Medication Charges Part 11

  • IRON FUM-B12-IF-C-FOLIC ACID 110-0.5 MG ORAL CAP 5199163501 100 each each 0.12 each 1 each $12.27
  • IRON SUCROSE 100 MG IRON/5 ML IV SOLUTION 0517-2340-10 5 mL Vial 6.096 mL 5 mL $199.23
  • "IRON,CARBONYL-VITAMIN C 65 MG IRON- 125 MG ORAL EC TABLET" 6373612301 60 each each 0.149 each 1 each $12.30
  • ISAVUCONAZONIUM SULFATE 186 MG ORAL CAP 0469-0520-14 14 each each 93.231 each 1 each $105.38
  • ISAVUCONAZONIUM SULFATE 372 MG IV VIAL 0469-0420-99 1 each each 336.37 each 1 each $676.95
  • ISOFLURANE  99.9 % INHL LIQUID UHCS-0002-41 1 each each 1.91 Bottle 1 each $96.41
  • ISOFLURANE  99.9 % INHL LIQUID 66794-019-10 100 mL Bottle 0.142 mL 100 mL "$9,937.41"
  • ISONIAZID 300 MG ORAL TAB 51079-083-20 100 each each 0.737 each 1 each $12.89
  • ISOPROPYL ALCOHOL 70 % MISC SOLUTION 0574-0067-16 473 mL Bottle 0.004 mL 473 mL $0.00
  • ISOPROTERENOL HCL 0.2 MG/ML INJ SOLUTION 23155-661-42 5 mL Vial 9.782 mL 5 mL $217.66
  • ISOPROTERENOL HCL 0.2 MG/ML INJ SOLUTION 70121-1605-7 5 mL Vial 14.881 mL 5 mL $243.16
  • ISOPROTERENOL HCL 0.2 MG/ML INJ SOLUTION 14789-015-05 5 mL Vial 22.158 mL 5 mL $279.54
  • ISOPROTERENOL HCL 0.2 MG/ML INJ SOLUTION UHCS-0004-08 1 mL AMPUL 22.158 mL 1 mL $325.91
  • ISOSORBIDE DINITRATE 10 MG ORAL TAB 0904-6619-61 100 each each 0.433 each 1 each $12.58
  • ISOSORBIDE DINITRATE 20 MG ORAL TAB 0904-6620-61 100 each each 0.506 each 1 each $12.66
  • ISOSORBIDE MONONITRATE  20 MG ORAL TAB 0228-2620-11 100 each each 0.105 each 1 each $12.26
  • ISOSORBIDE MONONITRATE  30 MG ORAL TB24 0904-6449-61 100 each each 0.275 each 1 each $12.43
  • ISOSORBIDE MONONITRATE  60 MG ORAL TB24 0904-6450-61 100 each each 0.299 each 1 each $12.45
  • ISOSORBIDE MONONITRATE  60 MG ORAL TB24 50268-452-15 50 each each 0.698 each 1 each $12.85
  • ISOSORBIDE-HYDRALAZINE 20-37.5 MG ORAL TAB 24338-010-18 180 each each 3.506 each 1 each $15.66
  • ISOSULFAN BLUE 1 % SUBQ SOLUTION 67457-220-05 5 mL Vial 194.029 mL 5 mL "$1,952.42"
  • ITRACONAZOLE 10 MG/ML ORAL SOLUTION 65162-087-74 150 mL Bottle 0.889 mL 150 mL $145.50
  • IVABRADINE 5 MG ORAL TAB 55513-800-60 60 each each 8.653 each 1 each $20.80
  • IVERMECTIN 3 MG ORAL TAB 42799-806-01 20 each each 2.587 each 1 each $14.74
  • IXABEPILONE 15 MG IV VIAL 70020-1910-1 1 each each 1766.4 each 1 each "$3,554.88"
  • IXABEPILONE 45 MG IV VIAL 70020-1911-1 1 each each 5299.2 each 1 each "$10,664.64"
  • JUVEN NUTRITION POWDER 5978166679 1 each each 6 each 1 each $6.00
  • JUVEN NUTRITION POWDER 5978166685 1 each each 6 each 1 each $6.00
  • KETAMINE  50 MG/ML INJ SOLUTION 67457-001-10 10 mL Vial 0.648 mL 10 mL $175.23
  • KETAMINE  50 MG/ML INJ SOLUTION (ANESTHESIA) UHCS-ANES-05 10 mL mL Vial 10 mL $0.00
  • KETAMINE 100 MG/ML INJ SOLUTION 0409-2051-05 5 mL Vial 1.293 mL 5 mL $175.22
  • KETAMINE 100 MG/ML INJ SOLUTION (ANESTHESIA) UHCS-ANES-04 1 vial vial Vial 1 vial $0.00
  • KETAMINE IN STERILE WATER 50 MG/ML INJ SYRINGE 69374-511-01 1 mL Syringe 4.5 mL 1 mL $173.25
  • KETAMINE IN STERILE WATER 50 MG/ML INJ SYRINGE 63037-137-25 1 mL Syringe 5 mL 1 mL $173.75
  • KETOCONAZOLE 2 % TP CREAM 16714-955-02 30 g Tube 0.679 g 30 g $74.37
  • KETOCONAZOLE 2 % TP SHAMPOO 63646-010-04 120 mL Bottle 0.079 mL 120 mL $63.48
  • KETOCONAZOLE 2 % TP SHAMPOO 45802-465-64 120 mL Bottle 0.085 mL 120 mL $64.20
  • KETOROLAC 0.5 % OPHT DROPS 61314-126-05 5 mL DROP BTL 1.302 mL 5 mL $67.26
  • KETOROLAC 0.5 % OPHT DROPS 17478-209-19 3 mL DROP BTL 4.503 mL 3 mL $74.26
  • KETOROLAC 15 MG/ML INJ SOLUTION 63323-161-12 1 mL Vial 0.619 mL 1 mL $169.37
  • KETOROLAC 15 MG/ML INJ SOLUTION 63323-161-01 1 mL Vial 0.619 mL 1 mL $169.37
  • KETOROLAC 15 MG/ML INJ SOLUTION 47781-583-93 1 mL Vial 0.97 mL 1 mL $169.72
  • KETOROLAC 15 MG/ML INJ SOLUTION 72611-719-01 1 mL Vial 0.97 mL 1 mL $169.72
  • KETOROLAC 15 MG/ML INJ SOLUTION 0641-6041-01 1 mL Vial 1.302 mL 1 mL $170.05
  • KETOROLAC 30 MG/ML (1 ML) INJ SOLUTION 63323-162-12 1 mL Vial 0.637 mL 1 mL $169.39
  • KETOROLAC 30 MG/ML (1 ML) INJ SOLUTION 0409-3795-19 1 mL Vial 0.961 mL 1 mL $169.71
  • KETOROLAC 30 MG/ML (1 ML) INJ SOLUTION 47781-584-93 1 mL Vial 1.035 mL 1 mL $169.79
  • KETOROLAC 60 MG/2 ML IM SOLUTION 63323-162-14 2 mL Vial 0.397 mL 2 mL $169.54
  • KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROPS 17478-717-10 5 mL DROP BTL 1.05 mL 5 mL $66.00
  • KIT FOR TC 99M-LABELED RBCS IV VIAL 69945-068-20 5 each each 290 each 1 each $290.00
  • KIT FOR TECHNETIUM TC 99M SODIUM PERTECHNETATE UHCS-RAD-024 1 each each 0 each 1 each $0.00
  • KIT PREP TC-99M-EXAMETAZIME 0.5 MG IV KIT 17156-023-05 1 each each 5272 each 1 each "$5,272.00"
  • LABETALOL 100 MG ORAL TAB 0904-5928-61 100 each each 0.291 each 1 each $12.44
  • LABETALOL 100 MG ORAL TAB 47781-552-05 500 each each 0.36 each 1 each $12.51
  • LABETALOL 200 MG ORAL TAB 0904-7110-61 100 each each 0.318 each 1 each $12.47
  • LABETALOL 200 MG ORAL TAB 0904-5929-61 100 each each 0.36 each 1 each $12.51
  • LABETALOL 300 MG ORAL TAB 0904-5930-61 100 each each 0.831 each 1 each $12.98
  • LABETALOL 5 MG/ML IV SOLUTION 0409-2267-20 20 mL Vial 0.093 mL 20 mL $170.61
  • LABETALOL 5 MG/ML IV SOLUTION 36000-322-02 20 mL Vial 0.096 mL 20 mL $170.67
  • LABETALOL 5 MG/ML IV SOLUTION 72266-102-01 20 mL Vial 0.163 mL 20 mL $172.01
  • LABETALOL 5 MG/ML IV SOLUTION 72611-734-01 20 mL Vial 0.323 mL 20 mL $175.21
  • LACOSAMIDE  50 MG ORAL TAB 0904-7244-68 60 each each 0.89 each 1 each $17.09
  • LACOSAMIDE  50 MG ORAL TAB 0131-2477-60 60 each each 11.453 each 1 each $27.65
  • LACOSAMIDE 100 MG ORAL TAB 0904-7245-68 60 each each 1.484 each 1 each $17.68
  • LACOSAMIDE 100 MG ORAL TAB 0131-2478-60 60 each each 17.905 each 1 each $34.11
  • LACOSAMIDE 200 MG/20 ML IV SOLUTION 70710-1359-6 20 mL Vial 1.272 mL 20 mL $194.19
  • LACOSAMIDE 200 MG/20 ML IV SOLUTION 70710-1359-1 20 mL Vial 1.272 mL 20 mL $194.19
  • LACOSAMIDE 200 MG/20 ML IV SOLUTION 25021-791-20 20 mL Vial 1.64 mL 20 mL $201.55
  • LACOSAMIDE 200 MG/20 ML IV SOLUTION 0131-1810-67 20 mL Vial 2.991 mL 20 mL $228.57
  • LACTATED RINGERS IRRIGATION SOLUTION 0338-0114-04 1000 mL Bottle 6.227 Bottle 1000 mL $77.78
  • LACTATED RINGERS IV BAG 0338-0117-03 500 mL Bag 3.455 Bag 500 mL $142.51
  • LACTATED RINGERS IV BAG 0338-0117-04 1000 mL Bag 3.698 Bag 1000 mL $142.75
  • LACTATED RINGERS IV BOLUS 0338-0117-03 500 mL Bag 3.455 Bag 500 mL $142.51
  • LACTATED RINGERS IV BOLUS 0409-7953-09 1000 mL Bag 0.005 mL 1000 mL $144.05
  • LACTOBACILLUS ACIDOPHILUS 500 MILLION CELL ORAL CAP 7733300450 50 each each 0.42 each 1 each $12.57
  • LACTOBACILLUS ACIDOPH-L.BULGAR 1 MILLION CELLS ORAL TAB 6498012950 50 each each 0.145 each 1 each $12.30
  • LACTOBACILLUS ACIDOPH-L.BULGAR 100 MILLION CELL ORAL GRANULE PACK 6498014612 12 each each 1.171 each 1 each $13.32
  • LACTOBACILLUS RHAMNOSUS GG 15 BILLION CELL ORAL SPRINKLE CAP 4910036374 30 each each 0.495 each 1 each $12.65
  • LACTULOSE 10 G ORAL PACKET 66220-719-30 30 each each 7.735 each 1 each $19.89
  • LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION 0121-4577-15 15 mL Cup 0.025 mL 15 mL $12.53
  • LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION 0121-4577-40 15 mL Cup 0.025 mL 15 mL $12.53
  • LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION 66689-039-01 15 mL Cup 0.046 mL 15 mL $12.84
  • LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION 50383-779-15 15 mL Cup 0.049 mL 15 mL $12.89
  • LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION 50383-779-17 15 mL Cup 0.049 mL 15 mL $12.89
  • LACTULOSE 10 GRAM/15 ML ORAL SOLUTION 50383-795-16 473 mL Bottle 0.012 mL 473 mL $17.83
  • LACTULOSE 10 GRAM/15 ML ORAL SOLUTION UHCS-0001-42 60 mL Bottle 0.014 mL 60 mL $49.44
  • LACTULOSE 20 G ORAL SOLUTION 0121-1154-30 30 mL Cup 0.012 mL 30 mL $12.51
  • LACTULOSE 20 G ORAL SOLUTION 0121-1154-40 30 mL Cup 0.014 mL 30 mL $12.57
  • LAMINARIA CERVICAL DILATOR 2 MM UHCS-0003-44 1 each each 8 each 1 each $32.30
  • LAMINARIA CERVICAL DILATOR 4 MM UHCS-0004-04 1 each each 8 each 1 each $32.30
  • LAMINARIA CERVICAL DILATOR 6 MM UHCS-0004-05 1 each each 8 each 1 each $32.30
  • LAMIVUDINE 10 MG/ML ORAL SOLUTION UHCS-0001-43 30 mL Bottle 0.248 mL 30 mL $56.04
  • LAMIVUDINE 10 MG/ML ORAL SOLUTION 54838-566-70 240 mL Bottle 0.248 mL 240 mL $108.12
  • LAMIVUDINE-ZIDOVUDINE 150-300 MG ORAL TAB 0378-5180-91 60 each each 2.057 each 1 each $14.21
  • LAMOTRIGINE  25 MG ORAL TAB 51079-498-20 100 each each 0.11 each 1 each $12.26
  • LAMOTRIGINE 100 MG ORAL TAB 0904-7008-61 100 each each 0.099 each 1 each $12.25
  • LANOLIN-MINERAL OIL TP LOTION 7214011019 250 mL Bottle 0.022 mL 250 mL $59.50
  • LANREOTIDE 120 MG/0.5 ML SUBQ SYRINGE 15054-1120-4 0.5 mL Syringe 19124 mL .5 mL "$19,243.53"
  • LANREOTIDE 90 MG/0.3 ML SUBQ SYRINGE 15054-1090-4 0.3 mL Syringe 27026.667 mL .3 mL "$16,317.35"
  • LANSINOH 7 GM UHCS-0001-83 7 g Tube 0.292 g 7 g $56.04
  • LANSOPRAZOLE 30 MG ORAL RD TABLET 16714-186-02 100 each each 3.762 each 1 each $15.91
  • LANSOPRAZOLE 30 MG ORAL RD TABLET 16714-186-01 1 each each 3.762 each 1 each $15.91
  • LANSOPRAZOLE 30 MG ORAL RD TABLET 68382-772-77 100 each each 5.834 each 1 each $17.98
  • LANTHANUM  500 MG ORAL CHEW TAB 66993-422-85 90 each each 5.322 each 1 each $17.47
  • LATANOPROST 0.005 % OPHT DROPS 59762-0333-2 2.5 mL DROP BTL 2.496 mL 2.5 mL $66.99
  • LC BEAD 100-300 UM UHCS-0005-06 1 each each 2100 each 1 each "$4,226.25"
  • LC BEAD 300-500 UM UHCS-0003-53 1 each each 2100 each 1 each "$4,226.25"
  • LENVATINIB 4 MG ORAL CAP 62856-704-30 30 each each 735.267 each 1 each $747.42
  • LETERMOVIR 480 MG ORAL TAB 0006-3076-04 14 each each 248.87 each 1 each $261.02
  • LETROZOLE 2.5 MG ORAL TAB 50268-476-15 50 each each 0.547 each 1 each $12.70
  • LEUCOVORIN CALCIUM   5 MG ORAL TAB 51079-581-06 50 each each 1.142 each 1 each $13.29
  • LEUCOVORIN CALCIUM  50 MG INJ VIAL 0143-9555-01 1 each each 2.71 each 1 each $171.46
  • LEUCOVORIN CALCIUM  50 MG INJ VIAL 25021-813-10 1 each each 4.157 each 1 each $172.91
  • LEUCOVORIN CALCIUM 100 MG INJ VIAL 67457-528-10 1 each each 5.19 each 1 each $173.94
  • LEUCOVORIN CALCIUM 100 MG INJ VIAL 25021-814-30 1 each each 6.42 each 1 each $175.17
  • LEUCOVORIN CALCIUM 350 MG INJ VIAL 0703-5145-91 1 each each 17.5 each 1 each $186.25
  • LEUPROLIDE  3.75 MG IM SYRINGE KIT 0074-3641-03 1 each each 1584.65 each 1 each "$3,189.11"
  • LEUPROLIDE  7.5 MG IM SYRINGE KIT 0074-3642-03 1 each each 1888.36 each 1 each "$3,800.33"
  • LEUPROLIDE (1MONTH)-NORETHIND 3.75 MG -5 MG (30) MISC KTST 0074-1052-05 1 each KIT 1290.88 each 1 each "$2,597.90"
  • LEUPROLIDE (3 MONTH) 11.25 MG IM SYRINGE KIT 0074-3663-03 1 each each 4753.99 each 1 each "$9,567.41"
  • LEUPROLIDE (3 MONTH) 22.5 MG IM SYRINGE KIT 0074-3346-03 1 each each 5665.05 each 1 each "$11,400.91"
  • LEUPROLIDE (4 MONTH) 30 MG IM SYRINGE KIT 0074-3683-03 1 each each 7553.42 each 1 each "$15,201.26"
  • LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYRINGE KIT 0074-3473-03 1 each each 11330.29 each 1 each "$22,802.21"
  • LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBULIZER 76204-800-01 3 mL Vial 0.386 mL 3 mL $11.96
  • LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBULIZER 76204-800-11 3 mL Vial 0.386 mL 3 mL $11.96
  • LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBULIZER 17478-171-01 1 each Vial 2.5 each 1 each $14.65
  • LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBULIZER 0093-4147-56 1 each Vial 1.92 each 1 each $16.88
  • LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBULIZER 17478-171-30 1 each Vial 2.5 each 1 each $17.58
  • LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBULIZER 76204-900-01 3 mL Vial 0.324 mL 3 mL $11.77
  • LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFA INHALER 0591-2927-54 15 g AER W/ADAP 2.821 g 15 g $116.57
  • LEVETIRACETAM  500 MG ORAL TAB 63739-411-10 100 each each 0.11 each 1 each $12.26
  • LEVETIRACETAM  500 MG ORAL TAB 0904-7124-61 100 each each 0.15 each 1 each $12.30
  • LEVETIRACETAM  500 MG ORAL TAB 50268-473-11 1 each each 0.196 each 1 each $12.35
  • LEVETIRACETAM (KEPPRA) IV 15 MG/ML (NICU) UHCS-0003-62 10 mL Vial 0.299 mL 10 mL $171.74
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 0904-7064-94 5 mL Cup 0.497 Cup 5 mL $12.65
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 0904-7064-93 5 mL Cup 0.586 Cup 5 mL $12.74
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 63739-158-32 5 mL Cup 0.391 mL 5 mL $14.11
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 63739-158-70 5 mL Cup 0.391 mL 5 mL $14.11
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 50268-470-13 5 mL Cup 0.45 mL 5 mL $14.40
  • LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 0904-7060-41 5 mL Cup 0.59 mL 5 mL $15.10
  • LEVETIRACETAM 500 MG/5 ML IV SOLUTION 55150-177-05 5 mL Vial 0.197 mL 5 mL $169.74
  • LEVETIRACETAM 500 MG/5 ML IV SOLUTION 0143-9574-25 5 mL Vial 0.222 mL 5 mL $169.86
  • LEVETIRACETAM 500 MG/5 ML IV SOLUTION 0409-1886-22 5 mL Vial 0.245 mL 5 mL $169.98
  • LEVETIRACETAM 500 MG/5 ML IV SOLUTION 0409-1886-02 5 mL Vial 0.245 mL 5 mL $169.98
  • LEVETIRACETAM IN NACL (ISO-OS)  500 MG/100 ML IV IVPB 44567-501-10 100 mL Bag 0.075 mL 100 mL $176.25
  • LEVETIRACETAM IN NACL (ISO-OS)  500 MG/100 ML IV IVPB 44567-501-01 100 mL Bag 0.075 mL 100 mL $176.25
  • LEVETIRACETAM IN NACL (ISO-OS)  500 MG/100 ML IV IVPB 70860-602-41 100 mL Bag 0.078 mL 100 mL $176.55
  • LEVETIRACETAM IN NACL (ISO-OS) 1000 MG/100 ML IV IVPB 44567-502-10 100 mL Bag 0.103 mL 100 mL $179.05
  • LEVETIRACETAM IN NACL (ISO-OS) 1000 MG/100 ML IV IVPB 44567-502-01 100 mL Bag 0.103 mL 100 mL $179.05
  • LEVETIRACETAM IN NACL (ISO-OS) 1000 MG/100 ML IV IVPB 70860-603-82 100 mL Bag 0.107 mL 100 mL $179.45

See Part 12