Primary Childrens Hospital chargemaster (2) (1) Essays

CDMChargemasterSuppliesPharmacyBill Item IDCharge DescriptionPricePrices are accurate as of date posted and may be subject to changePrice is subject to change based on changes to supply acquisition costPrice is subject to change based on changes to pharmacy acquisition costPrimary Children's Hospital1900003115Therapeutic Prophylactic/Dx Injection Subq/Im 963721176215270amantadine 100 mg capsule1176355010doxycycline hyclate 100 mg capsule1176406340gemfibrozil 600 mg tablet1176567540OXcarbazepine 300 mg tablet1176651440scopolamine 1 mg/72 hr patchscopolamine 1 mg/72 hr patch [1.3 or 1.5 mg total/patch]1176235070atenolol 25 mg tabletatenolol 50 mg tablet1176480170lisinopril 2.5 mg tablet1176482310loratadine 10 mg tablet1176708210valsartan 80 mg tablet1176714490warfarin 1 mg tabletwarfarin 2 mg tabletwarfarin 2.5 mg tabletwarfarin 4 mg tabletwarfarin 5 mg tablet1176401620fluvoxaMINE 50 mg tablet1176522250mirtazapine 15 mg tabletmirtazapine 30 mg tablet1176538010nafcillin 2,000 mg vial117 6666470sucralfate 1 g tablet1176207760acyclovir 200 mg capsule1176221860amoxicillin 250 mg capsuleamoxicillin 500 mg capsule1176283080cephalexin 250 mg capsulecephalexin 500 mg capsule1176338860dicyclomine 10 mg capsule1176343630dilTIAZem ER 90 mg/12 hour capsule1176346370diphenhydrAMINE 50 mg capsule1176353860doxepin 10 mg capsule1176447190indomethacin 25 mg capsule1176481990loperamide 2 mg capsule1176616970prazosin 1 mg capsuleprazosin 5 mg capsule1176646340rifAMPin 300 mg capsule1176708130valproic acid 250 mg capsule1176709460venlafaxine ER-24 hr 37.5 mg capsulevenlafaxine ER-24 hr 75 mg capsule1176476880lidocaine 5% (700 mg) patchlidocaine 5% patch1176573640pantoprazole 40 mg vial1176692780topotecan 1 mg/mL 4 mL powder vial1176473650levalbuterol 0.63 mg/3 mL inhalation solutionlevalbuterol 1.25 mg/3 mL inhalation solution1176668860sulfameth-trimeth (Septra) 80-16 mg/mL 10 mL vial1176562910octreotide 500 mcg/mL 1 mL injection1176290820chlorproMAZINE 25 mg/mL 1 mL ampul1176320290c ycloSPORINE 50 mg/mL 5 mL vial1176394040flumazenil 0.1 mg/mL 5 mL vialibuprofen 100 mg/5 mL oral suspension 5 mL UD11764429701176557560norepinephrine 1 mg/mL 4 mL injection1176589090PHENobarbital 65 mg/mL 1 mL vial1176674540terbutaline 1 mg/mL 1 mL vial1176690470tobramycin 40 mg/mL 2 mL vial1176367150epoetin alfa-ESRD 2,000 units/mL 1 mL vial1176293220cholestyramine/sucrose 4 g packet (sugar)1176410200glycerin-adult 2 g rectal suppositoryglycerin-pediatric 1.2 g rectal suppository1176201150acetaminophen 120 mg suppositoryacetaminophen 325 mg suppositoryacetaminophen 650 mg suppository1176253610bisacodyl 10 mg rectal suppository1176435960hydrocortisone acetate 25 mg supp.rectal1176347510atropine-diphenoxylate 0.025 mg-2.5 mg tablet1176274330carbidopa/levodopa 10mg-100mg tabletcarbidopa/levodopa 25 mg-100 mg tablet1176211620allopurinol 100 mg tabletallopurinol 300 mg tablet1176212530ALPRAZolam 0.5 mg tablet1176220040amitriptyline 25 mg tabletamitriptyline 50 mg tablet1176248280benztro pine mesylate 0.5 mg tablet1176253380bisacodyl 5 mg EC tablet1176259650bumetanide 0.5 mg tabletbumetanide 1 mg tablet1176260880buPROPion HCl 100 mg tablet1176261120busPIRone 5 mg tablet1176273180carBAMazepine 100 mg chewable tabletcarBAMazepine 200 mg tabletchlorproMAZINE 25 mg tablet1176302210clonazePAM 0.5 mg tabletclonazePAM 1 mg tablet1176302540cloNIDine 0.1 mg tabletcloNIDine 0.2 mg tablet1176320860cyproheptadine 4 mg tablet1176336130diazePAM 2 mg tabletdiazePAM 5 mg tabletdicyclomine 20 mg tabletdilTIAZem 30 mg tablet1176348760dipyridamole 50 mg tabletdoxazosin 1 mg tabletdoxazosin 2 mg tablet1176362850enalapril maleate 2.5 mg tabletenalapril 5 mg tablet1176383560famotidine 20 mg tablet1176402460folic acid 1 mg tablet1176403600furosemide 20 mg tablet1176431250hydrALAZINE 25 mg tabletibuprofen 200 mg tabletibuprofen 600 mg tablet1176459480isoniazid 300 mg Tab1176466980labetalol 100 mg tabletlabetalol 200 mg tablet1176482560LORazepam 0.5 mg tabletLORazepam 1 mg tablet1176482720l osartan 25 mg tabletlosartan 50 mg tablet1176502110metFORMIN 500 mg tablet1176505670methotrexate 2.5 mg tablet1176512840metoclopramide 5 mg tablet1176514090metoprolol tartrate 100 mg tablet1176514900metroNIDAZOLE 500 mg tablet1176525300montelukast 10 mg tablet1176537440nadolol 20 mg tabletnadolol 40 mg tablet1176541970naproxen 250 mg tabletnaproxen 375 mg tabletnaproxen 500 mg tablet1176553010NIFEdipine 30 mg ER tablet1176563410OLANZapine 10 mg tabletOLANZapine 5 mg tablet1176618460predniSONE 20 mg tablet1176622080prochlorperazine 5 mg tablet1176628360propranolol 10 mg tabletpropranolol 20 mg tabletpropranolol 40 mg tablet1176664150sotalol 80 mg tablet1176664070spironolactone 25 mg tablet1176690390tiZANidine 4 mg tablet1176693770traZODone 100 mg tablet1176709950verapamil 80 mg tabletchlorproMAZINE 50 mg Tabspironolactone 50 mg tabletvenlafaxine ER-24 hr 150 mg capsuleamantadine 50 mg/5 mL oral syrup1176298350clarithromycin 500 mg tablet1176669100sulfameth/trimeth (Bactrim) 400 mg-80 mg tablet1176265910calcitriol 0.25 mcg capsule1176282580celecoxib 100 mg capsulecelecoxib 200 mg capsule1176352610docusate sodium 100 mg capsule1176718290ziprasidone 20 mg capsule1176711420vitamin A 10,000 unit capsule1176472170lansoprazole DR 15 mg capsule1176552440nicotine 14 mg/24 hr patchnicotine 21 mg/24 hr patchnicotine 7 mg/24 hr patchloratadine 5 mg/5 mL Oral Syrup1176318150cyanocobalamin 1,000 mcg tablet1176232000aspirin 325 mg tablet1176238380azithromycin 250 mg tabletazithromycin 500 mg tablet1176297020citalopram 10 mg tabletcitalopram 20 mg tabletcitalopram 40 mg tablet1176376970ethambutol 100 mg tabletethambutol 400 mg tablet1176392550fluconazole 150 mg tabletfluconazole 50 mg tablet1176393700fludrocortisone 0.1 mg tablet1176398590FLUoxetine 10 mg tablet1176474560levoFLOXacin 250 mg tabletlevoFLOXacin 500 mg tablet1176475300levothyroxine 100 mcg tabletlevothyroxine 112 mcg tabletlevothyroxine 125 mcg tabletlevothyroxine 200 mcg tabletlevothyroxine 50 mcg tabletlevothyr oxine 75 mcg tabletlisinopril 10 mg tabletlisinopril 20 mg tabletlisinopril 5 mg tablet1176575390PARoxetine 10 mg tablet1176654740sertraline 100 mg tabletsertraline 25 mg tabletsertraline 50 mg tabletmontelukast sodium 4 mg chewable tabletmontelukast sodium 5 mg chewable tabletaspirin 325 mg tablet enteric coatedaspirin 81 mg tablet enteric coatedbuPROPion HCl 150 mg ER tab 12 hr (SR)1176213110alteplase 50 mg vial1176602510phytonadione 10 mg/mL 1 mL ampul1176606160pneumococcal 23-valent vaccine 25 mcg/0.5 mL injection1176608300polyethylene glycol 3350 powder 4,000 mLpolyethylene glycol 3350 powder 4000 mL1176234990atorvastatin