Medication Charges Part 9

EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN 49502-101-01 1 each each 131.625 each 1 each $300.38
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN 49502-102-02 2 each each 131.625 each 1 each $265.43
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN 49502-102-01 1 each each 131.625 each 1 each $300.98
EPINEPHRINE 1 MG/ML (1:1000) INJ SOLUTION 42023-168-01 30 mL Vial 5.234 mL 30 mL $325.77
EPINEPHRINE 1 MG/ML (1:1000) INJ SOLUTION UHCS-0005-44 30 mL Vial 5.24 mL 30 mL $406.95
EPINEPHRINE 1:10000 FOR CASS TUBE 0409-4921-34 10 mL Syringe 0.484 mL 10 mL $173.59
EPINEPHRINE BASE 0.1 MG/ML (1:10000) INJ SYRINGE 0409-4921-34 10 mL Syringe 0.484 mL 10 mL $173.59
EPINEPHRINE BASE 0.1 MG/ML (1:10000) INJ SYRINGE 0409-4933-11 10 mL Syringe 0.612 mL 10 mL $174.87
EPINEPHRINE BITARTRATE (BULK) MISC POWDER 51552-0454-9 0.18 g Jar 9 Jar .18 g $63.00
EPINEPHRINE BOLUS UHCS-ANES-31 1 mL Vial Vial 1 mL $0.00
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLUTION 54288-103-10 1 mL AMPUL 8.313 mL 1 mL $177.06
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLUTION 54288-103-01 1 mL AMPUL 8.313 mL 1 mL $177.06
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLUTION CUSTOM 54288-103-01 1 mL AMPUL 8.313 mL 1 mL $177.06
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLUTION CUSTOM 54288-103-10 1 mL AMPUL 8.313 mL 1 mL $177.06
EPIRUBICIN 50 MG/25 ML IV SOLUTION 0143-9202-01 25 mL Vial 1.789 mL 25 mL $544.23
EPLERENONE 25 MG ORAL TAB 59762-1710-3 90 each each 1.292 each 1 each $13.44
EPLERENONE 25 MG ORAL TAB 60687-451-21 30 each each 2.594 each 1 each $14.74
EPOETIN ALFA 2000 UNITS INJ SOLUTION 55513-126-10 1 mL Vial 31.843 mL 1 mL $200.59
EPOETIN ALFA 2000 UNITS INJ SOLUTION 59676-302-01 1 mL Vial 51.337 mL 1 mL $220.09
EPOETIN ALFA 3000 UNITS INJ SOLUTION 55513-267-10 1 mL Vial 47.766 mL 1 mL $216.95
EPOETIN ALFA 3000 UNITS INJ SOLUTION 59676-303-01 1 mL Vial 76.997 mL 1 mL $246.24
EPOETIN ALFA 4000 UNITS INJ SOLUTION 55513-148-10 1 mL Vial 63.687 mL 1 mL $232.44
EPOETIN ALFA 4000 UNITS INJ SOLUTION 59676-304-01 1 mL Vial 102.657 mL 1 mL $271.41
EPOETIN ALFA (EPOGEN) IV 250 UNITS/ML (NICU) UHCS-0000-60 8 mL Vial 31.843 mL 8 mL $423.49
EPOETIN ALFA 10000 UNITS INJ SOLUTION 59676-310-02 1 mL Vial 139.98 mL 1 mL $308.73
EPOETIN ALFA 10000 UNITS INJ SOLUTION 59676-310-01 1 mL Vial 139.985 mL 1 mL $308.74
EPOETIN ALFA 10000 UNITS INJ SOLUTION 55513-144-10 1 mL Vial 159.218 mL 1 mL $327.97
EPOETIN ALFA 20000 UNITS INJ SOLUTION 59676-320-04 1 mL Vial 279.97 mL 1 mL $563.44
EPOETIN ALFA 20000 UNITS INJ SOLUTION 55513-478-10 1 mL Vial 318.435 mL 1 mL $640.85
EPOETIN ALFA-EPBX 2000 UNITS INJ SOLUTION 0069-1305-10 1 mL Vial 16.666 mL 1 mL $185.42
EPOETIN ALFA-EPBX 3000 UNITS INJ SOLUTION 0069-1306-10 1 mL Vial 25 mL 1 mL $193.75
EPOETIN ALFA-EPBX 4000 UNITS INJ SOLUTION 0069-1307-10 1 mL Vial 33.333 mL 1 mL $202.08
EPOETIN ALFA-EPBX (RETACRIT) IV 250 UNITS/ML (NICU) UHCS-0005-11 8 mL Vial 17.432 mL 8 mL $308.21
EPOETIN ALFA-EPBX 10000 UNITS INJ SOLUTION 0069-1308-10 1 mL Vial 83.333 mL 1 mL $252.08
EPOETIN ALFA-EPBX 20000 UNITS/ML INJ SOLUTION 0069-1311-10 1 mL Vial 166.666 mL 1 mL $335.42
EPOETIN ALFA-EPBX 40000 UNITS INJ SOLUTION 0069-1309-04 1 mL Vial 333.333 mL 1 mL $670.83
EPOETIN ALFA-EPBX 40000 UNITS INJ SOLUTION 0069-1309-01 1 mL Vial 333.333 mL 1 mL $670.83
EPOPROSTENOL 1.5 MG IV VIAL (RECONSTITUTE W/ 5 ML) 0703-1995-01 1 each each 54.83 each 1 each $223.58
EPOPROSTENOL 1.5 MG IV VIAL (RECONSTITUTE W/ 5 ML) 0173-0519-00 1 each each 74.025 each 1 each $242.92
"EPOPROSTENOL 1.5 MG/50 ML (30,000 NG/ML) FOR CONTINUOUS NEBULIZATION" 0703-1995-01 1 each each 54.83 each 1 each $223.58
"EPOPROSTENOL 1.5 MG/50 ML (30,000 NG/ML) FOR CONTINUOUS NEBULIZATION" 0173-0519-00 1 each each 74.025 each 1 each $242.78
ERAVACYCLINE 50 MG IV VIAL 71773-050-05 1 each each 56.996 each 1 each $225.75
ERAVACYCLINE 50 MG IV VIAL 71773-050-01 1 each each 56.996 each 1 each $225.75
ERAVACYCLINE 50 MG IV VIAL 71773-050-12 1 each each 56.996 each 1 each $225.75
ERAVACYCLINE 100 MG IV VIAL 71773-100-12 1 each each 101.996 each 1 each $270.75
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP" 60687-500-01 100 each each 1.478 each 1 each $13.63
"ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS" 6936728302 60 mL Bottle 0.33 mL 60 mL $68.40
"ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS" 6954323460 60 mL DROP BTL 0.931 mL 60 mL $104.46
ERGOCALCIFEROL (VITAMIN D2) PO 8000 UNITS/ML (NICU) UHCS-0004-12 60 mL Bottle 0.702 mL 60 mL $63.72
ERIBULIN 1 MG/2 ML (0.5 MG/ML) IV SOLUTION 62856-389-01 2 mL Vial 667 mL 2 mL "$2,684.68"
ERTAPENEM 1 G INJ VIAL 43598-901-11 1 each each 29.558 each 1 each $198.31
ERTAPENEM 1 G INJ VIAL 43598-901-58 1 each each 29.558 each 1 each $198.31
ERTAPENEM 1 G INJ VIAL 42023-221-10 1 each each 46.185 each 1 each $214.94
ERTAPENEM 1 G INJ VIAL FOR PUSH 43598-901-11 1 each each 29.558 each 1 each $198.31
ERTAPENEM 1 G INJ VIAL FOR PUSH 43598-901-58 1 each each 29.558 each 1 each $198.31
ERTAPENEM 1 G INJ VIAL FOR PUSH 42023-221-10 1 each each 46.185 each 1 each $214.94
ERYTHROMYCIN 250 MG ORAL EC TABLET 13668-586-30 30 each each 3.563 each 1 each $15.71
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINTMENT 24208-910-19 1 g Tube 4.941 g 1 g $29.24
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINTMENT 17478-070-35 3.5 g Tube 3.937 g 3.5 g $74.53
ERYTHROMYCIN ETHYLSUCCINATE (E-MYCIN) PO 200MG/5ML (NICU) UHCS-0002-88 100 mL Bottle 2.259 mL 100 mL $247.50
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL RECON. SUSP. 62559-630-01 100 mL Bottle 1.981 mL 100 mL $246.70
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL RECON. SUSP. 24338-134-02 100 mL Bottle 2.259 mL 100 mL $274.50
ERYTHROMYCIN LACTOBIONATE 500 MG IV VIAL 14789-116-05 1 each each 64.66 each 1 each $233.41
ERYTHROMYCIN LACTOBIONATE 500 MG IV VIAL 0409-6482-01 1 each each 79.187 each 1 each $247.94
ESCITALOPRAM OXALATE 10 MG ORAL TAB 0904-6426-61 100 each each 0.11 each 1 each $12.26
ESMOLOL 100 MG/10 ML (10 MG/ML) IV SOLUTION 55150-194-10 10 mL Vial 0.208 mL 10 mL $170.83
ESMOLOL IN NACL (ISO-OSM) 2500 MG/250 ML (10 MG/ML) IV BAG 55150-420-01 250 mL Bag 0.387 mL 250 mL $235.80
ESMOLOL IN NACL (ISO-OSM) 2500 MG/250 ML (10 MG/ML) IV BAG 10019-672-10 250 mL Bag 0.414 mL 250 mL $242.55
ESMOLOL IN NACL (ISO-OSM) 2500 MG/250 ML (10 MG/ML) IV BAG 25021-308-84 250 mL Bag 0.518 mL 250 mL $268.55
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL EC CAP 0186-5020-31 30 each each 8.468 each 1 each $20.62
ESOMEPRAZOLE MAGNESIUM 40 MG ORAL EC CAP 0186-5040-31 30 each each 8.468 each 1 each $20.62
ESTRADIOL 1 MG ORAL TAB 0555-0886-02 100 each each 0.055 each 1 each $12.21
ESTRADIOL 0.05 MG/24 HR TD WEEKLY PATCH 0378-3350-99 4 each each 12.125 each 1 each $36.43
ESTRADIOL 0.1 MG/24 HR TD WEEKLY PATCH 0378-3352-99 4 each each 12.203 each 1 each $36.50
ESTRADIOL CYPIONATE 5 MG/ML IM OIL 0009-0271-01 5 mL Vial 28.422 mL 5 mL $310.86
ESTRADIOL VALERATE 20 MG/ML IM OIL 0517-0420-01 5 mL Vial 17.886 mL 5 mL $258.18
ESTROGENS-METHYLTESTOSTERONE 0.625-1.25 MG ORAL TAB 51293-639-01 100 each each 1.834 each 1 each $13.98
ESTROGENS-METHYLTESTOSTERONE 0.625-1.25 MG ORAL TAB 11528-020-01 100 each each 2.773 each 1 each $14.92
ESTROGENS-METHYLTESTOSTERONE 1.25-2.5 MG ORAL TAB 11528-010-01 100 each each 2.773 each 1 each $14.92
ETESEVIMAB 700 MG/20 ML (35 MG/ML) IV SOLUTION 0002-7950-01 20 mL Vial 0 mL 20 mL $0.00
ETHAMBUTOL 400 MG ORAL TAB 68850-012-02 100 each each 0.476 each 1 each $12.63
ETHIODIZED OIL 480 MG IODINE/ML INJ OIL 67684-1901-2 10 mL Vial 127.9 mL 10 mL "$2,573.99"
ETHYL ALCOHOL 70 % TP SOLUTION 49348-003-38 480 mL Bottle 0.003 mL 480 mL $55.44
ETHYL ALCOHOL 99 % IART SOLUTION 54288-105-15 5 mL AMPUL 155.182 mL 5 mL "$1,561.52"
ETHYL ALCOHOL 99 % IART SOLUTION 54288-105-02 5 mL AMPUL 155.182 mL 5 mL "$1,561.52"
ETHYL CHLORIDE 100 % TP AERO. SPRAY 386000102 116 mL SQUEEZ BTL 0.229 mL 116 mL $143.77
ETODOLAC 200 MG ORAL CAP 51672-4016-1 100 each each 0.996 each 1 each $13.15
ETOMIDATE 2 MG/ML IV SOLUTION 0143-9311-10 20 mL Vial 0.18 mL 20 mL $172.35
ETOMIDATE 2 MG/ML IV SOLUTION 0143-9507-01 20 mL Vial 0.18 mL 20 mL $172.35
ETOPOSIDE 20 MG/ML IV SOLUTION 0143-9376-01 5 mL Vial 0.86 mL 5 mL $503.80
ETOPOSIDE 20 MG/ML IV SOLUTION 16729-114-31 5 mL Vial 1.732 mL 5 mL $508.16
ETOPOSIDE 20 MG/ML IV SOLUTION 16729-114-08 25 mL Vial 0.847 mL 25 mL $520.68
EVACUATED CONTAINER 1000 ML UHCS-0001-64 1 each each 17.364 each 1 each $57.86
EXENATIDE 10 MCG/DOSE(250 MCG/ML) 2.4 ML SUBQ PEN 0310-6524-01 2.4 mL Cartridge 308.067 mL 2.4 mL "$1,487.96"
EXENATIDE 5 MCG/DOSE (250 MCG/ML) 1.2 ML SUBQ PEN 0310-6512-01 1.2 mL Cartridge 616.133 mL 1.2 mL "$1,487.96"
EZETIMIBE 10 MG ORAL TAB 16729-433-16 500 each each 0.046 each 1 each $12.20
EZETIMIBE 10 MG ORAL TAB 69238-1154-9 90 each each 0.277 each 1 each $12.43
EZETIMIBE 10 MG ORAL TAB 68382-773-05 500 each each 0.292 each 1 each $12.44
F-18 FDG UHCS-RAD-017 1 each each 1026 each 1 each "$1,026.00"
"FACTOR IX CPLX(PCC)NO4,3FACTOR 500 (+/-) UNIT IV VIAL" 68516-3207-1 1 each each 1.24 each 1 each $169.99
FAMCICLOVIR 125 MG ORAL TAB 60505-3245-3 30 each each 0.337 each 1 each $12.49
FAMOTIDINE (PF) 20 MG/2 ML IV SOLUTION 67457-433-22 2 mL Vial 0.24 mL 2 mL $169.23
FAMOTIDINE (PF) 20 MG/2 ML IV SOLUTION 63323-739-11 2 mL Vial 0.323 mL 2 mL $169.40
FAMOTIDINE (PF) 20 MG/2 ML IV SOLUTION 63323-739-12 2 mL Vial 0.323 mL 2 mL $169.40
FAMOTIDINE 20 MG ORAL TAB 58602-829-21 100 each each 0.032 each 1 each $12.18
FAMOTIDINE 20 MG ORAL TAB 63739-645-10 100 each each 0.062 each 1 each $12.21
FAMOTIDINE 20 MG ORAL TAB 68001-397-08 1000 each each 0.07 each 1 each $12.22
FAMOTIDINE 20 MG ORAL TAB 51079-966-20 100 each each 0.092 each 1 each $12.24
FAT EMULSION 20 % IV EMULSION 0338-0519-09 250 mL Bag 18.484 Bag 250 mL $239.88
FAT EMULSION 20 % IV EMULSION 0338-0519-13 500 mL Bag 19.196 Bag 500 mL $240.60
FAT EMULSION 20 % IV EMULSION (CYCLIC TPN) 0338-0519-09 250 mL Bag 18.484 Bag 250 mL $239.88
FAT EMULSION 20 % IV EMULSION (CYCLIC TPN) 0338-0519-13 500 mL Bag 19.196 Bag 500 mL $240.60
FAT EMUL-SOY-MCT-OLIV-FISH OIL 20 % IV EMULSION 63323-820-74 250 mL Bag 0.084 mL 250 mL $242.40
FAT EMUL-SOY-MCT-OLIV-FISH OIL 20 % IV EMULSION 63323-820-50 500 mL Bag 0.052 mL 500 mL $247.40
FAT EMUL-SOY-MCT-OLIV-FISH OIL 20 % IV EMULSION (CYCLIC TPN) 63323-820-74 250 mL Bag 0.084 mL 250 mL $242.40
FAT EMUL-SOY-MCT-OLIV-FISH OIL 20 % IV EMULSION (CYCLIC TPN) 63323-820-50 500 mL Bag 0.052 mL 500 mL $247.40
FEBUXOSTAT 40 MG ORAL TAB 55111-796-30 30 each each 1.017 each 1 each $13.17
FEBUXOSTAT 40 MG ORAL TAB 60687-538-21 30 each each 1.244 each 1 each $13.39
FEBUXOSTAT 40 MG ORAL TAB 60687-538-11 1 each each 1.244 each 1 each $13.39
FEBUXOSTAT 40 MG ORAL TAB 62332-190-30 30 each each 1.632 each 1 each $13.78
FELBAMATE 600 MG ORAL TAB 72578-057-16 90 each each 0.946 each 1 each $13.10
FELODIPINE 5 MG ORAL TB24 68462-234-01 100 each each 0.115 each 1 each $12.27
FENOFIBRATE 54 MG ORAL TAB 68084-827-25 30 each each 1.003 each 1 each $13.15
FENOFIBRATE 160 MG ORAL TAB 50268-313-11 1 each each 1.449 each 1 each $13.60
FENOFIBRATE 160 MG ORAL TAB 68084-328-21 30 each each 2.095 each 1 each $14.25
FENTANYL 12 MCG/HR TD 72HR PATCH 47781-423-47 5 each each 4.896 each 1 each $34.60
FENTANYL 12 MCG/HR TD 72HR PATCH 47781-423-11 1 each each 4.896 each 1 each $34.60
FENTANYL 25 MCG/HR TD 72HR PATCH 47781-424-47 5 each each 3.7 each 1 each $33.40
FENTANYL 50 MCG/HR TD 72HR PATCH 47781-426-47 5 each each 6.142 each 1 each $35.84
FENTANYL 75 MCG/HR TD 72HR PATCH 47781-427-47 5 each each 8.942 each 1 each $38.64
FENTANYL 75 MCG/HR TD 72HR PATCH 47781-427-11 1 each each 8.942 each 1 each $38.64
FENTANYL (PF)-BUPIVACAINE-NACL 5 MCG/ML -0.0625 % EPID SOLUTION 61553-137-02 250 mL Bag 27.134 Bag 250 mL $249.88
FENTANYL (PF)-BUPIVACAINE-NACL 5 MCG/ML- 0.125 % INJ SOLUTION 61553-140-02 250 mL Bag 30.282 Bag 250 mL $253.03
FENTANYL (SUBLIMAZE) IV 5 MCG/ML (NICU) UHCS-0000-49 20 mL Vial 0.268 mL 20 mL $174.11
FENTANYL 100 MCG/HR TD 72HR PATCH 47781-428-47 5 each each 10.72 each 1 each $40.42
FENTANYL 100 MCG/HR TD 72HR PATCH 60505-7009-0 1 each each 18.01 each 1 each $47.71
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION 0409-9093-35 5 mL AMPUL 0.067 mL 5 mL $169.09
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION 0409-9093-32 2 mL AMPUL 0.268 mL 2 mL $169.29
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION 0409-9093-37 2 mL AMPUL 0.268 mL 2 mL $169.29
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION 0409-9094-28 10 mL Vial 0.267 mL 10 mL $171.42
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION 0409-9094-31 20 mL Vial 0.167 mL 20 mL $172.09
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLUTION (ANESTHESIA) UHCS-ANES-01 2 mL AMPUL AMPUL 2 mL $0.00
FENTANYL CITRATE (PF) 50MCG/ML SPINAL (ANESTHESIA) UHCS-ANES-02 1 ampule ampule Ampule 1 ampule $0.00
FENTANYL CITRATE (PF)-0.9%NACL 10 MCG/2 ML (5 MCG/ML) IV SYRINGE 61553-339-28 2 mL Syringe 2.055 mL 2 mL $172.86
FENTANYL CITRATE (PF)-0.9%NACL 10 MCG/ML IV SOLUTION 70092-1093-37 250 mL Bag 23.47 Bag 250 mL $246.22
FENTANYL CITRATE (PF)-0.9%NACL 10 MCG/ML IV SOLUTION 69374-523-21 250 mL Bag 36 Bag 250 mL $258.75
FENTANYL CITRATE (PF)-0.9%NACL 10 MCG/ML IV SOLUTION 63037-101-05 250 mL Bag 0.16 mL 250 mL $262.75
FENTANYL CITRATE-0.9% NACL (PF) 10 MCG/ML EPIDURAL 70092-1093-37 250 mL Bag 23.47 Bag 250 mL $246.22
FENTANYL-ROPIVACAINE-NACL (PF) 2-0.2 MCG/ML-% INJ SOLUTION 70092-1108-36 100 mL Bag 0.282 mL 100 mL $250.95

See Part 10