.73"
DAPAGLIFLOZIN 5 MG ORAL TAB 0310-6205-30 30 each each 14.272 each 1 each $26.42
DAPAGLIFLOZIN 10 MG ORAL TAB 0310-6210-30 30 each each 14.272 each 1 each $26.42
DAPSONE 100 MG ORAL TAB 70954-136-10 30 each each 0.874 each 1 each $13.02
DAPSONE 100 MG ORAL TAB 49938-101-30 30 each each 2.586 each 1 each $14.74
DAPTOMYCIN 350 MG IV VIAL 25021-179-16 1 each each 20.783 each 1 each $189.91
DAPTOMYCIN 5 MG/ML IV (NICU) UHCS-0005-12 1 each each 13.2 Syringe 1 each $181.95
DAPTOMYCIN 500 MG IV VIAL 0143-9378-01 1 each each 14.32 each 1 each $183.07
DAPTOMYCIN 500 MG IV VIAL FOR PUSH 0143-9378-01 1 each each 14.32 each 1 each $183.07
DARATUMUMAB 20 MG/ML IV SOLUTION 20ML 57894-502-20 20 mL Vial 133.131 mL 20 mL "$5,358.52"
DARATUMUMAB 20 MG/ML IV SOLUTION 5ML 57894-502-05 5 mL Vial 133.132 mL 5 mL "$1,339.64"
DARBEPOETIN ALFA IN POLYSORBAT 40 MCG/0.4 ML INJ SYRINGE 55513-021-04 0.4 mL Syringe 720.744 mL .4 mL $580.20
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRINGE 55513-027-04 0.3 mL Syringe 3603.742 mL .3 mL "$2,175.76"
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRINGE 55513-111-01 0.6 mL Syringe 3603.75 mL .6 mL "$4,351.53"
DARIFENACIN 7.5 MG ORAL TB24 13668-202-30 30 each each 3.027 each 1 each $15.18
DARUNAVIR ETHANOLATE 600 MG ORAL TAB 59676-562-01 60 each each 33.874 each 1 each $46.02
DARUNAVIR ETHANOLATE 800 MG ORAL TAB 59676-566-30 30 each each 67.748 each 1 each $79.90
DAUNORUBICIN 5 MG/ML IV SOLUTION 42658-021-02 4 mL Vial 8.177 mL 4 mL $532.21
DAUNORUBICIN 5 MG/ML IV SOLUTION 0143-9551-10 4 mL Vial 14.433 mL 4 mL $557.23
DECITABINE 50 MG IV VIAL 72205-031-01 1 each each 50.8 each 1 each $550.30
DEFEROXAMINE 500 MG INJ VIAL 0409-2336-10 1 each each 8.735 each 1 each $177.49
DEFIBROTIDE 80 MG/ML IV SOLUTION 68727-800-02 2.5 mL Vial 412 mL 2.5 mL "$2,072.88"
DEFIBROTIDE 80 MG/ML IV SOLUTION 68727-800-01 2.5 mL Vial 412 mL 2.5 mL "$2,072.88"
DEMECLOCYCLINE 150 MG ORAL TAB 0904-6180-61 100 each each 4.959 each 1 each $17.11
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLUTION 55513-730-01 1.7 mL Vial 1641.676 mL 1.7 mL "$5,616.59"
DENOSUMAB 60 MG/ML SUBQ SYRINGE 55513-710-01 1 mL Syringe 1517.38 mL 1 mL "$3,053.73"
DESFLURANE 100 % INHL LIQUID UHCS-0002-40 1 each Bottle 10.44 Bottle 1 each $104.94
DESFLURANE 100 % INHL LIQUID 10019-644-34 240 mL Bottle 0.495 mL 240 mL "$23,938.74"
DESMOPRESSIN 4 MCG/ML INJ SOLUTION 43598-931-09 1 mL AMPUL 18.474 mL 1 mL $187.22
DESMOPRESSIN 4 MCG/ML INJ SOLUTION 69918-899-10 1 mL AMPUL 20.248 mL 1 mL $189.00
DESMOPRESSIN 4 MCG/ML INJ SOLUTION 0703-5051-03 1 mL Vial 42.608 mL 1 mL $211.36
DESMOPRESSIN 0.1 MG ORAL TAB 68084-606-21 30 each each 1.237 each 1 each $13.39
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASL SPRP 60505-0815-0 5 mL AER W/ADAP 16.024 mL 5 mL $154.37
DESONIDE 0.05 % TP CREAM 45802-422-35 15 g Tube 1.109 g 15 g $70.64
DESONIDE 0.05 % TP OINTMENT 0168-0309-15 15 g Tube 1.861 g 15 g $81.92

See Part 7