Medication Charges Part 7

DESOXIMETASONE 0.25 % TP CREAM 51672-1270-3 60 g Jar 0.67 g 60 g $94.20
DESOXIMETASONE 0.25 % TP OINTMENT 52565-030-60 60 g Tube 0.577 g 60 g $88.62
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24 51991-311-33 30 each each 0.697 each 1 each $12.85
DEXAMETHASONE 1 MG ORAL TAB 0054-8174-25 100 each each 0.222 each 1 each $12.37
DEXAMETHASONE 2 MG ORAL TAB 0054-8176-25 100 each each 0.447 each 1 each $12.60
DEXAMETHASONE 4 MG ORAL TAB 0054-8175-25 100 each each 0.709 each 1 each $12.96
DEXAMETHASONE (DECADRON) IV 0.4MG/ML (NICU) UHCS-0000-65 10 mL Vial 0.786 mL 10 mL $176.61
DEXAMETHASONE (DECADRON) IV 1 MG/ML (NICU) UHCS-0000-67 4 mL Vial 0.789 mL 4 mL $171.91
DEXAMETHASONE (DECADRON) PO 1 MG/ML (NICU) UHCS-0000-68 4 mL Bottle 2.42 mL 4 mL $31.28
DEXAMETHASONE (DECADRON) PO IV 0.4MG/ML (NICU) UHCS-0000-66 10 mL Vial 2.42 mL 10 mL $192.95
DEXAMETHASONE (PF) 9 % IO SUSPENSION UHCS-0005-49 1 each each 523.6 each 1 each "$1,053.75"
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION UHCS-0001-37 60 mL Bottle 0.028 mL 60 mL $50.28
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION 0054-3177-63 500 mL Bottle 0.022 mL 500 mL $59.60
DEXAMETHASONE 1 MG/ML ORAL DROPS 0054-3176-44 30 mL DROP BTL 0.575 mL 30 mL $65.85
DEXAMETHASONE 10MG/ML INJ ORDERABLE 0641-0367-25 1 mL Vial 0.789 mL 1 mL $169.54
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLUTION 70069-021-25 1 mL Vial 2.586 mL 1 mL $171.34
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLUTION 67457-423-12 1 mL Vial 0.454 mL 1 mL $169.20
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLUTION 67457-423-00 1 mL Vial 0.454 mL 1 mL $169.20
DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OPHT DROPS 24208-720-02 5 mL DROP BTL 7.368 mL 5 mL $97.59
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJ SOLUTION 0641-0367-25 1 mL Vial 0.789 mL 1 mL $169.54
DEXMEDETOMIDINE 100 MCG/ML IV SOLUTION 70860-605-03 2 mL Vial 1.015 mL 2 mL $170.78
DEXMEDETOMIDINE 100 MCG/ML IV SOLUTION 71288-505-03 2 mL Vial 1.145 mL 2 mL $171.04
DEXMEDETOMIDINE 100 MCG/ML IV SOLUTION 66794-230-02 2 mL Vial 1.15 mL 2 mL $171.05
DEXMEDETOMIDINE 100 MCG/ML IV SOLUTION 16729-432-93 2 mL Vial 3.325 mL 2 mL $175.40
DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLUTION 55150-297-10 100 mL Flex Cont 0.153 mL 100 mL $184.05
DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLUTION 0143-9525-10 100 mL Flex Cont 0.157 mL 100 mL $184.45
DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLUTION 43066-557-12 100 mL Bag 0.163 mL 100 mL $185.05
DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLUTION 0338-9557-12 100 mL Bag 0.163 mL 100 mL $185.05
DEXRAZOXANE HCL 500 MG IV VIAL 0013-8727-89 1 each each 455.68 each 1 each $955.18
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL LIQUID 61787-513-04 118 mL Bottle 0.035 mL 118 mL $52.73
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRUP 0121-0638-00 5 mL Cup 0.227 mL 5 mL $13.29
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRUP 0121-1276-00 10 mL Cup 0.127 mL 10 mL $13.42
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRUP 0904-6464-20 118 mL Bottle 0.01 mL 118 mL $49.78
DEXTROMETHORPHAN-GUAIFENESIN 30-600 MG ORAL TB12 63824-056-34 40 each each 0.366 each 1 each $12.52
DEXTROMETHORPHAN-QUINIDINE 20-10 MG ORAL CAP 64597-301-60 60 each each 23.359 each 1 each $35.51
DEXTROSE 10 % IN WATER (D10W) 10 % IV BAG 0338-0023-02 250 mL Bag 4.259 Bag 250 mL $143.31
DEXTROSE 10 % IN WATER (D10W) 10 % IV BAG 0338-0023-03 500 mL Bag 4.531 Bag 500 mL $143.58
DEXTROSE 10 % IN WATER (D10W) 10 % IV BAG 0338-0023-04 1000 mL Bag 5.936 Bag 1000 mL $144.99
DEXTROSE 10 % IN WATER (D10W) 500 ML FOR BULK CHARGE 0409-7930-03 500 mL Bag 0.011 Bag 500 mL $139.06
DEXTROSE 10 % IV BOLUS 0409-7930-03 500 mL Bag 0.011 Bag 500 mL $139.06
DEXTROSE 10 % IV BOLUS 0409-7930-09 1000 mL Bag 0.005 mL 1000 mL $144.05
DEXTROSE 25 % IN WATER (D25W) IV SYRINGE 0409-1775-10 10 mL Syringe 1.127 mL 10 mL $180.02
DEXTROSE 40 % ORAL GEL 574006930 37.5 g Tube 0.078 g 37.5 g $51.53
DEXTROSE 5 % 100 ML FOR BULK CHARGE UHCS-0002-34 100 mL Bag 0.015 mL 100 mL $125.70
DEXTROSE 5 % 100 ML SINGLE WRAP FOR BULK CHARGE UHCS-0002-32 100 mL Vial 0.02 mL 100 mL $126.20
DEXTROSE 5 % 25 ML FOR BULK CHARGE UHCS-0002-31 25 mL Bag 0.066 mL 25 mL $125.85
DEXTROSE 5 % IN WATER (D5W) 5 % IV IVPB 0338-0551-11 50 mL Bag 0.064 mL 50 mL $0.00
DEXTROSE 5 % IN WATER (D5W) 5 % IV IVPB 0409-7100-69 100 mL Bag 0.016 mL 100 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-02 250 mL Bag 2.762 Bag 250 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-18 100 mL Bag 1.972 Bag 100 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-11 50 mL Bag 1.846 Bag 50 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-48 100 mL Bag 1.906 Bag 100 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-41 50 mL Bag 1.981 Bag 50 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0409-7922-02 250 mL Bag 0.019 mL 250 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-03 500 mL Bag 3.107 Bag 500 mL $142.16
DEXTROSE 5 % IN WATER (D5W) IV BAG 0338-0017-04 1000 mL Bag 3.795 Bag 1000 mL $142.85
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0338-0017-02 250 mL Bag 2.762 Bag 250 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7923-20 25 mL Bag 0.066 Bag 25 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7923-23 100 mL Bag 0.02 mL 100 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7923-36 50 mL Bag 0.028 mL 50 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7923-37 100 mL Bag 0.015 mL 100 mL $0.00
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7922-30 500 mL Bag 2.318 Bag 500 mL $141.37
DEXTROSE 5 % IN WATER (D5W) IV FLUSH 0409-7922-03 500 mL Bag 0.011 mL 500 mL $144.55
DEXTROSE 5 % IV 1000 ML FOR BULK CHARGE UHCS-0002-28 1000 mL Bag 3.795 Bag 1000 mL $142.85
DEXTROSE 5 % IV 250 ML BAG FOR BULK CHARGE UHCS-0002-27 250 mL Bag 0.01 Bag 250 mL $139.06
DEXTROSE 5 % IV 50 ML SINGLE WRAP FOR BULK CHARGE UHCS-0002-30 50 mL Bag 0.041 mL 50 mL $126.25
DEXTROSE 5 % IV 500 ML FOR BULK CHARGE UHCS-0002-29 500 mL Bag 3.107 Bag 500 mL $142.16
DEXTROSE 5 % SYRINGE FOR FLUSH UHCS-0003-61 5 mL Syringe 0.023 Syringe 5 mL $21.96
DEXTROSE 5 %-LACTATED RINGERS IV BAG 0338-0125-04 1000 mL Bag 4.298 Bag 1000 mL $143.35
DEXTROSE 5% 10 ML FLUSH SYRINGE UHCS-0004-60 10 mL Syringe 0.023 mL 10 mL $22.17
DEXTROSE 5% IN WATER (D5W) IV (COLD) UHCS-0001-88 250 mL Bag 0.01 Bag 250 mL $0.00
DEXTROSE 5% IN WATER (D5W) IV FLUSH (NO TRIGGER FILL) 0409-7923-36 50 mL Bag 0.028 mL 50 mL $0.00
DEXTROSE 5%-0.2 % SOD CHLORIDE IV BAG 0338-0077-04 1000 mL Bag 4.834 Bag 1000 mL $143.88
DEXTROSE 50 % IN WATER (D50W) IV SYRINGE 0409-7517-66 50 mL Syringe 0.216 mL 50 mL $179.55
DEXTROSE 50 % IN WATER (D50W) IV SYRINGE 0409-7517-16 50 mL Syringe 0.216 mL 50 mL $179.55
DEXTROSE 50 % IN WATER (D50W) IV SYRINGE 0409-4902-64 50 mL Syringe 0.221 mL 50 mL $179.80
DEXTROSE 50 % IN WATER (D50W) IV SYRINGE 70092-1475-50 50 mL Syringe 0.257 mL 50 mL $181.60
DEXTROSE 50% IN WATER (D50W) IV VIAL 0409-6648-02 50 mL Vial 0.069 mL 50 mL $172.20
DEXTROSE 50% IN WATER (D50W) IV VIAL 0409-6648-16 50 mL Vial 0.069 mL 50 mL $172.20
DEXTROSE 50% SOLUTION UHCS-0004-52 50 mL Syringe 0.142 Syringe 50 mL $168.89
DEXTROSE 70 % IN WATER (D70W) IV BAG 0338-0719-06 2000 mL Bag 0.008 mL 2000 mL $155.05
DEXTROSE 70 % IN WATER (D70W) IV BAG 0409-7120-07 2000 mL Bag 0.009 mL 2000 mL $157.05
DIATRIZOATE MEG-DIATRIZOAT SOD 66-10 % ORAL SOLUTION 0270-0445-35 30 mL Bottle 0.225 mL 30 mL $55.35
DIATRIZOATE MEG-DIATRIZOAT SOD 66-10 % ORAL SOLUTION 0270-0445-40 120 mL Bottle 0.068 mL 120 mL $56.76
DIATRIZOATE MEG-DIATRIZOAT SOD 66-10 % ORAL SOLUTION 0019-4816-04 30 mL Bottle 0.32 mL 30 mL $58.20
DIAZEPAM 2 MG ORAL TAB 51079-284-20 100 each each 0.046 each 1 each $16.25
DIAZEPAM 5 MG ORAL TAB 63739-073-10 100 each each 0.034 each 1 each $16.23
DIAZEPAM (VALIUM) IV 0.2 MG/ML (NICU) UHCS-0000-63 25 mL Vial 10.992 mL 25 mL $443.55
DIAZEPAM 5 MG/ML INJ SYRINGE 0409-1273-32 2 mL Cartridge 10.992 mL 2 mL $190.73
DIAZEPAM 5 MG/ML INJ SYRINGE (ANESTHESIA) UHCS-ANES-19 1 Syringe Syringe Syringe 1 Syringe $0.00
DIAZOXIDE 50 MG/ML ORAL SUSPENSION 0575-6200-30 30 mL Bottle 11.893 mL 30 mL $378.39
DIBUCAINE 1 % TP OINTMENT 45802-050-03 28 g Tube 0.165 g 28 g $58.62
DICLOFENAC SODIUM 50 MG ORAL EC TABLET 16571-202-06 60 each each 0.168 each 1 each $12.32
DICLOFENAC SODIUM 75 MG ORAL EC TABLET 51079-224-20 100 each each 0.387 each 1 each $12.54
DICLOFENAC SODIUM 75 MG ORAL EC TABLET 68084-333-11 1 each each 0.619 each 1 each $12.77
DICLOFENAC SODIUM 0.1 % OPHT DROPS 61314-014-25 2.5 mL DROP BTL 3.036 mL 2.5 mL $68.34
DICLOFENAC SODIUM 1 % TP GEL 65162-833-66 100 g Tube 0.094 g 100 g $63.40
DICLOFENAC SODIUM 1 % TP GEL 0378-8750-06 100 g Tube 0.355 g 100 g $89.50
DICLOFENAC SODIUM 3 % TP GEL 0115-1483-61 100 g Tube 0.859 g 100 g $139.90
DICLOXACILLIN 250 MG ORAL CAP 0093-3123-01 100 each each 0.631 each 1 each $12.78
DICYCLOMINE 10 MG ORAL CAP 60687-369-01 100 each each 0.314 each 1 each $12.46
DICYCLOMINE 10 MG ORAL CAP 60687-369-11 1 each each 0.314 each 1 each $12.46
DICYCLOMINE 10 MG/ML IM SOLUTION 0641-6173-01 2 mL Vial 7.944 mL 2 mL $184.64
DICYCLOMINE 10 MG/ML IM SOLUTION 0641-6173-10 2 mL Vial 7.944 mL 2 mL $184.64
DICYCLOMINE 10 MG/ML IM SOLUTION 0517-1980-01 2 mL Vial 8.518 mL 2 mL $185.79
DICYCLOMINE 10 MG/ML IM SOLUTION 24201-585-01 2 mL Vial 18.009 mL 2 mL $204.77
DICYCLOMINE 10 MG/ML IM SOLUTION 24201-585-10 2 mL Vial 18.009 mL 2 mL $204.77
DICYCLOMINE 20 MG ORAL TAB 0904-6988-61 100 each each 0.307 each 1 each $12.46
DICYCLOMINE 20 MG ORAL TAB 51079-119-20 100 each each 0.456 each 1 each $12.61
DIGOXIN (LANOXIN) IV 10 MCG/ML (NICU) UHCS-0000-61 10 mL Vial 5.721 mL 10 mL $225.96
DIGOXIN (LANOXIN) PO 50MCG/ML (NICU) UHCS-0000-62 60 mL Bottle 2.155 mL 60 mL $150.90
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJ SOLUTION 70515-262-10 1 mL AMPUL 116.692 mL 1 mL $285.44
DIGOXIN 125 MCG (0.125 MG) ORAL TAB 0904-5921-61 100 each each 0.87 each 1 each $13.02
DIGOXIN 250 MCG (0.25 MG) ORAL TAB 0904-5922-61 100 each each 0.848 each 1 each $13.00
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLUTION 0641-1410-35 2 mL AMPUL 1.45 mL 2 mL $171.65
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLUTION 0641-6184-01 2 mL AMPUL 1.45 mL 2 mL $171.65
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION 0054-0057-46 60 mL DROP BTL 2.155 mL 60 mL $177.90
DIGOXIN IMMUNE FAB 40 MG IV VIAL 50633-120-11 1 each each 4083.72 each 1 each "$8,218.49"
DIHYDROERGOTAMINE 1 MG/ML INJ SOLUTION 61990-0411-1 1 mL AMPUL 77.768 mL 1 mL $246.52
DILTIAZEM HCL 30 MG ORAL TAB 0093-0318-01 100 each each 0.072 each 1 each $12.22
DILTIAZEM HCL 60 MG ORAL TAB 0093-0319-01 100 each each 0.135 each 1 each $12.29
DILTIAZEM HCL 90 MG ORAL TAB 0093-0320-01 100 each each 0.172 each 1 each $12.32
DILTIAZEM HCL 100 MG IV VIAL 0409-4350-03 1 each each 9.012 each 1 each $177.76
DILTIAZEM HCL 120 MG ORAL CP24 60687-195-01 100 each each 0.289 each 1 each $12.44
DILTIAZEM HCL 120 MG ORAL CP24 60687-195-11 1 each each 0.289 each 1 each $12.44
DILTIAZEM HCL 180 MG ORAL CP24 60687-206-01 100 each each 0.259 each 1 each $12.41
DILTIAZEM HCL 180 MG ORAL CP24 60687-206-11 1 each each 0.259 each 1 each $12.41
DILTIAZEM HCL 240 MG ORAL CP24 60687-217-01 100 each each 0.566 each 1 each $12.72
DILTIAZEM HCL 240 MG ORAL CP24 60687-217-11 1 each each 0.566 each 1 each $12.72
DILTIAZEM HCL 300 MG ORAL CP24 60687-228-01 100 each each 1.056 each 1 each $13.21
DILTIAZEM HCL 5 MG/ML IV SOLUTION 0641-9217-10 5 mL Vial 0.285 mL 5 mL $170.18
DILTIAZEM HCL 5 MG/ML IV SOLUTION 0641-9217-01 5 mL Vial 0.285 mL 5 mL $170.18
DILTIAZEM HCL 5 MG/ML IV SOLUTION 0641-6013-01 5 mL Vial 0.285 mL 5 mL $170.18
DILTIAZEM HCL 5 MG/ML IV SOLUTION 0641-9219-10 25 mL Vial 0.192 mL 25 mL $173.55
DILTIAZEM HCL IN 0.7% NACL 125 MG/125 ML (1 MG/ML) IV INFUSION 69374-997-15 125 mL Bag 0.12 mL 125 mL $183.75
DILUENT FOR EPOPROSTENOL (GLY) IV SOLUTION 0173-0518-01 50 mL Vial 0.3229 mL 50 mL $0.00
DIMERCAPROL 100 MG/ML IM SOLUTION 17478-526-03 3 mL AMPUL 52.107 mL 3 mL $325.07
DIMETHYL SULFOXIDE 50 % IVES SOLUTION 67457-177-50 50 mL Bottle 12.225 mL 50 mL "$1,230.14"
DINOPROSTONE 10 MG VAGL INER 55566-2800-1 1 each each 443.13 each 1 each $764.43
DIPH PERTUS(ACEL) TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SYRINGE 58160-810-52 0.5 mL Syringe 40.038 mL .5 mL $188.77
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL ELIXIR 0121-0489-00 5 mL Cup 0.549 mL 5 mL $14.90
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQUID 70677-0144-1 118 mL Bottle 0.013 mL 118 mL $15.03
DIPHENHYDRAMINE HCL 25 MG ORAL CAP 0904-5306-61 100 each each 0.025 each 1 each $24.35
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLUTION 0641-0376-25 1 mL Vial 0.545 mL 1 mL $169.30
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLUTION 0641-0376-21 1 mL Vial 0.545 mL 1 mL $169.30
DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % TP CREAM 45802-358-03 28 g Tube 0.056 g 28 g $59.54
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TAB 59762-1061-1 100 each each 0.378 each 1 each $16.58
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5 ML ORAL LIQUID UHCS-0000-23 5 mL Syringe 0.701 mL 5 mL $19.71
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5 ML ORAL LIQUID 0054-3194-46 60 mL Bottle 0.701 mL 60 mL $58.26
"DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML IM SUSPENSION" 58160-842-11 0.5 mL Vial 69.672 mL .5 mL $203.59

See Part 8