Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Abacavir-Dolutegravir-Lamivud 600-50-300 Mg Po Tabs $ 1,164.99 Abatacept 250 Mg Iv Solr $ 13,414.87 Acarbose 50 Mg Po Tabs $ 12.19 Acebutolol Hcl 200 Mg Po Caps $ 11.84 Acetaminophen 120 Mg Pr Supp $ 6.11 Acetaminophen 162.5 Mg (1/2 X 325 Mg) Po Tabs $ 0.08 Acetaminophen 325 Mg Po Tabs $ 0.55 Acetaminophen 325 Mg Pr Supp $ 8.08 Acetaminophen 650 Mg Pr Supp $ 7.13 Acetaminophen 80 Mg Po Chew $ 0.76 Acetaminophen 80 Mg Po Tbdp $ 0.99 Acetaminophen 80 Mg Pr Supp $ 8.08 Acetazolamide 125 Mg Po Tabs $ 21.97 Acetazolamide 250 Mg Po Tabs $ 42.22 Acetazolamide 31.25 Mg (1/4 X 125 Mg) Po Tabs $ 5.49 Acetazolamide 62.5 Mg (1/2 X 125 Mg) Po Tabs $ 10.99 Acetazolamide Er 500 Mg Po Cp12 $ 43.23 Acetylcholine Chloride 20 Mg Io Solr $ 1,196.30 Aclidinium Bromide 400 Mcg/Act In Aepb $ 3,403.82 Acyclovir 200 Mg Po Caps $ 9.80 Acyclovir 400 Mg Po Tabs $ 21.87 Acyclovir 800 Mg Po Tabs $ 36.96 Adalimumab 40 Mg/0.8Ml Subq Pskt $ 31,292.91 Ado-Trastuzumab Emtansine 100 Mg Iv Solr $ 48,254.46 Ado-Trastuzumab Emtansine 160 Mg Iv Solr $ 77,207.29 Aerochamber Mv Misc $ 35.83 Agalsidase Beta 35 Mg Iv Solr $ 73,422.72 Agalsidase Beta 5 Mg Iv Solr $ 10,487.23 Albendazole 200 Mg Po Tabs $ 29.87 Albumin (Urine) Test Vi Strp $ 4.60 Albuterol Sulfate 2 Mg Po Tabs $ 59.22 Albuterol Sulfate Er 4 Mg Po Tb12 $ 23.47 Aldesleukin 22000000 Units Iv Solr $ 73,794.80 Alendronate Sodium 70 Mg Po Tabs $ 386.60 Alglucosidase Alfa 50 Mg Iv Solr $ 9,773.57 Allopurinol 100 Mg Po Tabs $ 3.80 Allopurinol 25 Mg (1/4 X 100 Mg) Po Tabs $ 0.57 Allopurinol 300 Mg Po Tabs $ 7.64 Allopurinol 50 Mg (1/2 X 100 Mg) Po Tabs $ 1.13 Allopurinol 75 Mg (1/4 X 300 Mg) Po Tabs $ 1.92 Allopurinol Sodium 500 Mg Iv Solr $ 48,227.46 Alprazolam 0.125 Mg (1/2 X 0.25 Mg) Po Tabs $ 3.21 Alprazolam 0.25 Mg Po Tabs $ 6.40 Alprazolam 0.5 Mg Po Tabs $ 7.44 Alprazolam 1 Mg Po Tabs $ 9.05 Alteplase 100 Mg Iv Solr $ 106,449.14 Alteplase 1Mg/Ml For Neurosurgery Intraventricular $ 1,851.39 Alteplase 2 Mg Ij Solr $ 1,851.39 Alteplase 2 Mg Inj Solution $ 1,851.39 Alteplase 50 Mg Iv Solr $ 53,224.62 Alteplase For Pe Without Cardiac Arrest $ 106,449.14 Alteplase Inj Bolus For Cardiac Arrest With Pe $ 53,224.62 Alteplase Inj Bolus For Ischemic Stroke $ 106,449.14 Alteplase Iv Soln For Ischemic Stroke $ 106,449.14 Alum Sulfate-Ca Acetate Ex Pack $ 11.42 Alvimopan 12 Mg Po Caps $ 1,017.79 Amantadine Hcl 100 Mg Po Caps $ 26.71 Ambrisentan 10 Mg Po Tabs $ 3,914.31 Ambrisentan 5 Mg Po Tabs $ 3,914.31 Amifostine 500 Mg Iv Solr $ 13,499.74 Amiloride Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 6.50

Page 1 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Amiloride Hcl 5 Mg Po Tabs $ 13.00 Aminocaproic Acid 125 Mg (1/4 X 500 Mg) Po Tabs $ 8.41 Aminocaproic Acid 250 Mg (1/2 X 500 Mg) Po Tabs $ 16.81 Aminocaproic Acid 500 Mg Po Tabs $ 33.62 Amiodarone Hcl 100 Mg Po Tabs $ 74.89 Amiodarone Hcl 200 Mg Po Tabs $ 6.11 Amiodarone Hcl 25 Mg (1/4 X 100) Po Tabs $ 18.73 Amiodarone Hcl 50 Mg (1/2 X 100 Mg) Po Tabs $ 37.45 Amitriptyline Hcl 10 Mg Po Tabs $ 3.04 Amitriptyline Hcl 100 Mg Po Tabs $ 25.60 Amitriptyline Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 1.85 Amitriptyline Hcl 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 0.45 Amitriptyline Hcl 25 Mg Po Tabs $ 3.69 Amitriptyline Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 0.90 Amitriptyline Hcl 50 Mg Po Tabs $ 11.75 Amitriptyline Hcl 75 Mg Po Tabs $ 19.23 Amlodipine Besy-Benazepril Hcl 10-20 Mg Po Caps $ 140.89 Amlodipine Besy-Benazepril Hcl 2.5-10 Mg Po Caps $ 84.46 Amlodipine Besy-Benazepril Hcl 5-10 Mg Po Caps $ 27.29 Amlodipine Besy-Benazepril Hcl 5-20 Mg Po Caps $ 28.82 Amlodipine Besylate 0.625 Mg (1/4 X 2.5 Mg) Po Tabs $ 16.06 Amlodipine Besylate 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 16.06 Amlodipine Besylate 10 Mg Po Tabs $ 22.73 Amlodipine Besylate 2.5 Mg Po Tabs $ 17.43 Amlodipine Besylate 5 Mg Po Tabs $ 16.56 Ammonia Aromatic In Inha $ 5.29 Amobarbital Sodium 500 Mg Ij Solr $ 8,866.97 Amoxicillin 250 Mg Po Caps $ 2.51 Amoxicillin 500 Mg Po Caps $ 4.37 Amoxicillin-Pot Clavulanate 250-125 Mg Po Tabs $ 59.65 Amoxicillin-Pot Clavulanate 500-125 Mg Po Tabs $ 38.15 Amoxicillin-Pot Clavulanate 875-125 Mg Po Tabs $ 49.91 Amphetamine-Dextroamphet Er 10 Mg Po Cp24 $ 61.81 Amphetamine-Dextroamphet Er 20 Mg Po Cp24 $ 61.81 Amphetamine-Dextroamphet Er 25 Mg Po Cp24 $ 61.81 Amphetamine-Dextroamphet Er 30 Mg Po Cp24 $ 71.06 Amphetamine-Dextroamphetamine 10 Mg Po Tabs $ 85.11 Amphetamine-Dextroamphetamine 12.5 Mg Po Tabs $ 17.28 Amphetamine-Dextroamphetamine 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 10.37 Amphetamine-Dextroamphetamine 20 Mg Po Tabs $ 17.28 Amphetamine-Dextroamphetamine 30 Mg Po Tabs $ 20.73 Amphetamine-Dextroamphetamine 5 Mg Po Tabs $ 20.73 Amphotericin B 50 Mg Iv Solr $ 529.87 Amphotericin B Liposome 50 Mg Iv Susr $ 3,446.14 Ampicillin Sodium 1 G Iv Solr $ 190.22 Ampicillin Sodium 2 G Ij Solr $ 194.67 Ampicillin Sodium 2 G Ij Solr $ 184.93 Ampicillin Sodium 500 Mg Ij Solr $ 48.63 Ampicillin-Sulbactam Sodium 1.5 (1-0.5) G Ij Solr $ 105.95 Ampicillin-Sulbactam Sodium 3 (2-1) G Ij Solr $ 107.51 Anagrelide Hcl 0.5 Mg Po Caps $ 112.53 Anastrozole 1 Mg Po Tabs $ 120.92 Antihemophilic Factor (Recomb) Kogenate Fs Iv Kit $ 19.86 Anti-Thymocyte Glob (Rabbit) 25 Mg Iv Solr $ 10,158.32 Antivenin Latrodectus Mactans Ij Kit $ 335.16 Apixaban 2.5 Mg Po Tabs $ 89.54 Apixaban 2.5 Mg Po Tabs $ 89.55 Apixaban 5 Mg Po Tabs $ 89.54 Apixaban 5 Mg Po Tabs $ 89.55 Apraclonidine Hcl 1 % Op Soln $ 335.39 Aprepitant 125 Mg Po Caps $ 4,134.79

Page 2 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Aprepitant 40 Mg Po Caps $ 1,427.83 Aprepitant 80 Mg Po Caps $ 2,053.90 Aquacel Extra Hydrofiber Ex Pads $ 88.85 Aquacel-Ag Extra Hydrofiber 4"X5" Ex Pads $ 1,118.78 Aripiprazole 1 Mg (1/2 X 2 Mg) Po Tabs $ 161.66 Aripiprazole 10 Mg Po Tabs $ 323.11 Aripiprazole 15 Mg Po Tabs $ 309.87 Aripiprazole 2 Mg Po Tabs $ 323.67 Aripiprazole 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 134.91 Aripiprazole 3.75 Mg (1/4 X 15 Mg) Po Tabs $ 67.46 Aripiprazole 5 Mg Po Tabs $ 323.11 Aripiprazole 7.5 Mg (1/2 X 15 Mg) Po Tabs $ 134.91 Aripiprazole Er 300 Mg Im Srer $ 20,636.38 Aripiprazole Er 400 Mg Im Srer $ 27,515.18 Asparaginase Erwinia Chrysanth 10000 Units Ij Solr $ 61,660.16 Aspirin 162.5 Mg (1/2 X 325 Mg) Po Tabs $ 0.14 Aspirin 20.25 Mg (1/4 X 81 Mg) Po Chew $ 0.24 Aspirin 300 Mg (1/2 X 600 Mg) Pr Supp $ 7.60 Aspirin 300 Mg Pr Supp $ 14.70 Aspirin 325 Mg Po Tabs $ 0.28 Aspirin 40.5 Mg (1/2 X 81 Mg) Po Chew $ 0.39 Aspirin 600 Mg Pr Supp $ 15.20 Aspirin 81 Mg Po Chew $ 0.96 Aspirin Ec 325 Mg Po Tbec $ 0.23 Aspirin Ec 81 Mg Po Tbec $ 0.14 Aspirin-Dipyridamole Er 25-200 Mg Po Cp12 $ 84.84 Atazanavir Sulfate 150 Mg Po Caps $ 294.99 Atenolol 100 Mg Po Tabs $ 15.05 Atenolol 12.5 Mg ( 1/2 X 25 Mg) Po Tabs $ 4.03 Atenolol 25 Mg Po Tabs $ 7.37 Atenolol 50 Mg Po Tabs $ 2.50 Atenolol 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 2.02 Atomoxetine Hcl 25 Mg Po Caps $ 159.43 Atomoxetine Hcl 40 Mg Po Caps $ 173.21 Atorvastatin Calcium 10 Mg Po Tabs $ 6.36 Atorvastatin Calcium 20 Mg Po Tabs $ 5.29 Atorvastatin Calcium 40 Mg Po Tabs $ 6.97 Atorvastatin Calcium 5 Mg (1/2 X 10 Mg) Po Tabs $ 3.18 Atorvastatin Calcium 80 Mg Po Tabs $ 19.77 Atovaquone-Proguanil Hcl 250-100 Mg Po Tabs $ 74.67 Azacitidine 10 Mg/Ml Inj $ 6,302.40 Azacitidine 100 Mg Ij Susr $ 6,302.40 Azathioprine 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 3.31 Azathioprine 25 Mg (1/2 X 50 Mg) Po Tabs $ 6.60 Azathioprine 50 Mg Po Tabs $ 13.21 Azithromycin 125 Mg (1/2 X 250 Mg) Po Tabs $ 37.30 Azithromycin 250 Mg Po Tabs $ 74.50 Azithromycin 500 Mg Iv Solr $ 103.60 Azithromycin 500 Mg Po Tabs $ 191.32 Aztreonam 1 G Ij Solr $ 459.46 B & B A-3 Athletic Supporter Misc $ 53.63 B & B A-3 Athletic Supporter Misc $ 51.91 B & B A-3 Athletic Supporter Misc $ 53.63 B & B A-3 Athletic Supporter Misc $ 51.91 B & B A-3 Athletic Supporter Misc $ 51.91 B & B S-10 Swimmer Supporter Misc $ 47.18 Bacitracin 50000 Units Im Solr $ 154.64 Bacitracin-Neomycin-Polymyxin 400-5-5000 Ex Oint $ 2.80 Bacitracin-Polymyxin B 500-10000 Unit/Gm Ex Oint $ 3.94 Baclofen 10 Mg Po Tabs $ 24.91 Baclofen 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 1.11

Page 3 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Baclofen 5 Mg (1/2 X 10 Mg) Po Tabs $ 2.22 Basiliximab 20 Mg Iv Solr $ 45,090.46 Bcg Live 50 Mg Is Susr $ 1,899.88 Bcg Live 81 Mg/Vial Is Susr $ 2,688.89 B-Complex/Vitamin C Po Tabs $ 0.53 Belatacept 250 Mg Iv Solr $ 11,445.44 Belimumab 120 Mg Iv Solr $ 6,362.30 Belimumab 400 Mg Iv Solr $ 21,206.91 Belinostat 500 Mg Iv Solr $ 31,061.64 Belladonna Alkaloids-Opium 16.2-30 Mg Pr Supp $ 277.38 Belladonna Alkaloids-Opium 16.2-60 Mg Pr Supp $ 337.21 Benazepril Hcl 10 Mg Po Tabs $ 9.60 Benazepril Hcl 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 2.40 Benazepril Hcl 20 Mg Po Tabs $ 9.57 Benazepril Hcl 5 Mg Po Tabs $ 10.58 Bendamustine Hcl 100 Mg Iv Solr $ 46,823.68 Bendamustine Hcl 25 Mg Iv Solr $ 11,705.92 Beneprotein Po Pack $ 6.80 Benzocaine 20 % Mt Soln $ 128.87 Benzocaine 20 % Mt Soln $ 165.21 Benzonatate 100 Mg Po Caps $ 25.23 Benztropine Mesylate 0.125 Mg (1/4 X 0.5 Mg) Po Tabs $ 0.98 Benztropine Mesylate 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 1.96 Benztropine Mesylate 0.5 Mg Po Tabs $ 12.10 Benztropine Mesylate 1 Mg Po Tabs $ 5.06 Benztropine Mesylate 2 Mg Po Tabs $ 8.11 Bethanechol Chloride 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 13.46 Bethanechol Chloride 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 3.60 Bethanechol Chloride 25 Mg Po Tabs $ 26.91 Bethanechol Chloride 5 Mg Po Tabs $ 9.08 Bicalutamide 50 Mg Po Tabs $ 187.08 Biotin 10 Mg Po Caps $ 4.06 Biotin 5 Mg Po Tabs $ 1.52 Bisacodyl 10 Mg Pr Supp $ 1.81 Bisacodyl 5 Mg Po Tbec $ 0.73 Bisoprolol 1.25 Mg (1/4 X 5 Mg) Po Tab $ 3.13 Bisoprolol Fumarate 10 Mg Po Tabs $ 14.14 Bisoprolol Fumarate 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 6.15 Bisoprolol Fumarate 5 Mg Po Tabs $ 14.14 Bisoprolol-Hydrochlorothiazide 10-6.25 Mg Po Tabs $ 11.51 Bisoprolol-Hydrochlorothiazide 2.5-6.25 Mg Po Tabs $ 11.51 Bisoprolol-Hydrochlorothiazide 5-6.25 Mg Po Tabs $ 78.19 Bivalirudin Trifluoroacetate 250 Mg Iv Solr $ 11,463.67 Bleomycin Sulfate 15 Units Ij Solr $ 543.58 Bleomycin Sulfate 30 Units Ij Solr $ 1,201.92 Blinatumomab 35 Mcg Iv Solr $ 46,190.39 Bortezomib 3.5 Mg Ij Solr $ 25,256.87 Bortezomib Iv 1 Mg/Ml Inj $ 25,256.87 Bosentan 125 Mg Po Tabs $ 2,344.93 Bosentan 62.5 Mg Po Tabs $ 2,344.93 Brentuximab Vedotin 50 Mg Iv Solr $ 125,417.76 Brentuximab Vedotin 50 Mg Iv Solr (Study Med) $ 125,417.76 Bromocriptine Mesylate 0.625 Mg (1/4 X 2.5 Mg) Po Tabs $ 9.48 Bromocriptine Mesylate 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 18.95 Bromocriptine Mesylate 2.5 Mg Po Tabs $ 37.85 Budesonide 180 Mcg/Act In Aepb $ 2,859.29 Budesonide 3 Mg Po Cpep $ 189.96 Bumetanide 0.125 Mg (1/4 X 0.5 Mg) Po Tabs $ 0.74 Bumetanide 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 1.46 Bumetanide 0.5 Mg Po Tabs $ 10.05 Bumetanide 1 Mg Po Tabs $ 4.12

Page 4 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Buprenorphine 10 Mcg/Hr Td Ptwk $ 1,533.12 Buprenorphine 5 Mcg/Hr Td Ptwk $ 1,024.86 Buprenorphine Hcl 1 Mg (1/2 Of 2 Mg) Sl Subl $ 20.87 Buprenorphine Hcl 150 Mcg Bu Film $ 66.97 Buprenorphine Hcl 2 Mg Sl Subl $ 41.73 Buprenorphine Hcl 300 Mcg Bu Film $ 105.18 Buprenorphine Hcl 450 Mcg Bu Film $ 142.91 Buprenorphine Hcl 600 Mcg Bu Film $ 152.50 Buprenorphine Hcl 75 Mcg Bu Film $ 66.97 Buprenorphine Hcl 750 Mcg Bu Film $ 160.36 Buprenorphine Hcl 8 Mg Sl Subl $ 83.88 Buprenorphine Hcl 900 Mcg Bu Film $ 165.08 Bupropion Hcl 100 Mg Po Tabs $ 19.80 Bupropion Hcl 25 Mg (1/4 X 100 Mg) Po Tabs $ 3.04 Bupropion Hcl 37.5 Mg (1/2 X 75 Mg) Po Tabs $ 6.00 Bupropion Hcl 50 Mg (1/2 X 100 Mg) Po Tabs $ 6.06 Bupropion Hcl 75 Mg Po Tabs $ 15.59 Bupropion Hcl Er (Sr) 100 Mg Po Tb12 $ 17.03 Bupropion Hcl Er (Sr) 150 Mg Po Tb12 $ 19.52 Buspirone Hcl 1.25 (1/4 X 5 Mg) Po Tabs $ 1.95 Buspirone Hcl 10 Mg Po Tabs $ 13.56 Buspirone Hcl 15 Mg Po Tabs $ 20.35 Buspirone Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 3.89 Buspirone Hcl 5 Mg Po Tabs $ 7.77 Buspirone Hcl 7.5 Mg Po Tabs $ 15.93 Busulfan 2 Mg Po Tabs $ 283.33 Butalbital-Apap-Caffeine 50-325-40 Mg Po Tabs $ 17.02 C1 Esterase Inhibitor (Human) 500 Units Iv Kit $ 35,743.68 Cabergoline 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 184.77 Cabergoline 0.5 Mg Po Tabs $ 348.91 Cabergoline 0.5 Mg Po Tabs $ 369.52 Caffeine 100 Mg (1/2 X 200 Mg) Po Tabs $ 0.57 Caffeine 200 Mg Po Tabs $ 1.16 Calcitriol 0.25 Mcg Po Caps $ 12.20 Calcitriol 0.5 Mcg Po Caps $ 19.49 Calcium Acetate (Phos Binder) 667 Mg Po Caps $ 7.96 Calcium Acetate 667 Mg Po Caps $ 10.35 Calcium Carbonate 1250 (500 Ca) Mg Po Tabs $ 0.93 Calcium Carbonate Antacid 187.5 Mg (1/4 X 750 Mg) Po Tabs $ 0.15 Calcium Carbonate Antacid 375 Mg (1/2 X 750 Mg) Po Chew $ 0.29 Calcium Carbonate Antacid 500 Mg Po Chew $ 0.13 Calcium Carbonate Antacid 750 Mg Po Chew $ 0.59 Calcium Carbonate-Vitamin D 250-100 Mg-Unit (1/2 X 500-200 Mg-Unit) Po Tabs $ 0.49 Calcium Carbonate-Vitamin D 500-200 Mg-Unit Po Tabs $ 0.30 Calmol-4 76-10 % Pr Supp $ 6.05 Canagliflozin 100 Mg Po Tabs $ 199.30 Canagliflozin 300 Mg Po Tabs $ 199.30 Candesartan Cilexetil 16 Mg Po Tabs $ 30.80 Candesartan Cilexetil 32 Mg Po Tabs $ 42.00 Candesartan Cilexetil 8 Mg Po Tabs $ 30.80 Cangrelor Tetrasodium 50 Mg Iv Solr $ 9,059.90 Capecitabine 150 Mg Po Tabs $ 163.99 Capsaicin-Cleansing Gel 8 % Ex Kit $ 8,491.39 Captopril 12.5 Mg Po Tabs $ 17.30 Captopril 25 Mg Po Tabs $ 18.78 Captopril 3.125 Mg (1/4 X 12.5 Mg)Po Tabs $ 3.93 Captopril 50 Mg Po Tabs $ 20.47 Captopril 6.25 Mg (1/2 X 12.5 Mg) Po Tabs $ 7.85 Carbamazepine 100 Mg (1/2 X 200 Mg) Po Tabs $ 2.32 Carbamazepine 100 Mg Po Chew $ 6.64 Carbamazepine 200 Mg Po Tabs $ 11.28

Page 5 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Carbamazepine 25 Mg (1/4 X 100 Mg) Po Chew $ 1.61 Carbamazepine 50 Mg (1/2 X 100 Mg) Po Chew $ 3.23 Carbamazepine 50 Mg (1/4 X 200 Mg) Po Tabs $ 0.29 Carbamazepine Er 100 Mg Po Cp12 $ 19.80 Carbamazepine Er 200 Mg Po Cp12 $ 19.80 Carbamazepine Er 300 Mg Po Cp12 $ 18.01 Carbidopa-Levodopa 10-100 Mg Po Tabs $ 7.15 Carbidopa-Levodopa 12.5-125 Mg ( 1/2 X 25-250 Mg) Po Tabs $ 4.33 Carbidopa-Levodopa 12.5-50 Mg (1/2 X 25-100 Mg) Po Tabs $ 6.39 Carbidopa-Levodopa 2.5-25 Mg (1/4 X 10-100 Mg) Po Tabs $ 3.06 Carbidopa-Levodopa 25-100 Mg Po Tabs $ 12.77 Carbidopa-Levodopa 25-100 Mg Po Tabs $ 8.79 Carbidopa-Levodopa 25-250 Mg Po Tabs $ 8.64 Carbidopa-Levodopa 25-250 Mg Po Tabs $ 16.28 Carbidopa-Levodopa 5-50 Mg (1/2 X 10-100 Mg) Po Tabs $ 6.12 Carbidopa-Levodopa 6.25-62.5 Mg (1/4 X 25-250 Mg) Po Tab $ 2.16 Carbidopa-Levodopa Er 25-100 Mg Po Tbcr $ 8.42 Carbidopa-Levodopa Er 50-200 Mg Po Tbcr $ 17.56 Carboxymethylcell-Glycerin Pf 0.5-0.9 % Op Soln $ 3.90 Carfilzomib (Kyprolis) 2Mg/Ml Inj Vial $ 36,580.05 Carfilzomib 10 Mg Iv Solr $ 6,096.65 Carfilzomib 30 Mg Iv Solr $ 18,290.09 Carfilzomib 60 Mg Iv Solr $ 36,580.05 Carisoprodol 175 Mg (1/2 X 350 Mg) Po Tabs $ 3.02 Carisoprodol 350 Mg Po Tabs $ 6.05 Carisoprodol 87.5 Mg (1/4 X 350Mg) Po Tab $ 1.51 Carmustine 100 Mg Iv Solr $ 60,718.90 Carmustine In Polifeprosan 7.7 Mg Il Wafr $ 47,247.56 Carvedilol 1.5625 (1/2 X 3.125 Mg) Po Tabs $ 10.60 Carvedilol 12.5 Mg Po Tabs $ 21.54 Carvedilol 25 Mg Po Tabs $ 21.54 Carvedilol 3.125 Mg Po Tabs $ 21.18 Carvedilol 6.25 Mg Po Tabs $ 59.77 Carvedilol 6.25 Mg Po Tabs $ 21.54 Caspofungin Acetate 50 Mg Iv Solr $ 4,699.13 Caspofungin Acetate 70 Mg Iv Solr $ 4,880.40 Cefazolin 1 Gm In Nss Ivpb Ads $ 77.25 Cefazolin 3 Gm Ivpb Ads $ 92.31 Cefazolin Sodium 1 G Ij Solr $ 87.15 Cefazolin Sodium 1 G Ij Solr $ 15.34 Cefazolin Sodium 10 G Ij Solr $ 167.33 Cefazolin Sodium 300 G Ij Solr $ 4,043.76 Cefazolin Sodium 500 Mg Ij Solr $ 27.91 Cefdinir 300 Mg Po Caps $ 51.55 Cefepime Hcl 1 G Ij Solr $ 236.28 Cefepime Hcl 1 G Ij Solr $ 83.66 Cefepime Hcl 2 G Ij Solr $ 139.44 Cefotetan Disodium 1 G Ij Solr $ 268.14 Cefotetan Disodium 2 G Ij Solr $ 536.43 Cefoxitin Sodium 1 G Iv Solr $ 44.76 Cefoxitin Sodium 10 G Ij Solr $ 1,254.82 Cefoxitin Sodium 2 G Iv Solr $ 177.79 Cefoxitin Sodium-Dextrose 1-4 Gm-%(50Ml) Iv Solr $ 176.81 Cefoxitin Sodium-Dextrose 2-2.2 Gm-%(50Ml) Iv Solr $ 324.62 Cefprozil 250 Mg Po Tabs $ 44.14 Ceftaroline Fosamil 600 Mg Iv Solr $ 2,678.93 Ceftazidime 1 G Ij Solr $ 121.58 Ceftazidime 2 G Ij Solr $ 131.21 Ceftazidime-Avibactam 2.5 (2-0.5) G Iv Solr $ 5,003.22 Ceftolozane-Tazobactam 1.5 (1-0.5) G Iv Solr $ 1,588.78 Ceftriaxone Sodium 1 G Ij Solr $ 534.52

Page 6 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Ceftriaxone Sodium 1 G Ij Solr $ 534.52 Ceftriaxone Sodium 2 G Ij Solr $ 1,062.17 Ceftriaxone Sodium 250 Mg Ij Solr $ 9.07 Ceftriaxone Sodium 500 Mg Ij Solr $ 21.77 Cefuroxime Axetil 250 Mg Po Tabs $ 199.15 Celecoxib 100 Mg Po Caps $ 44.01 Celecoxib 200 Mg Po Caps $ 76.34 Cephalexin 250 Mg Po Caps $ 7.00 Cephalexin 500 Mg Po Caps $ 13.87 Cerovite Jr 30 Mg (1/2 X 60 Mg) Po Chew $ 0.32 Cerovite Jr Po Chew $ 0.65 Certolizumab Pegol 2 X 200 Mg Subq Kit $ 52,344.63 Certolizumab Pegol 2 X 200 Mg/Ml Subq Kit $ 52,344.63 Childrens Chewable Vitamins Po Chew $ 0.53 Chlorambucil 2 Mg Po Tabs $ 294.27 Chlordiazepoxide Hcl 10 Mg Po Caps $ 4.01 Chlordiazepoxide Hcl 25 Mg Po Caps $ 4.31 Chlordiazepoxide Hcl 5 Mg Po Caps $ 3.56 Chloroquine Phosphate 500 Mg Po Tabs $ 121.52 Chlorothiazide 250 Mg Po Tabs $ 6.98 Chlorothiazide Sodium 500 Mg Iv Solr $ 725.76 Chlorpheniramine Maleate 4 Mg Po Tabs $ 0.64 Chlorpromazine Hcl 10 Mg Po Tabs $ 43.34 Chlorpromazine Hcl 100 Mg Po Tabs $ 150.06 Chlorpromazine Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 7.35 Chlorpromazine Hcl 25 Mg Po Tabs $ 61.92 Chlorpromazine Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 6.05 Chlorthalidone 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 2.78 Chlorthalidone 25 Mg Po Tabs $ 12.17 Cholestyramine Light 4 G Po Pack $ 51.54 Chorionic Gonadotropin 10000 Units Im Solr $ 1,227.64 Cilostazol 100 Mg Po Tabs $ 18.40 Cilostazol 100 Mg Po Tabs $ 18.40 Cilostazol 25 Mg (1/2 X 50 Mg) Po Tabs $ 120.84 Cilostazol 50 Mg Po Tabs $ 18.40 Cinacalcet Hcl 15 Mg (1/2 X 30 Mg) Po Tabs $ 119.51 Cinacalcet Hcl 30 Mg Po Tabs $ 309.00 Cinacalcet Hcl 7.5 Mg (1/4 X 30 Mg) Po Tabs $ 77.21 Ciprofloxacin Hcl 125 Mg (1/2 X 250 Mg) Po Tabs $ 23.15 Ciprofloxacin Hcl 250 Mg Po Tabs $ 46.31 Ciprofloxacin Hcl 500 Mg Po Tabs $ 32.02 Ciprofloxacin Hcl 62.5 Mg (1/4 X 250 Mg) Po Tabs $ 11.58 Ciprofloxacin Hcl 750 Mg Po Tabs $ 77.21 Citalopram Hydrobromide 10 Mg Po Tabs $ 24.46 Citalopram Hydrobromide 10 Mg Po Tabs $ 24.65 Citalopram Hydrobromide 20 Mg Po Tabs $ 27.13 Citalopram Hydrobromide 40 Mg Po Tabs $ 35.20 Citalopram Hydrobromide 5 Mg (1/2 X 10Mg) Po Tabs $ 12.24 Clarithromycin 250 Mg Po Tabs $ 60.63 Clarithromycin 500 Mg Po Tabs $ 117.82 Clindamycin Hcl 150 Mg Po Caps $ 7.37 Clobazam 10 Mg Po Tabs $ 243.34 Clobazam 2.5 Mg (1/4 X 10Mg) Po Tab $ 28.12 Clobazam 5 Mg (1/2 X 10Mg) Oral Tab $ 64.21 Clomipramine Hcl 25 Mg Po Caps $ 113.32 Clomipramine Hcl 50 Mg Po Caps $ 113.32 Clonazepam 0.125 Mg (1/4 X 0.5 Mg) Po Tabs $ 1.89 Clonazepam 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 3.78 Clonazepam 0.5 Mg Po Tabs $ 7.55 Clonazepam 1 Mg Po Tabs $ 7.96 Clonazepam 2 Mg Po Tabs $ 11.93

Page 7 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Clonidine 0.1 Mg/24Hr Td Ptwk $ 333.88 Clonidine 0.2 Mg/24Hr Td Ptwk $ 562.11 Clonidine 0.3 Mg/24Hr Td Ptwk $ 779.79 Clonidine Hcl 0.025 Mg (1/4 X 0.1 Mg) Po Tabs $ 0.60 Clonidine Hcl 0.05 Mg (1/2 X 0.1 Mg) Po Tabs $ 1.19 Clonidine Hcl 0.1 Mg Po Tabs $ 2.38 Clonidine Hcl 0.2 Mg Po Tabs $ 3.27 Clopidogrel Bisulfate 18.75 Mg (1/4 X 75 Mg) Po Tabs $ 1.04 Clopidogrel Bisulfate 37.5 Mg (1/2 X 75 Mg) Po Tabs $ 2.08 Clopidogrel Bisulfate 75 Mg Po Tabs $ 4.15 Clorazepate Dipotassium 1.875 Mg (1/2 X 3.75 Mg) Po Tabs $ 6.79 Clorazepate Dipotassium 15 Mg Po Tabs $ 47.12 Clorazepate Dipotassium 3.75 Mg Po Tabs $ 12.95 Clorazepate Dipotassium 7.5 Mg Po Tabs $ 28.67 Clotrimazole 10 Mg Mt Troc $ 16.21 Clozapine 100 Mg Po Tabs $ 34.55 Clozapine 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 6.67 Clozapine 25 Mg Po Tabs $ 13.34 Clozapine 25 Mg Po Tbdp $ 30.22 Coenzyme Q-10 100 Mg Po Caps $ 4.94 Coenzyme Q-10 100 Mg Po Caps $ 8.52 Coenzyme Q10 200 Mg Po Caps $ 7.64 Coenzyme Q10 30 Mg Po Caps $ 2.55 Colchicine 0.3 Mg (1/2 X 0.6 Mg) Po Tabs $ 29.63 Colchicine 0.6 Mg Po Tabs $ 67.90 Colesevelam Hcl 625 Mg Po Tabs $ 44.15 Colistimethate 75 Mg/Ml Oral Soln $ 338.69 Colistimethate Sodium (Cba) 150 Mg Ij Solr $ 338.59 Collagenase Clostrid Histolyt 0.9 Mg Ij Solr $ 56,444.17 Copper Gluconate 2 Mg Po Caps $ 1.00 Corticorelin Ovine Triflutate 100 Mcg Iv Solr $ 11,038.31 Cortisone Acetate 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 15.76 Cortisone Acetate 25 Mg Po Tabs $ 31.50 Cosyntropin 0.25 Mg Ij Solr $ 1,289.19 Crotalidae Immune Fab (Equine) Iv Solr $ 14,757.12 Crotalidae Polyval Immune Fab Iv Solr $ 38,683.01 Culturelle Po Caps $ 6.11 Cyclobenzaprine Hcl 10 Mg Po Tabs $ 9.77 Cyclobenzaprine Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 8.28 Cyclobenzaprine Hcl 5 Mg Po Tabs $ 16.54 Cyclophosphamide 2 G Ij Solr $ 23,082.54 Cyclophosphamide 2 G Ij Solr $ 21,639.95 Cyclophosphamide 25 Mg Po Caps $ 94.37 Cyclophosphamide 50 Mg Po Caps $ 173.18 Cyclophosphamide 500 Mg Ij Solr $ 5,409.95 Cyclophosphamide 500 Mg Ij Solr $ 5,770.64 Cyclosporine 0.05 % Op Emul $ 112.43 Cyclosporine 25 Mg Po Caps $ 44.36 Cyclosporine Modified 100 Mg Po Caps $ 55.40 Cyclosporine Modified 25 Mg Po Caps $ 13.86 Cyproheptadine Hcl 1 Mg (1/4 X 4 Mg) Po Tabs $ 4.20 Cyproheptadine Hcl 2 Mg (1/2 X 4 Mg) Po Tabs $ 8.42 Cyproheptadine Hcl 4 Mg Po Tabs $ 10.76 Dabigatran Etexilate Mesylate 150 Mg Po Caps $ 80.75 Dabigatran Etexilate Mesylate 75 Mg Po Caps $ 80.75 Dacarbazine 100 Mg Iv Solr $ 148.90 Dacarbazine 200 Mg Iv Solr $ 189.07 Dactinomycin 0.5 Mg Iv Solr $ 29,281.08 Danazol 100 Mg Po Caps $ 54.87 Danazol 200 Mg Po Caps $ 91.42 Dantrolene 0.33 Mg/Ml In Sterile Water Inj Dil $ 1,072.19

Page 8 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Dantrolene Sodium 20 Mg Iv Solr $ 846.72 Dantrolene Sodium 25 Mg Po Caps $ 12.94 Dantrolene Sodium 250 Mg Iv Susr $ 32,799.11 Dapsone 100 Mg Po Tabs $ 33.87 Dapsone 25 Mg Po Tabs $ 27.60 Daptomycin 500 Mg Iv Solr $ 6,211.94 Daptomycin 500 Mg Iv Solr (Piggyback Component) $ 5,388.67 Darunavir Ethanolate 600 Mg Po Tabs $ 340.64 Darunavir Ethanolate 800 Mg Po Tabs $ 681.29 Dasatinib 100 Mg Po Tabs $ 5,518.52 Dasatinib 140 Mg Po Tabs $ 5,518.52 Dasatinib 20 Mg Po Tabs $ 1,530.94 Dasatinib 50 Mg Po Tabs $ 3,061.87 Dasatinib 70 Mg Po Tabs $ 3,061.87 Dasatinib 80 Mg Po Tabs $ 5,518.52 Decitabine 50 Mg Inj Study Med $ 14,968.20 Decitabine 50 Mg Iv Solr $ 14,968.20 Deferoxamine Mesylate (213 Mg/Ml) Im Dilution $ 113.83 Deferoxamine Mesylate 500 Mg Ij Solr $ 113.83 Degarelix Acetate 80 Mg Subq Solr $ 5,908.29 Dekas Plus Po Caps $ 5.75 Dekas Plus Po Chew $ 5.59 Demeclocycline Hcl 150 Mg Po Tabs $ 107.17 Desmopressin Acetate 0.025 Mg (1/4 X 0.1 Mg) Po Tabs $ 7.61 Desmopressin Acetate 0.05 Mg (1/2 X 0.1 Mg) Po Tabs $ 15.22 Desmopressin Acetate 0.1 Mg Po Tabs $ 53.28 Desmopressin Acetate 0.2 Mg Po Tabs $ 76.76 Dexamethasone 0.125 Mg (1/4 X .5 Mg) Po Tab $ 0.53 Dexamethasone 0.1875 Mg (1/4 X 0.75 Mg) Po Tabs $ 0.93 Dexamethasone 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 1.05 Dexamethasone 0.375 Mg (1/2 X 0.75 Mg) Po Tabs $ 1.86 Dexamethasone 0.5 Mg Po Tabs $ 1.39 Dexamethasone 0.75 Mg Po Tabs $ 2.68 Dexamethasone 1.5 Mg Po Tabs $ 4.81 Dexamethasone 2 Mg Po Tabs $ 7.48 Dexamethasone 4 Mg Po Tabs $ 11.99 Dexamethasone 6 Mg Po Tabs $ 17.98 Dexmethylphenidate Hcl 5 Mg Po Tabs $ 10.91 Dexrazoxane Hcl 250 Mg Iv Solr $ 3,317.43 Dexrazoxane Hcl 500 Mg Iv Solr $ 6,634.76 Dextroamphetamine Sulfate 5 Mg Po Tabs $ 29.23 Diazepam 0.5 Mg (1/4 X 2 Mg) Po Tabs $ 0.32 Diazepam 1 Mg (1/2 X 2 Mg) Po Tabs $ 0.64 Diazepam 10 Mg Po Tabs $ 4.28 Diazepam 2 Mg Po Tabs $ 1.27 Diazepam 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 1.11 Diazepam 5 Mg Po Tabs $ 2.22 Diclofenac Sodium 25 Mg Po Tbec $ 14.33 Diclofenac Sodium 50 Mg Po Tbec $ 9.54 Diclofenac Sodium 75 Mg Po Tbec $ 17.88 Dicloxacillin Sodium 250 Mg Po Caps $ 6.66 Dicyclomine Hcl 10 Mg Po Caps $ 6.64 Dicyclomine Hcl 20 Mg Po Tabs $ 3.58 Diflunisal 500 Mg Po Tabs $ 20.31 Digoxin 0.0625 Mg (1/2 X 0.125 Mg) Po Tabs $ 7.17 Digoxin 125 Mcg Po Tabs $ 14.33 Digoxin 250 Mcg Po Tabs $ 7.66 Digoxin Immune Fab 40 Mg Iv Solr $ 46,218.82 Diltiazem Hcl 15 Mg (1/2 X 30 Mg) Po Tabs $ 2.27 Diltiazem Hcl 30 Mg Po Tabs $ 3.06 Diltiazem Hcl 45 Mg (1/2 X 90 Mg) Po Tabs $ 4.33

Page 9 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Diltiazem Hcl 60 Mg Po Tabs $ 2.84 Diltiazem Hcl 7.5 Mg (1/4 X 30 Mg) Po Tabs $ 1.14 Diltiazem Hcl 90 Mg Po Tabs $ 8.64 Diltiazem Hcl Er Coated Beads 120 Mg Po Cp24 $ 9.36 Diltiazem Hcl Er Coated Beads 180 Mg Po Cp24 $ 18.21 Diltiazem Hcl Er Coated Beads 240 Mg Po Cp24 $ 6.12 Diltiazem Hcl Er Coated Beads 300 Mg Po Cp24 $ 26.54 Diltiazem Hcl Er Coated Beads 300 Mg Po Cp24 $ 27.01 Dimenhydrinate 25 Mg (1/2 X 50 Mg) Po Tab $ 0.18 Dimenhydrinate 50 Mg Po Tabs $ 0.37 Dinoprostone 10 Mg Va Inst $ 4,966.52 Dinoprostone 20 Mg Va Supp $ 26,710.02 Diphenhydramine Hcl 25 Mg Po Caps $ 0.84 Diphenhydramine Hcl 25 Mg Po Tabs $ 2.04 Diphenoxylate-Atropine 1.25-0.0125 (1/2 X 2.5-0.025) Mg Po Tabs $ 3.53 Diphenoxylate-Atropine 2.5-0.025 Mg Po Tabs $ 8.82 Dipyridamole 25 Mg Po Tabs $ 10.69 Dipyridamole 50 Mg Po Tabs $ 6.62 Dipyridamole 75 Mg Po Tabs $ 8.29 Disopyramide Phosphate 100 Mg Po Caps $ 28.80 Disopyramide Phosphate 150 Mg Po Caps $ 34.03 Disopyramide Phosphate Er 100 Mg Po Cp12 $ 48.50 Disopyramide Phosphate Er 150 Mg Po Cp12 $ 57.32 Divalproex Sodium 125 Mg Po Csdr $ 21.74 Divalproex Sodium 125 Mg Po Tbec $ 8.94 Divalproex Sodium 250 Mg Po Tbec $ 17.76 Divalproex Sodium 500 Mg Po Tbec $ 36.30 Divalproex Sodium 62.5 Mg (1/2 X 125Mg) Po Packet $ 7.39 Divalproex Sodium Er 250 Mg Po Tb24 $ 24.75 Divalproex Sodium Er 500 Mg Po Tb24 $ 67.50 Docusate Sodium 100 Mg Po Caps $ 0.44 Docusate Sodium 50 Mg Po Caps $ 2.96 Dofetilide 125 Mcg Po Caps $ 125.72 Dofetilide 250 Mcg Po Caps $ 125.72 Dofetilide 500 Mcg Po Caps $ 125.72 Donepezil Hcl 10 Mg Po Tabs $ 64.21 Donepezil Hcl 10 Mg Po Tbdp $ 87.30 Donepezil Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 42.02 Donepezil Hcl 5 Mg Po Tabs $ 78.45 Doxazosin Mesylate 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 6.80 Doxazosin Mesylate 1 Mg Po Tabs $ 37.95 Doxazosin Mesylate 2 Mg Po Tabs $ 9.31 Doxazosin Mesylate 4 Mg Po Tabs $ 59.12 Doxepin Hcl 10 Mg Po Caps $ 6.30 Doxepin Hcl 100 Mg Po Caps $ 20.13 Doxepin Hcl 25 Mg Po Caps $ 8.50 Doxepin Hcl 50 Mg Po Caps $ 11.77 Doxorubicin Hcl 50 Mg Iv Solr $ 3,841.58 Doxycycline For Sclerotherapy $ 318.49 Doxycycline Hyclate 100 Mg Iv Solr $ 318.49 Doxycycline Hyclate 100 Mg Po Tabs $ 55.76 Doxycycline Hyclate 25 Mg (1/4 X 100 Mg) Po Tabs $ 13.94 Doxycycline Hyclate 50 Mg (1/2 X 100 Mg) Po Tabs $ 27.88 Doxylamine Succinate (Sleep) 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 1.15 Doxylamine Succinate (Sleep) 25 Mg Po Tabs $ 2.30 Dronabinol 2.5 Mg Po Caps $ 59.39 Dronabinol 5 Mg Po Caps $ 123.62 Dronedarone Hcl 200 Mg (1/2 X 400 Mg) Po Tabs $ 86.23 Dronedarone Hcl 400 Mg Po Tabs $ 132.73 Dronedarone Hcl 400 Mg Po Tabs $ 132.73 Dtap-Ipv-Hib Vaccine Im Susr $ 1,155.33

Page 10 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Duloxetine Hcl 20 Mg Po Cpep $ 18.14 Duloxetine Hcl 30 Mg Po Cpep $ 59.72 Duloxetine Hcl 60 Mg Po Cpep $ 59.72 Duoderm Cgf Dressing Ex Misc $ 111.63 Dutasteride 0.5 Mg Po Caps $ 60.99 Efavirenz 200 Mg Po Caps $ 131.80 Efavirenz 600 Mg Po Tabs $ 395.39 Efavirenz-Emtricitab-Tenofovir 600-200-300 Mg Po Tabs $ 1,152.16 Elotuzumab 400 Mg Iv Solr $ 40,193.56 Eltrombopag Olamine 25 Mg Po Tabs $ 1,986.35 Eltrombopag Olamine 75 Mg Po Tabs $ 5,391.99 Empagliflozin 10 Mg Po Tabs $ 198.72 Empagliflozin 25 Mg Po Tabs $ 198.72 Emtricitabine 200 Mg Po Caps $ 263.07 Emtricitabine-Tenofovir Df 200-300 Mg Po Tabs $ 667.60 Enalapril Maleate 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 4.72 Enalapril Maleate 10 Mg Po Tabs $ 19.60 Enalapril Maleate 2.5 Mg Po Tabs $ 14.69 Enalapril Maleate 5 Mg Po Tabs $ 12.47 Entacapone 100 Mg (1/2 X 200 Mg) Po Tabs $ 22.88 Entacapone 200 Mg Po Tabs $ 45.75 Epinephrine 0.15 Mg/0.15Ml Ij Soaj $ 29,635.20 Epinephrine 0.3 Mg/0.3Ml Ij Soaj $ 1,890.00 Epipen 2-Pak 0.3 Mg/0.3Ml Ij Soaj $ 3,680.86 Epipen Jr 2-Pak 0.15 Mg/0.3Ml Ij Soaj $ 3,680.86 Eplerenone 25 Mg (1/2 X 50 Mg) Po Tabs $ 21.87 Eplerenone 50 Mg Po Tabs $ 137.90 Eplerenone 50 Mg Po Tabs $ 41.99 Epoprostenol Sodium 1.5 Mg Iv Solr $ 566.60 Epoprostenol Sodium 1.5 Mg Iv Solr $ 546.03 Ertapenem Sodium 1 G Ij Solr $ 1,794.04 Ertapenem Sodium 1 G Ij Solr $ 1,632.43 Ertapenem Sodium 1 G Iv Solr $ 1,883.56 Erythromycin Lactobionate 500 Mg Iv Solr $ 1,037.48 Erythromycin Stearate 125 Mg (1/2 X 250 Mg) Po Tabs $ 66.16 Erythromycin Stearate 250 Mg Po Tabs $ 132.31 Escitalopram Oxalate 10 Mg Po Tabs $ 43.55 Escitalopram Oxalate 2.5 Mg (1/2 X 5 Mg) Po Tab $ 20.86 Escitalopram Oxalate 20 Mg Po Tabs $ 52.21 Escitalopram Oxalate 5 Mg Po Tabs $ 41.83 Eslicarbazepine Acetate 400 Mg Po Tabs $ 390.34 Esomeprazole Sodium 40 Mg Iv Solr $ 422.15 Estradiol 0.05 Mg/24Hr Td Ptwk $ 398.59 Estradiol 0.1 Mg/24Hr Td Ptwk $ 398.59 Estradiol 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 0.96 Estradiol 0.5 Mg Po Tabs $ 5.55 Estradiol 1 Mg Po Tabs $ 3.83 Estrogens Conjugated 0.15 Mg (1/2 X 0.3 Mg) Po Tabs $ 18.31 Estrogens Conjugated 0.3 Mg Po Tabs $ 68.02 Estrogens Conjugated 0.45 Mg Po Tabs $ 68.02 Estrogens Conjugated 0.625 Mg Po Tabs $ 68.02 Estrogens Conjugated 0.9 Mg Po Tabs $ 68.02 Estrogens Conjugated 1.25 Mg Po Tabs $ 68.02 Estrogens Conjugated 25 Mg Ij Solr $ 3,590.09 Eszopiclone 3 Mg Po Tabs $ 189.67 Etanercept 25 Mg Subq Solr $ 7,823.19 Ethacrynate Sodium 50 Mg Iv Solr $ 45,964.80 Ethacrynic Acid 25 Mg Po Tabs $ 295.67 Ethambutol Hcl 100 Mg Po Tabs $ 5.97 Ethambutol Hcl 400 Mg Po Tabs $ 9.43 Ethosuximide 250 Mg Po Caps $ 22.49

Page 11 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Etodolac 200 Mg Po Caps $ 14.48 Etonogestrel 68 Mg Subq Impl $ 11,307.54 Etoposide 50 Mg Po Caps $ 1,012.43 Etoposide Phosphate 100 Mg Iv Solr $ 2,220.68 Etravirine 100 Mg Po Tabs $ 136.76 Everolimus 0.25 Mg Po Tabs $ 106.32 Everolimus 0.5 Mg Po Tabs $ 212.64 Everolimus 0.75 Mg Po Tabs $ 318.96 Ezetimibe 10 Mg Po Tabs $ 139.10 Ezetimibe 5 Mg (1/2 X 10 Mg) Po Tabs $ 52.42 Famciclovir 250 Mg Po Tabs $ 63.72 Famciclovir 500 Mg Po Tabs $ 127.95 Famotidine 10 Mg Po Tabs $ 3.02 Famotidine 20 Mg Po Tabs $ 17.54 Famotidine 40 Mg Po Tabs $ 47.19 Famotidine 5 Mg (1/4 X 20 Mg) Po Tabs $ 4.39 Febuxostat 40 Mg Po Tabs $ 133.07 Febuxostat 80 Mg Po Tabs $ 133.07 Felbamate 100 Mg (1/4 X 400 Mg) Po Tabs $ 13.29 Felbamate 150 Mg (1/4 X 600 Mg) Po Tabs $ 15.07 Felbamate 200 Mg (1/2 X 400 Mg) Po Tabs $ 26.56 Felbamate 300 Mg (1/2 X 600 Mg) Po Tabs $ 30.16 Felbamate 400 Mg Po Tabs $ 52.62 Felbamate 600 Mg Po Tabs $ 60.31 Felodipine Er 10 Mg Po Tb24 $ 27.37 Felodipine Er 2.5 Mg Po Tb24 $ 15.23 Felodipine Er 5 Mg Po Tb24 $ 15.23 Fenofibrate 160 Mg Po Tabs $ 71.86 Fenofibrate 54 Mg Po Tabs $ 7.98 Fenofibrate 80 Mg (1/2 X 160 Mg) Po Tabs $ 35.94 Fentanyl 100 Mcg/Hr Td Pt72 $ 538.41 Fentanyl 12 (12.5) Mcg/Hr Td Pt72 $ 204.64 Fentanyl 25 Mcg/Hr Td Pt72 $ 214.36 Fentanyl 50 Mcg/Hr Td Pt72 $ 265.95 Fentanyl 75 Mcg/Hr Td Pt72 $ 468.64 Fentanyl Citrate 100 Mcg Bu Tabs $ 650.98 Fentanyl Citrate 200 Mcg Bu Lpop $ 189.54 Fentanyl Citrate 200 Mcg Bu Tabs $ 822.49 Fentanyl Citrate 600 Mcg Bu Lpop $ 294.13 Fentanyl Citrate 800 Mcg Bu Lpop $ 348.51 Ferrous Sulfate 162.5 (32.5 Fe) Mg (1/2 X 325 Mg) Po Tabs $ 0.34 Ferrous Sulfate 325 (65 Fe) Mg Po Tabs $ 0.68 Fibrin Sealant Patch 2X4 (Evarrest) $ 12,096.00 Fidaxomicin 200 Mg Po Tabs $ 2,338.04 Finasteride 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 16.79 Finasteride 5 Mg Po Tabs $ 33.58 Flecainide Acetate 100 Mg Po Tabs $ 40.47 Flecainide Acetate 25 Mg (1/2 X 50 Mg) Po Tabs $ 10.18 Flecainide Acetate 50 Mg Po Tabs $ 20.36 Floseal Applicator Tips $ 191.02 Floseal Applicator Tips $ 855.49 Floxuridine 0.5 G Ij Solr $ 1,874.96 Fluconazole 100 Mg Po Tabs $ 88.73 Fluconazole 200 Mg Po Tabs $ 164.76 Fluconazole 25 Mg (1/2 X 50 Mg) Po Tabs $ 28.12 Fluconazole 50 Mg Po Tabs $ 56.16 Flucytosine 250 Mg Po Caps $ 233.45 Flucytosine 500 Mg Po Caps $ 1,798.60 Fludarabine Phosphate 50 Mg Iv Solr $ 1,488.94 Fludrocortisone Acetate 0.025 Mg (1/4 X 0.1 Mg) Po Tabs $ 1.89 Fludrocortisone Acetate 0.05 Mg (1/2 X 0.1 Mg) Po Tabs $ 3.77

Page 12 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Fludrocortisone Acetate 0.1 Mg Po Tabs $ 7.54 Fluocinolone Acetonide 0.19 Mg Intravitreal Impl $ 106,444.80 Fluorescein Sodium 0.6 Mg Op Strp $ 1.51 Fluorescein Sodium 1 Mg Op Strp $ 1.90 Fluoxetine Hcl 10 Mg Po Caps $ 26.19 Fluoxetine Hcl 20 Mg Po Caps $ 25.04 Fluoxymesterone 10 Mg Po Tabs $ 58.24 Fluphenazine Hcl 1 Mg Po Tabs $ 6.35 Fluphenazine Hcl 2.5 Mg Po Tabs $ 7.64 Fluphenazine Hcl 5 Mg Po Tabs $ 13.61 Fluticasone Furoate 100 Mcg/Act In Aepb $ 69.98 Fluticasone Furoate 100 Mcg/Act In Aepb $ 69.98 Fluticasone Furoate 200 Mcg/Act In Aepb $ 93.69 Fluticasone Furoate 200 Mcg/Act In Aepb $ 93.68 Fluticasone Furoate-Vilanterol 100-25 Mcg/Inh In Aepb $ 46.77 Fluticasone Furoate-Vilanterol 100-25 Mcg/Inh In Aepb $ 58.45 Fluticasone Furoate-Vilanterol 200-25 Mcg/Inh In Aepb $ 58.45 Fluticasone-Salmeterol 100-50 Mcg/Dose In Aepb $ 131.10 Fluticasone-Salmeterol 250-50 Mcg/Dose In Aepb $ 131.10 Fluticasone-Salmeterol 500-50 Mcg/Dose In Aepb $ 213.67 Fluticasone-Umeclidin-Vilant 100-62.5-25 Mcg/Inh In Aepb $ 109.90 Flutter Devi $ 468.12 Fluvastatin Sodium 20 Mg Po Caps $ 61.59 Fluvoxamine Maleate 100 Mg Po Tabs $ 26.61 Fluvoxamine Maleate 25 Mg Po Tabs $ 23.18 Fluvoxamine Maleate 50 Mg Po Tabs $ 25.95 Folic Acid 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 0.91 Folic Acid 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 1.83 Folic Acid 1 Mg Po Tabs $ 3.64 Folic Acid 100 Mcg (1/4 X 400 Mcg) Po Tabs $ 0.09 Folic Acid 200 Mcg (1/2 X 400 Mcg) Po Tabs $ 0.18 Fosaprepitant Dimeglumine 150 Mg Iv Solr $ 4,047.73 Fosfomycin Tromethamine 3 G Po Pack $ 1,051.34 Fosinopril Sodium 10 Mg Po Tabs $ 20.39 Fosinopril Sodium 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 3.00 Fosinopril Sodium 20 Mg Po Tabs $ 20.39 Fosinopril Sodium 40 Mg Po Tabs $ 20.39 Fosinopril Sodium 5 Mg (1/2 X 10 Mg) Po Tabs $ 6.00 Furosemide 10 Mg (1/2 X 20 Mg) Po Tabs $ 0.82 Furosemide 20 Mg Po Tabs $ 2.11 Furosemide 40 Mg Po Tabs $ 1.34 Furosemide 5 Mg (1/4 X 20 Mg) Po Tabs $ 0.40 Furosemide 80 Mg Po Tabs $ 3.28 Gabapentin 100 Mg Po Caps $ 1.42 Gabapentin 300 Mg Po Caps $ 1.87 Gabapentin 400 Mg Po Caps $ 2.14 Galantamine Hydrobromide 4 Mg Po Tabs $ 30.76 Galantamine Hydrobromide 8 Mg Po Tabs $ 64.55 Ganciclovir Sodium 500 Mg Iv Solr $ 1,003.97 Gelatin Adsorbable Op Film $ 2,706.85 Gemcitabine Hcl 1 G Iv Solr $ 945.36 Gemcitabine Hcl 1 G Iv Solr $ 772.04 Gemcitabine Hcl 200 Mg Iv Solr $ 189.07 Gemcitabine Hcl 200 Mg Iv Solr $ 630.24 Gemcitabine Hcl 200 Mg Iv Solr $ 150.47 Gemfibrozil 300 Mg (1/2 X 600 Mg) Po Tabs $ 22.34 Gemfibrozil 600 Mg Po Tabs $ 44.66 Gemtuzumab Ozogamicin 4.5 Mg Iv Solr $ 133,075.18 Gilteritinib Fumarate 40 Mg Po Tabs $ 3,024.00 Glimepiride 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 1.02 Glimepiride 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 2.04

Page 13 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Glimepiride 1 Mg Po Tabs $ 4.05 Glimepiride 2 Mg Po Tabs $ 12.40 Glimepiride 4 Mg Po Tabs $ 12.38 Glipizide 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 0.95 Glipizide 10 Mg Po Tabs $ 6.74 Glipizide 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 1.89 Glipizide 5 Mg Po Tabs $ 3.78 Glipizide Er 10 Mg Po Tb24 $ 8.11 Glipizide Er 2.5 Mg Po Tb24 $ 4.10 Glipizide Er 5 Mg Po Tb24 $ 4.10 Glucagon Hcl Rdna (Diagnostic) 1 Mg Ij Solr $ 2,075.67 Glucarpidase 1000 Units Iv Solr $ 382,935.17 Glucose 4 G Po Chew $ 2.35 Glucose 4 G Po Chew $ 1.21 Glyburide 0.625 Mg (1/2 X 1.25 Mg) Po Tabs $ 1.39 Glyburide 1.25 Mg Po Tabs $ 2.78 Glyburide 2.5 Mg Po Tabs $ 3.08 Glyburide 5 Mg Po Tabs $ 9.11 Glyburide Micronized 1.5 Mg Po Tabs $ 4.19 Glyburide Micronized 3 Mg Po Tabs $ 36.57 Glyburide Micronized 6 Mg Po Tabs $ 10.84 Glycerin (Laxative) 1 G Pr Supp $ 8.50 Glycerin (Laxative) 1.2 G Pr Supp $ 4.42 Glycerin (Laxative) 2 G Pr Supp $ 4.35 Glycopyrrolate 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 3.31 Glycopyrrolate 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 6.62 Glycopyrrolate 1 Mg Po Tabs $ 13.24 Goserelin Acetate 10.8 Mg Subq Impl $ 21,954.24 Goserelin Acetate 10.8 Mg Subq Impl $ 23,051.95 Goserelin Acetate 3.6 Mg Subq Impl $ 7,683.98 Granisetron Hcl 1 Mg Po Tabs $ 594.81 Granulotion Packet $ 76.61 Guanfacine Hcl 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 2.20 Guanfacine Hcl 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 4.40 Guanfacine Hcl 1 Mg Po Tabs $ 8.79 Haemophilus B Polysac Conj Vac Im Solr $ 189.00 Haemophilus B Polysac Conj Vac Im Solr $ 198.19 Haloperidol 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 1.64 Haloperidol 0.5 Mg Po Tabs $ 3.50 Haloperidol 1 Mg Po Tabs $ 4.96 Haloperidol 10 Mg Po Tabs $ 18.07 Haloperidol 2 Mg Po Tabs $ 6.37 Haloperidol 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 5.16 Haloperidol 5 Mg Po Tabs $ 10.32 Hemin 350 Mg Iv Solr $ 92,800.01 Hurricaine Spr Extension Tubes Misc $ 1.09 Hydralazine Hcl 10 Mg Po Tabs $ 4.18 Hydralazine Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 2.56 Hydralazine Hcl 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 1.04 Hydralazine Hcl 25 Mg Po Tabs $ 5.12 Hydralazine Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 2.07 Hydralazine Hcl 50 Mg Po Tabs $ 4.44 Hydralazine Hcl 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 2.87 Hydrochlorothiazide 12.5 Mg Po Caps $ 4.28 Hydrochlorothiazide 25 Mg Po Tabs $ 1.49 Hydrochlorothiazide 50 Mg Po Tabs $ 1.66 Hydrocodone-Acetaminophen 5-325 Mg Po Tabs $ 5.46 Hydrocortisone 1 % Ex Crea $ 1.21 Hydrocortisone 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 1.41 Hydrocortisone 10 Mg Po Tabs $ 20.23 Hydrocortisone 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 2.81

Page 14 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Hydrocortisone 20 Mg Po Tabs $ 10.96 Hydrocortisone 5 Mg Po Tabs $ 11.98 Hydrocortisone Acetate 25 Mg Pr Supp $ 145.40 Hydrocortisone Na Succinate Pf 100 Mg Ij Solr $ 120.26 Hydrocortisone Na Succinate Pf 100 Mg Ij Solr $ 162.49 Hydrocortisone Na Succinate Pf 100 Mg Ij Solr $ 162.43 Hydrocortisone Na Succinate Pf 250 Mg Ij Solr $ 300.50 Hydromorphone 0.5 Mg (1/4 X 2 Mg) Po Tabs $ 1.21 Hydromorphone 1 Mg (1/2 X 2 Mg) Po Tabs $ 6.95 Hydromorphone Hcl 2 Mg Po Tabs $ 7.21 Hydromorphone Hcl 4 Mg Po Tabs $ 7.23 Hydroxocobalamin 5 G Iv Solr $ 9,934.65 Hydroxychloroquine Sulfate 100 Mg (1/2 X 200 Mg) Po Tab $ 6.21 Hydroxychloroquine Sulfate 200 Mg Po Tabs $ 41.21 Hydroxyurea 500 Mg Po Caps $ 11.13 Hydroxyzine Hcl 10 Mg Po Tabs $ 2.87 Hydroxyzine Hcl 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 1.60 Hydroxyzine Hcl 25 Mg Po Tabs $ 9.22 Hydroxyzine Hcl 5 Mg ( 1/2 X 10 Mg) Po Tabs $ 3.20 Hydroxyzine Hcl 50 Mg Po Tabs $ 11.24 Hyoscyamine Sulfate 0.125 Mg Sl Subl $ 11.05 Hyoscyamine Sulfate Er 0.375 Mg Po Tb12 $ 9.96 Ibuprofen 100 Mg (1/2 X 200 Mg) Po Tabs $ 0.34 Ibuprofen 200 Mg Po Tabs $ 0.81 Ibuprofen 300 Mg (1/2 X 600 Mg) Po Tabs $ 1.54 Ibuprofen 400 Mg Po Tabs $ 2.18 Ibuprofen 600 Mg Po Tabs $ 3.07 Ibuprofen 800 Mg Po Tabs $ 4.03 Icaps Lutein & Zeaxanthin Po Tbec $ 1.97 Ifosfamide 1 G Iv Solr $ 914.64 Ifosfamide 3 G Iv Solr $ 1,648.60 Imatinib Mesylate 100 Mg Po Tabs $ 1,132.65 Imatinib Mesylate 400 Mg Po Tabs $ 4,081.36 Imatinib Mesylate 50 Mg (1/2 X 100 Mg) Po Tabs $ 566.36 Imiglucerase 400 Units Iv Solr $ 19,861.63 Imipenem-Cilastatin 250 Mg Iv Solr $ 241.88 Imipenem-Cilastatin 500 Mg Iv Solr $ 455.30 Imipramine Hcl 10 Mg Po Tabs $ 4.33 Imipramine Hcl 25 Mg Po Tabs $ 7.24 Imipramine Hcl 50 Mg Po Tabs $ 12.29 Imiquimod 5 % Ex Crea $ 75.60 Immune Globulin (Human) 10 G Iv Solr $ 22,394.54 Immune Globulin (Human) 5 G Iv Solr $ 11,197.27 Incobotulinumtoxina 50 Units Im Solr $ 3,060.29 Indapamide 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 4.31 Indapamide 2.5 Mg Po Tabs $ 15.62 Indinavir Sulfate 400 Mg Po Caps $ 30.69 Indocyanine Green 25 Mg Iv Solr $ 997.50 Indomethacin 25 Mg Po Caps $ 4.05 Indomethacin 50 Mg Pr Supp $ 2,056.32 Indomethacin Sodium 1 Mg Iv Solr $ 6,477.41 Infliximab 100 Mg Iv Solr $ 14,125.91 Infliximab-Dyyb 100 Mg Iv Solr $ 11,446.24 Insulin Pen Needle 29G X 12.7Mm Misc $ 5.74 Insulin Pen Needle 30G X 8 Mm Misc $ 5.06 Insulin Pen Needle 30G X 8 Mm Misc $ 4.06 Insulin Pen Needle 30G X 8 Mm Misc $ 4.06 Insulin Pen Needle 32G X 6 Mm Misc $ 6.18 Interferon Alfa-2B 18000000 Units Ij Solr $ 5,225.37 Interferon Alfa-2B 50000000 Units Ij Solr $ 14,516.51 Interlink Primary Infusion Set $ 19.86

Page 15 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Interlink Secondary Infusion Set $ 8.87 Irbesartan 150 Mg Po Tabs $ 30.96 Irbesartan 300 Mg Po Tabs $ 37.23 Irbesartan 75 Mg Po Tabs $ 12.94 Isavuconazonium Sulfate 186 Mg Po Caps $ 1,119.67 Isavuconazonium Sulfate 372 Mg Iv Solr $ 3,814.98 Isometheptene-Dichloral-Apap 65-100-325 Mg Po Caps $ 46.42 Isoniazid 150 Mg (1/2 X 300 Mg) Po Tabs $ 1.28 Isoniazid 300 Mg Po Tabs $ 12.98 Isosorbide Dinitrate 10 Mg Po Tabs $ 10.93 Isosorbide Dinitrate 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 4.97 Isosorbide Dinitrate 20 Mg Po Tabs $ 12.02 Isosorbide Dinitrate 5 Mg Po Tabs $ 14.08 Isosorbide Dinitrate Er 40 Mg Po Tbcr $ 23.95 Isosorbide Mononitrate Cr 15 Mg (1/2 X 30 Mg) Po Tb24 $ 8.46 Isosorbide Mononitrate Er 30 Mg Po Tb24 $ 16.90 Isosorbide Mononitrate Er 60 Mg Po Tb24 $ 20.73 Isradipine 2.5 Mg Po Caps $ 13.76 Isradipine 5 Mg Po Caps $ 20.12 Itraconazole 100 Mg Po Caps $ 243.38 Ivabradine Hcl 5 Mg Po Tabs $ 89.19 Ivabradine Hcl 7.5 Mg Po Tabs $ 89.19 Ivacaftor 150 Mg Po Tabs $ 5,161.56 Ixabepilone 15 Mg Iv Solr $ 17,484.16 Ixabepilone 45 Mg Iv Solr $ 52,815.37 K Phos Mono-Sod Phos Di & Mono 77.5-426-65 Mg (1/2 X 155-852-130 Mg) Po Tabs $ 1.16 Ketoconazole 100 Mg (1/2 X 200 Mg) Po Tabs $ 15.93 Ketoconazole 200 Mg Po Tabs $ 31.85 Ketoconazole 200 Mg Po Tabs $ 31.85 Ketoconazole 50 Mg (1/4 X 200 Mg) Po Tabs $ 7.96 Labetalol Hcl 100 Mg Po Tabs $ 22.99 Labetalol Hcl 200 Mg Po Tabs $ 35.16 Labetalol Hcl 25 Mg (1/4 X 100 Mg) Po Tabs $ 5.75 Labetalol Hcl 50 Mg (1/2 X 100 Mg) Po Tabs $ 11.50 Lacosamide 100 Mg Po Tabs $ 174.25 Lacosamide 25 Mg (1/4 X 100 Mg) Po Tabs $ 126.01 Lacosamide 50 Mg Po Tabs $ 122.61 Lactase 1500 Unit (1/2 X 3000 Unit) Po Tabs $ 0.49 Lactase 3000 Units Po Tabs $ 0.99 Lamivudine 150 Mg Po Tabs $ 72.18 Lamivudine 75 Mg (1/2 X 150 Mg) Po Tabs $ 36.09 Lamivudine-Zidovudine 150-300 Mg Po Tabs $ 181.72 Lamotrigine 100 Mg Po Tabs $ 2.32 Lamotrigine 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 20.97 Lamotrigine 200 Mg Po Tabs $ 56.98 Lamotrigine 25 Mg Po Tabs $ 41.93 Lamotrigine 25 Mg Po Tabs $ 41.93 Lamotrigine 6.25 Mg (1/4 X 25 Mg) Po Tab $ 10.48 Lansoprazole 30 Mg Po Tbdp $ 59.50 Lansoprazole 30 Mg Po Tbdp $ 167.37 Lanthanum Carbonate 250 Mg (1/2 X 500 Mg) Po Chew $ 52.34 Lanthanum Carbonate 500 Mg Po Chew $ 145.23 Lavender Essential Oil Ud $ 54.43 Leflunomide 10 Mg Po Tabs $ 165.55 Leflunomide 20 Mg Po Tabs $ 60.48 Lenalidomide 10 Mg Po Caps $ 8,706.94 Lenalidomide 5 Mg Po Caps $ 8,706.94 Letermovir 240 Mg Po Tabs $ 2,476.66 Letermovir 480 Mg Po Tabs $ 2,476.66 Letrozole 2.5 Mg Po Tabs $ 182.60 Leucovorin Calcium 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 5.11

Page 16 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Leucovorin Calcium 100 Mg Ij Solr $ 241.92 Leucovorin Calcium 100 Mg Ij Solr $ 241.92 Leucovorin Calcium 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 68.95 Leucovorin Calcium 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 10.21 Leucovorin Calcium 200 Mg Ij Solr $ 483.84 Leucovorin Calcium 25 Mg Po Tabs $ 137.98 Leucovorin Calcium 350 Mg Ij Solr $ 229.22 Leucovorin Calcium 5 Mg Po Tabs $ 20.42 Leucovorin Calcium 50 Mg Ij Solr $ 120.96 Leuprolide Acetate (3 Month) 11.25 Mg (Ped) Im Kit $ 103,060.34 Leuprolide Acetate (3 Month) 11.25 Mg Im Kit $ 47,188.31 Leuprolide Acetate (3 Month) 22.5 Mg Im Kit $ 56,231.68 Leuprolide Acetate (4 Month) 30 Mg Im Kit $ 74,975.65 Leuprolide Acetate (6 Month) 45 Mg Im Kit $ 112,464.98 Leuprolide Acetate (6 Month) 45 Mg Subq Kit $ 29,828.74 Leuprolide Acetate 1 Mg/0.2Ml Ij Kit $ 8,981.28 Leuprolide Acetate 3.75 Mg Im Kit $ 15,729.24 Leuprolide Acetate 7.5 Mg Im Kit $ 18,743.96 Levetiracetam 125 Mg (1/2 X 250 Mg) Po Tabs $ 1.39 Levetiracetam 250 Mg Po Tabs $ 26.56 Levetiracetam 500 Mg Po Tabs $ 7.25 Levetiracetam 62.5 Mg (1/4 X 250 Mg) Po Tabs $ 6.64 Levofloxacin 125 Mg (1/2 X 250 Mg) Po Tabs $ 76.97 Levofloxacin 250 Mg Po Tabs $ 169.45 Levofloxacin 500 Mg Po Tabs $ 169.56 Levofloxacin 62.5 Mg (1/4 X 250 Mg) Po Tabs $ 74.22 Levofloxacin 750 Mg Po Tabs $ 680.31 Levofloxacin 750 Mg Po Tabs $ 248.11 Levoleucovorin Calcium 50 Mg Iv Solr $ 604.80 Levonorgestrel 13.5 Mg Iu Iud $ 9,603.72 Levonorgestrel 20 Mcg/24Hr Iu Iud $ 11,533.64 Levorphanol Tartrate 1 Mg (1/2 X 2 Mg) Po Tabs $ 6.95 Levorphanol Tartrate 2 Mg Po Tabs $ 21.58 Levothyroxine Sodium 100 Mcg Iv Solr $ 1,277.14 Levothyroxine Sodium 100 Mcg Or Tabs $ 6.16 Levothyroxine Sodium 100 Mcg/ 5 Ml Dilution Inj $ 1,277.14 Levothyroxine Sodium 112 Mcg Or Tabs $ 6.82 Levothyroxine Sodium 12.5 Mcg (1/2 X 25 Mcg) Or Tabs $ 1.99 Levothyroxine Sodium 125 Mcg Or Tabs $ 7.23 Levothyroxine Sodium 150 Mcg Or Tabs $ 7.44 Levothyroxine Sodium 175 Mcg Or Tabs $ 8.12 Levothyroxine Sodium 18.75 Mcg (1/4 X 75 Mcg) Or Tabs $ 1.24 Levothyroxine Sodium 200 Mcg Iv Solr $ 2,554.17 Levothyroxine Sodium 200 Mcg Or Tabs $ 8.13 Levothyroxine Sodium 25 Mcg Or Tabs $ 4.40 Levothyroxine Sodium 37.5 Mcg (1/2 X 75 Mcg) Or Tabs $ 2.49 Levothyroxine Sodium 44 Mcg (1/2 X 88 Mcg) Or Tabs $ 2.81 Levothyroxine Sodium 50 Mcg Or Tabs $ 5.00 Levothyroxine Sodium 56 Mcg (1/2 X 112 Mcg) Or Tabs $ 3.42 Levothyroxine Sodium 6.25 Mcg (1/4 X 25 Mcg) Or Tabs $ 0.99 Levothyroxine Sodium 62.5 Mcg (1/2 X 125 Mcg) Or Tabs $ 3.32 Levothyroxine Sodium 75 Mcg Or Tabs $ 6.01 Levothyroxine Sodium 88 Mcg Or Tabs $ 5.62 Lidocaine 4 % Ex Ptch $ 42.27 Linaclotide 72 Mcg Po Caps $ 170.89 Linagliptin 5 Mg Po Tabs $ 175.87 Linezolid 600 Mg Po Tabs $ 1,851.41 Liothyronine Sodium 12.5 Mcg (1/2 X 25 Mcg) Po Tabs $ 7.78 Liothyronine Sodium 2.5 Mcg (1/2 X 5 Mcg) Po Tabs $ 5.92 Liothyronine Sodium 25 Mcg Po Tabs $ 30.46 Liothyronine Sodium 5 Mcg Po Tabs $ 19.05

Page 17 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Lisdexamfetamine Dimesylate 60 Mg Po Caps $ 122.51 Lisinopril 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 3.31 Lisinopril 10 Mg Po Tabs $ 1.51 Lisinopril 2.5 Mg Po Tabs $ 6.41 Lisinopril 2.5 Mg Po Tabs $ 6.61 Lisinopril 20 Mg Po Tabs $ 10.73 Lisinopril 5 Mg Po Tabs $ 0.79 Lithium Carbonate 150 Mg Po Caps $ 1.90 Lithium Carbonate 225 Mg (1/2 X 450 Mg) Po Tbcr $ 2.71 Lithium Carbonate 300 Mg Po Caps $ 1.91 Lithium Carbonate Er 300 Mg Po Tbcr $ 4.69 Lithium Carbonate Er 450 Mg Po Tbcr $ 5.41 Loperamide Hcl 2 Mg Po Caps $ 5.06 Lopinavir-Ritonavir 200-50 Mg Po Tabs $ 103.23 Loratadine 10 Mg Po Tabs $ 9.32 Loratadine 5 Mg (1/2 X 10 Mg) Po Tabs $ 1.52 Loratadine-Pseudoephedrine Er 10-240 Mg Po Tb24 $ 5.44 Lorazepam 0.125 Mg (1/4 X 0.5 Mg) Po Tabs $ 0.46 Lorazepam 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 0.46 Lorazepam 0.5 Mg Po Tabs $ 0.92 Lorazepam 1 Mg Po Tabs $ 1.11 Lorazepam 2 Mg Po Tabs $ 13.31 Losartan 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 4.23 Losartan Potassium 100 Mg Po Tabs $ 31.07 Losartan Potassium 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 8.46 Losartan Potassium 25 Mg Po Tabs $ 7.02 Losartan Potassium 50 Mg Po Tabs $ 22.68 Losartan Potassium-Hctz 100-25 Mg Po Tabs $ 46.55 Losartan Potassium-Hctz 25-6.25 Mg (1/2 X 50-12.5 Mg) Po Tabs $ 12.61 Losartan Potassium-Hctz 50-12.5 Mg Po Tabs $ 25.22 Lovastatin 20 Mg Po Tabs $ 23.92 Loxapine Succinate 25 Mg Po Caps $ 19.40 Lubiprostone 24 Mcg Po Caps $ 74.81 Lubiprostone 8 Mcg Po Caps $ 43.32 Lurasidone Hcl 20 Mg (1/2 X 40 Mg) Po Tabs $ 204.22 Lurasidone Hcl 40 Mg Po Tabs $ 493.27 Mafenide Acetate 5 % Ex Pack $ 2,349.33 Magnesium Chloride 64 Mg Po Tbec $ 1.45 Maprotiline Hcl 25 Mg Po Tabs $ 11.62 Measles, Mumps & Rubella Vac Ij Solr $ 947.16 Measles-Mumps-Rubella-Varicell Subq Susr $ 2,714.79 Mechlorethamine Hcl 10 Mg Ij Solr $ 2,346.40 Meclizine Hcl 12.5 Mg Po Tabs $ 7.20 Meclizine Hcl 25 Mg Po Tabs $ 8.63 Meclizine Hcl 3.125 Mg (1/4 X 12.5 Mg) Po Tabs $ 0.83 Meclizine Hcl 6.25 Mg (1/2 X 12.5 Mg) Po Tabs $ 1.64 Medroxyprogesterone Acetate 10 Mg Po Tabs $ 4.95 Medroxyprogesterone Acetate 2.5 Mg Po Tabs $ 3.16 Medroxyprogesterone Acetate 5 Mg (1/2 X 10 Mg) Po Tab $ 2.48 Megestrol Acetate 10 Mg (1/2 X 20 Mg) Po Tabs $ 3.32 Megestrol Acetate 20 Mg Po Tabs $ 6.62 Megestrol Acetate 40 Mg Po Tabs $ 10.54 Melatonin 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 0.13 Melatonin 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 0.27 Melatonin 1 Mg Po Tabs $ 0.18 Melatonin 3 Mg Po Tabs $ 2.61 Melphalan 2 Mg Po Tabs $ 136.93 Melphalan Hcl 50 Mg Iv Solr $ 4,726.80 Memantine Hcl 10 Mg Po Tabs $ 9.62 Memantine Hcl 5 Mg Po Tabs $ 9.62 Memantine Hcl Er 14 Mg Po Cp24 $ 156.27

Page 18 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Memantine Hcl Er 21 Mg Po Cp24 $ 187.40 Memantine Hcl Er 28 Mg Po Cp24 $ 187.40 Memantine Hcl Er 7 Mg Po Cp24 $ 187.40 Meningococcal A C Y&W-135 Olig Im Solr $ 1,580.04 Menthol 3 Mg Mt Lozg $ 0.54 Menthol 9.1 Mg Mt Lozg $ 0.84 Meperidine Hcl 50 Mg Po Tabs $ 14.40 Mepolizumab 100 Mg Subq Solr $ 35,740.46 Meprobamate 200 Mg Po Tabs $ 14.11 Meprobamate 400 Mg Po Tabs $ 18.46 Mercaptopurine 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 10.28 Mercaptopurine 25 Mg (1/2 X 50 Mg) Po Tabs $ 20.66 Mercaptopurine 50 Mg Po Tabs $ 41.23 Meropenem 1 G Iv Solr $ 153.38 Meropenem 20 Mg/Ml Pediatric Injection $ 312.90 Meropenem 500 Mg Iv Solr $ 139.44 Meropenem-Sodium Chloride 1 Gm/50Ml Iv Solr $ 312.90 Meropenem-Sodium Chloride 500 Mg/50Ml Iv Solr $ 232.69 Mesalamine 1.2 G Po Tbec $ 101.90 Mesalamine 1000 Mg Pr Supp $ 468.43 Mesalamine 400 Mg Po Cpdr $ 46.92 Mesalamine Er 250 Mg Po Cpcr $ 36.72 Mesalamine Er 500 Mg Po Cpcr $ 73.45 Mesna 400 Mg Po Tabs $ 950.63 Metaxalone 200 Mg (1/4 X 800 Mg) Po Tabs $ 15.09 Metaxalone 800 Mg Po Tabs $ 60.38 Metformin Er 500 Mg Po Tb24 $ 6.85 Metformin Hcl 1000 Mg Po Tabs $ 13.83 Metformin Hcl 125 Mg (1/4 X 500 Mg) Po Tabs $ 1.76 Metformin Hcl 250 Mg (1/2 X 500 Mg) Po Tabs $ 3.54 Metformin Hcl 425 Mg (1/2 X 850 Mg) Po Tabs $ 6.05 Metformin Hcl 500 Mg Po Tabs $ 7.07 Metformin Hcl 850 Mg Po Tabs $ 12.10 Metformin Hcl Er 750 Mg Po Tb24 $ 12.07 Methadone Hcl 10 Mg Po Tabs $ 3.07 Methadone Hcl 2.5 Mg ( 1/2 X 5 Mg) Po Tabs $ 1.95 Methadone Hcl 40 Mg Po Tbso $ 3.35 Methadone Hcl 5 Mg Po Tabs $ 3.92 Methazolamide 25 Mg (1/2 X 50 Mg) Po Tabs $ 16.37 Methazolamide 50 Mg Po Tabs $ 77.23 Methimazole 10 Mg Po Tabs $ 7.74 Methimazole 10 Mg Po Tabs $ 7.74 Methimazole 2.5 Mg ( 1/2 X 5 Mg) Po Tab $ 2.24 Methimazole 5 Mg Po Tabs $ 4.48 Methocarbamol 250 Mg (1/2 X 500 Mg) Po Tabs $ 2.15 Methohexital 10 Mg/Ml Inj Dil $ 857.71 Methohexital Sodium 0.5 G Ij Solr $ 857.71 Methohexital Sodium 2.5 G Ij Solr $ 3,498.26 Methotrexate 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 31.45 Methotrexate 2.5 Mg Po Tabs $ 62.87 Methotrexate Sodium 1 G Ij Solr $ 1,002.08 Methotrexate Sodium 1 G Ij Solr $ 779.92 Methsuximide 300 Mg Po Caps $ 51.57 Methyldopa 125 Mg (1/2 X 250 Mg) Po Tabs $ 2.10 Methyldopa 250 Mg Po Tabs $ 4.19 Methyldopa 500 Mg Po Tabs $ 13.11 Methylergonovine Maleate 0.2 Mg Po Tabs $ 677.29 Methylphenidate 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 8.72 Methylphenidate Hcl 10 Mg Po Tabs $ 10.50 Methylphenidate Hcl 20 Mg Po Tabs $ 15.10 Methylphenidate Hcl 5 Mg Po Tabs $ 17.52

Page 19 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Methylphenidate Hcl Er 18 Mg Po Tbcr $ 140.15 Methylphenidate Hcl Er 27 Mg Po Tbcr $ 143.67 Methylphenidate Hcl Er 36 Mg Po Tbcr $ 103.71 Methylprednisolone 1 Mg (1/4 X 4 Mg) Po Tabs $ 3.60 Methylprednisolone 2 Mg (1/2 X 4 Mg) Po Tabs $ 7.21 Methylprednisolone 4 Mg Po Tabs $ 14.40 Methylprednisolone 500 Mg Piggyback In Acudose $ 208.66 Methylprednisolone Sodium Succ 1000 Mg Ij Solr $ 506.72 Methylprednisolone Sodium Succ 1000 Mg Ij Solr For Ards $ 506.72 Methylprednisolone Sodium Succ 125 Mg Ij Solr $ 117.18 Methylprednisolone Sodium Succ 2000 Mg Ij Solr $ 1,005.28 Methylprednisolone Sodium Succ 40 Mg Ij Solr $ 72.77 Methylprednisolone Sodium Succ 500 Mg Ij Solr $ 279.62 Metoclopramide Hcl 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 1.05 Metoclopramide Hcl 10 Mg Po Tabs $ 9.65 Metoclopramide Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 2.10 Metoclopramide Hcl 5 Mg Po Tabs $ 4.18 Metolazone 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 16.76 Metolazone 2.5 Mg Po Tabs $ 33.53 Metolazone 5 Mg Po Tabs $ 38.10 Metoprolol Succinate 12.5 Mg ( 1/2 X 25 Mg) Po Tb24 $ 5.63 Metoprolol Succinate 6.25 Mg (1/4 X 25 Mg) Po Tb24 $ 2.81 Metoprolol Succinate Er 25 Mg Po Tb24 $ 11.24 Metoprolol Tartrate 100 Mg Po Tabs $ 8.07 Metoprolol Tartrate 12.5 Mg ( 1/2 X 25 Mg) Po Tabs $ 1.41 Metoprolol Tartrate 25 Mg Po Tabs $ 2.82 Metoprolol Tartrate 50 Mg Po Tabs $ 3.51 Metoprolol Tartrate 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 0.71 Metoprolol Xl Tbcr 100 Mg Or $ 18.79 Metoprolol Xl Tbcr 50 Mg Or $ 11.24 Metronidazole 125 Mg (1/2 X 250 Mg) Po Tabs $ 2.80 Metronidazole 250 Mg Po Tabs $ 5.59 Metronidazole 500 Mg Po Tabs $ 9.27 Metronidazole 62.5 Mg (1/4 X 250 Mg) Po Tabs $ 1.40 Mexiletine Hcl 150 Mg Po Caps $ 25.56 Mexiletine Hcl 250 Mg Po Caps $ 35.26 Micafungin Sodium 100 Mg Iv Solr $ 2,607.53 Micafungin Sodium 50 Mg Iv Solr $ 1,303.76 Midodrine Hcl 10 Mg Po Tabs $ 50.18 Midodrine Hcl 2.5 Mg Po Tabs $ 12.11 Midodrine Hcl 5 Mg Po Tabs $ 9.07 Midostaurin 25 Mg Po Caps $ 1,836.18 Miglitol 25 Mg Po Tabs $ 33.21 Minocycline Hcl 100 Mg Po Caps $ 34.24 Minocycline Hcl 50 Mg Po Caps $ 17.13 Minoxidil 0.625 Mg (1/4 X 2.5 Mg) Po Tabs $ 1.48 Minoxidil 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 2.96 Minoxidil 10 Mg Po Tabs $ 17.02 Minoxidil 2.5 Mg Po Tabs $ 5.93 Mirtazapine 15 Mg Po Tabs $ 27.37 Mirtazapine 15 Mg Po Tbdp $ 26.18 Mirtazapine 3.75 Mg (1/2 X 7.5 Mg) Po Tabs $ 13.28 Mirtazapine 30 Mg Po Tbdp $ 26.97 Mirtazapine 7.5 Mg Po Tabs $ 26.54 Misoprostol 100 Mcg Po Tabs $ 8.31 Misoprostol 200 Mcg Po Tabs $ 19.35 Misoprostol 25 Mcg (1/4 X 100 Mcg) Po Tabs $ 2.08 Misoprostol 50 Mcg (1/2 X 100 Mcg) Po Tabs $ 4.15 Mitomycin 20 Mg Iv Solr $ 9,293.68 Mitomycin 5 Mg Iv Solr $ 3,577.40 Mitotane 500 Mg Po Tabs $ 58.05

Page 20 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Modafinil 100 Mg Po Tabs $ 265.88 Modafinil 200 Mg Po Tabs $ 356.69 Modafinil 50 Mg (1/2 X 100 Mg) Po Tabs $ 132.94 Montelukast Sodium 10 Mg Po Tabs $ 56.24 Montelukast Sodium 2 Mg (1/2 X 4 Mg) Po Chew $ 31.68 Montelukast Sodium 2.5 Mg (1/2 X 5 Mg) Po Chew $ 50.68 Montelukast Sodium 2.5 Mg(1/4 X 10 Mg) Po Tabs $ 17.74 Montelukast Sodium 4 Mg Po Chew $ 50.69 Montelukast Sodium 5 Mg Po Chew $ 57.02 Morphine Sulfate 10 Mg Pr Supp $ 63.00 Morphine Sulfate 15 Mg Po Tabs $ 9.16 Morphine Sulfate 30 Mg Po Tabs $ 8.89 Morphine Sulfate 5 Mg Pr Supp $ 50.40 Morphine Sulfate 7.5 (1/2 X 15 Mg) Po Tabs $ 1.66 Morphine Sulfate Er 100 Mg Po Tbcr $ 76.97 Morphine Sulfate Er 15 Mg Po Tbcr $ 13.84 Morphine Sulfate Er 30 Mg Po Tbcr $ 34.07 Morphine Sulfate Er 60 Mg Po Tbcr $ 53.67 Moxifloxacin Hcl 400 Mg Po Tabs $ 368.28 Multi-Vitamins Po Tabs $ 0.19 Mycophenolate Mofetil 250 Mg Po Caps $ 39.95 Mycophenolate Mofetil 500 Mg Po Tabs $ 79.89 Mycophenolate Mofetil Hcl 500 Mg Iv Solr $ 1,306.10 Mycophenolate Sodium 180 Mg Po Tbec $ 50.40 Mycophenolate Sodium 360 Mg Po Tbec $ 100.80 Nabumetone 250 Mg (1/2 X 500 Mg) Po Tabs $ 4.15 Nabumetone 500 Mg Po Tabs $ 8.31 Nabumetone 750 Mg Po Tabs $ 16.38 Nadolol 10 Mg ( 1/2 X 20 Mg) Po Tabs $ 17.11 Nadolol 20 Mg Po Tabs $ 62.41 Nadolol 40 Mg Po Tabs $ 72.84 Nadolol 5 Mg (1/4 X 20 Mg) Po Tabs $ 8.56 Nafcillin Sodium 1 G Ij Solr $ 207.60 Nafcillin Sodium 10 G Iv Solr $ 1,973.77 Nafcillin Sodium 2 G Ij Solr $ 402.84 Naloxegol Oxalate 12.5 Mg Po Tabs $ 143.29 Naloxegol Oxalate 25 Mg Po Tabs $ 143.29 Naloxone Hcl 4 Mg/0.1Ml Na Liqd $ 756.00 Naltrexone 380 Mg Im Susr $ 15,833.66 Naltrexone Hcl 25Mg (1/2 50Mg) Po Tabs $ 25.40 Naltrexone Hcl 50 Mg Po Tabs $ 27.58 Naproxen 125 Mg (1/2 X 250 Mg) Po Tabs $ 4.42 Naproxen 187.5 Mg (1/2 X 375 Mg) Po Tabs $ 5.36 Naproxen 250 Mg Po Tabs $ 8.83 Naproxen 375 Mg Po Tabs $ 9.95 Naproxen Sodium 275 Mg Po Tabs $ 8.53 Naratriptan Hcl 1 Mg Po Tabs $ 297.26 Naratriptan Hcl 2.5 Mg Po Tabs $ 297.26 Nefazodone Hcl 100 Mg Po Tabs $ 48.37 Nefazodone Hcl 200 Mg Po Tabs $ 50.22 Nefazodone Hcl 50 Mg Po Tabs $ 47.23 Nelfinavir Mesylate 250 Mg Po Tabs $ 48.95 Neomycin Sulfate 250 Mg (1/2 X 500 Mg) Po Tabs $ 6.88 Neomycin Sulfate 500 Mg Po Tabs $ 16.41 Nephrocaps 1 Mg Po Caps $ 6.77 Niacin 100 Mg Po Tabs $ 0.26 Niacin 50 Mg (1/2 X 100 Mg) Po Tabs $ 0.26 Niacin 50 Mg (1/2 X 100 Mg) Po Tabs $ 0.13 Niacin Er (Antihyperlipidemic) 500 Mg Po Tbcr $ 62.52 Niacin Er (Antihyperlipidemic) 750 Mg Po Tbcr $ 89.17 Nicardipine Hcl 20 Mg Po Caps $ 22.47

Page 21 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Nicardipine Hcl 30 Mg Po Caps $ 32.18 Nicotine 14 Mg/24Hr Td Pt24 $ 21.51 Nicotine 21 Mg/24Hr Td Pt24 $ 21.51 Nicotine 7 Mg/24Hr Td Pt24 $ 28.79 Nicotine Polacrilex 2 Mg Mt Gum $ 3.98 Nifedipine 10 Mg Po Caps $ 19.79 Nifedipine 10 Mg/ 0.34 Ml Cap Pediatrics $ 19.79 Nifedipine 20 Mg Po Caps $ 23.21 Nifedipine Er 30 Mg Po Tb24 $ 14.05 Nifedipine Er 60 Mg Po Tb24 $ 25.03 Nifedipine Er 90 Mg Po Tb24 $ 35.66 Nimodipine 30 Mg Po Caps $ 166.79 Nintedanib Esylate 150 Mg Po Caps $ 1,994.04 Nitazoxanide 500 Mg Po Tabs $ 1,493.86 Nitrofurantoin Macrocrystal 100 Mg Po Caps $ 34.07 Nitrofurantoin Macrocrystal 50 Mg Po Caps $ 44.53 Nitroglycerin 0.1 Mg/Hr Td Pt24 $ 18.74 Nitroglycerin 0.2 Mg/Hr Td Pt24 $ 19.17 Nitroglycerin 0.3 Mg/Hr Td Pt24 $ 67.25 Nitroglycerin 0.4 Mg Sl Subl $ 15.08 Nitroglycerin 0.4 Mg Sl Subl $ 15.08 Nitroglycerin 0.4 Mg/Hr Td Pt24 $ 21.90 Nitroglycerin 0.6 Mg Sl Subl $ 6.90 Nitroglycerin 0.6 Mg/Hr Td Pt24 $ 24.15 Nitroglycerin 0.8 Mg/Hr Td Pt24 $ 72.94 Nitrous Oxide For Inhalation Gas Peds Sedation Only $ 50.40 Norethindrone Acet-Ethinyl Est 1-20 Mg-Mcg Po Tabs $ 21.98 Norgestrel-Ethinyl Estradiol 0.3-30 Mg-Mcg Po Tabs $ 10.99 Nortriptyline Hcl 10 Mg Po Caps $ 4.45 Nortriptyline Hcl 25 Mg Po Caps $ 8.89 Nutrisource Fiber Po Pack $ 4.90 O-2 Suspensory Misc $ 85.88 O-2 Suspensory Misc $ 85.88 O-2 Suspensory Misc $ 85.88 O-2 Suspensory Misc $ 85.88 Occult Blood Vi Strp $ 5.97 Octreotide Acetate 20 Mg Im Kit $ 37,720.57 Octreotide Acetate 20 Mg Im Kit $ 51,586.32 Octreotide Acetate 30 Mg Im Kit $ 64,038.04 Octreotide Acetate 30 Mg Im Kit $ 77,246.77 Olanzapine 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 60.38 Olanzapine 10 Mg Im Solr $ 415.10 Olanzapine 10 Mg Po Tabs $ 223.05 Olanzapine 10 Mg Po Tbdp $ 211.41 Olanzapine 2.5 Mg Po Tabs $ 112.87 Olanzapine 2.5Mg (1/2 X 5Mg) Tbdp $ 181.08 Olanzapine 5 Mg Po Tabs $ 133.22 Olanzapine 5 Mg Po Tbdp $ 143.88 Olanzapine 7.5 Mg Po Tabs $ 162.12 Olmesartan Medoxomil 10 Mg (1/2 X 20 Mg) Po Tabs $ 31.67 Olmesartan Medoxomil 20 Mg Po Tabs $ 63.29 Olmesartan Medoxomil 40 Mg Po Tabs $ 123.26 Olmesartan Medoxomil 5 Mg Po Tabs $ 51.76 Omalizumab 150 Mg Subq Solr $ 13,382.51 Omega-3 Fish Oil 1000 Mg Po Caps $ 0.34 Omega-3 Fish Oil 1000 Mg Po Caps $ 0.59 Omeprazole 20 Mg Po Cpdr $ 32.10 Omni-Stat Gauze 4X4 Each $ 302.40 Omni-Stat Granules 3 Gram Pouch $ 352.80 Omni-Stat Nose Bleed Pads $ 141.12 Onabotulinumtoxina 100 Units Ij Solr $ 7,269.70

Page 22 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Onabotulinumtoxina 200 Units Ij Solr $ 14,539.39 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 2X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 3X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 4X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 5X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 6X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 7X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 1X5.5Ml & 8X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 1X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 2X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 3X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 4X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 5X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 6X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X5.5Ml & 7X8.3Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 2X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 3X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 4X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 5X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 6X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 7X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 8X8.3 Ml Iv Kit $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 8X8.3 Ml Iv Kit *No Charge* $ 15,150,000.00 Onasemnogene Abeparvovec-Xioi 9X8.3 Ml Iv Kit $ 15,150,000.00 Ondansetron 2 Mg Odt (1/2 Of 4 Mg Odt) $ 232.98 Ondansetron 4 Mg Po Tbdp $ 232.98 Ondansetron 8 Mg Po Tbdp $ 372.86 Ondansetron 8 Mg Po Tbdp $ 374.29 Ondansetron Hcl 2 Mg (1/2 X 4 Mg) Po Tabs $ 119.15 Ondansetron Hcl 4 Mg Po Tabs $ 238.19 Ondansetron Hcl 8 Mg Po Tabs $ 415.90 Ondansetron Hcl 8 Mg Po Tabs $ 415.93 Ondansetron Hcl 8 Mg Po Tabs $ 415.90 Ondansetron Hcl 8 Mg Po Tabs $ 416.02 Ondansetron Hcl 8 Mg Po Tabs $ 416.02 Oseltamivir Phosphate 30 Mg Po Caps $ 142.93 Oseltamivir Phosphate 75 Mg Po Caps $ 155.81 Oxazepam 10 Mg Po Caps $ 8.78 Oxazepam 15 Mg Po Caps $ 14.67 Oxcarbazepine 150 Mg Po Tabs $ 15.38 Oxcarbazepine 300 Mg Po Tabs $ 27.77 Oxcarbazepine 75 Mg (1/2 X 150 Mg) Po Tabs $ 7.69 Oxidized Cellulose Ex Pads $ 1,989.13 Oxidized Cellulose Ex Pads 1 X 2 $ 864.61 Oxidized Cellulose Ex Pads 2 X 4 $ 1,591.30 Oxybutynin Chloride 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 1.56 Oxybutynin Chloride 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 3.13 Oxybutynin Chloride 5 Mg Po Tabs $ 4.50 Oxybutynin Chloride 5 Mg Po Tabs $ 6.25 Oxybutynin Chloride Er 10 Mg Po Tb24 $ 33.14 Oxybutynin Chloride Er 10 Mg Po Tb24 $ 33.18 Oxybutynin Chloride Er 15 Mg Po Tb24 $ 78.88 Oxybutynin Chloride Er 5 Mg Po Tb24 $ 33.10 Oxycodone Hcl 2.5Mg (1/2 X 5 Mg) Tab $ 5.59 Oxycodone Hcl 30 Mg Po Tabs $ 36.18 Oxycodone Hcl 5 Mg Po Tabs $ 5.58 Oxycodone Hcl Er 10 Mg Po T12A $ 48.69 Oxycodone Hcl Er 15 Mg Po T12A $ 73.52 Oxycodone Hcl Er 20 Mg Po T12A $ 93.12 Oxycodone Hcl Er 40 Mg Po T12A $ 155.48 Oxycodone Hcl Er 80 Mg Po T12A $ 271.31

Page 23 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Oxycodone-Acetaminophen 2.5-162.5 Mg (1/2 X 5-325) Po Tabs $ 7.44 Oxycodone-Acetaminophen 5-325 Mg Po Tabs $ 14.88 Oxycodone-Acetaminophen 5-325 Mg Po Tabs $ 13.80 Oxygen $ 206.94 Paclitaxel Protein-Bound Part 100 Mg Iv Susr $ 21,711.90 Pain-Ease Spray For Iv Therapy $ 10.99 Palifermin (Kepivance) 5Mg/Ml Dilution $ 30,961.60 Paliperidone Er 3 Mg Po Tb24 $ 307.72 Pancrelipase (Lip-Prot-Amyl) 10440 Units Po Tabs $ 35.55 Pancrelipase (Lip-Prot-Amyl) 10500 Units Po Cpep $ 36.33 Pancrelipase (Lip-Prot-Amyl) 12000 Units Po Cpep $ 37.62 Pancrelipase (Lip-Prot-Amyl) 16800 Units Po Cpep $ 58.32 Pancrelipase (Lip-Prot-Amyl) 21000 Units Po Cpep $ 72.65 Pancrelipase (Lip-Prot-Amyl) 24000-76000 Units Po Cpep $ 74.57 Pancrelipase (Lip-Prot-Amyl) 3000-9500 Units Po Cpep $ 15.90 Pancrelipase (Lip-Prot-Amyl) 4200 Units Po Cpep $ 14.53 Pancrelipase (Lip-Prot-Amyl) 6000 Units Po Cpep $ 18.82 Pantoprazole Sodium 40 Mg Iv Solr $ 60.48 Pantoprazole Sodium 40 Mg Po Pack $ 182.23 Pantoprazole Sodium 40 Mg Po Tbec $ 53.09 Paragard Intrauterine Copper Iu Iud $ 10,698.91 Paroxetine Hcl 10 Mg Po Tabs $ 28.37 Paroxetine Hcl 20 Mg Po Tabs $ 77.75 Paroxetine Hcl 30 Mg Po Tabs $ 27.51 Paroxetine Hcl 40 Mg Po Tabs $ 23.44 Paroxetine Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 14.18 Pb-Hyoscy-Atropine-Scopolamine 16.2 Mg Po Tabs $ 104.60 Pb-Hyoscy-Atropine-Scopolamine 16.2 Mg Po Tabs $ 114.95 Peginterferon Alfa-2B 150 Mcg/0.5Ml Subq Kit $ 10,531.99 Peginterferon Alfa-2B 200 Mcg Subq Kit $ 23,953.00 Peginterferon Alfa-2B 300 Mcg Subq Kit $ 35,929.46 Peginterferon Alfa-2B 600 Mcg Subq Kit $ 71,858.91 Pembrolizumab 50 Mg Iv Solr $ 34,511.42 Pemetrexed Disodium 100 Mg Iv Solr $ 11,148.95 Pemetrexed Disodium 500 Mg Iv Solr $ 55,744.73 Pemetrexed Disodium 500 Mg Iv Solr G-Cmc $ 55,744.73 Penicillamine 250 Mg Po Tabs $ 732.84 Penicillin G Potassium 20000000 Units Ij Solr $ 612.46 Penicillin G Potassium 5000000 Units Ij Solr $ 176.51 Penicillin V Potassium 125 Mg (1/2 X 250 Mg) Po Tabs $ 12.00 Penicillin V Potassium 250 Mg Po Tabs $ 12.00 Penicillin V Potassium 500 Mg Po Tabs $ 11.76 Pentamidine Isethionate 300 Mg Ij Solr $ 2,327.12 Pentamidine Isethionate 300 Mg In Solr $ 2,018.72 Pentostatin 10 Mg Iv Solr $ 29,936.40 Pentoxifylline Er 400 Mg Po Tbcr $ 58.90 Perampanel 2 Mg Po Tabs $ 195.55 Perampanel 4 Mg Po Tabs $ 387.07 Perampanel 8 Mg Po Tabs $ 387.07 Perphenazine 1 Mg (1/2 X 2 Mg) Po Tabs $ 9.91 Perphenazine 2 Mg Po Tabs $ 11.73 Perphenazine 4 Mg Po Tabs $ 21.21 Ph Test Vi Test $ 400.98 Phenazopyridine Hcl 100 Mg Po Tabs $ 27.22 Phenazopyridine Hcl 50 Mg (1/2 X 100 Mg) Po Tabs $ 2.56 Phenobarbital 16.2 Mg Po Tabs $ 5.14 Phenobarbital 24.3 Mg (1/4 X 97.2 Mg) Po Tabs $ 1.29 Phenobarbital 32.4 Mg Po Tabs $ 6.46 Phenobarbital 4.05 Mg (1/4 X 16.2 Mg) Tab $ 0.56 Phenobarbital 48.6 Mg (1/2 X 97.2 Mg) Po Tabs $ 2.58 Phenobarbital 64.8 Mg Po Tabs $ 8.08

Page 24 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Phenobarbital 8.1 Mg (1/2 X 16.2 Mg) Po Tabs $ 1.10 Phenobarbital 97.2 Mg Po Tabs $ 12.00 Phenoxybenzamine Hcl 10 Mg Po Caps $ 1,304.81 Phentolamine Mesylate 5 Mg Ij Solr $ 5,392.70 Phenytoin 25 Mg (1/2 X 50 Mg) Po Chew $ 3.42 Phenytoin 50 Mg Po Chew $ 14.71 Phenytoin Sodium Extended 100 Mg Po Caps $ 6.47 Phenytoin Sodium Extended 30 Mg Po Caps $ 13.53 Phytonadione 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 96.82 Phytonadione 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 193.64 Phytonadione 5 Mg Po Tabs $ 710.76 Pilocarpine Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 7.68 Pilocarpine Hcl 5 Mg Po Tabs $ 18.29 Pimozide 2 Mg Po Tabs $ 28.42 Pindolol 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 5.54 Pindolol 5 Mg Po Tabs $ 13.31 Pioglitazone Hcl 15 Mg Po Tabs $ 70.63 Pioglitazone Hcl 30 Mg Po Tabs $ 87.53 Pioglitazone Hcl 45 Mg Po Tabs $ 20.76 Pioglitazone Hcl 7.5 Mg (1/2 X 15 Mg) Po Tabs $ 35.28 Piperacillin Sod-Tazobactam So 3.375 (3-0.375) G Iv Solr $ 143.64 Piperacillin Sod-Tazobactam So 3.375 (3-0.375) G Iv Solr $ 82.79 Piperacillin Sod-Tazobactam So 4.5 (4-0.5) G Iv Solr $ 191.51 Piperacillin Sod-Tazobactam So 4.5 (4-0.5) G Iv Solr $ 271.73 Piperacillin Sod-Tazobactam So 4.5 (4-0.5) G Iv Solr $ 191.51 Polatuzumab Vedotin-Piiq 140 Mg Iv Solr $ 236,340.00 Polyethylene Glycol 3350 Po Pack $ 28.05 Polymyxin B Sulfate 500000 Units Ij Solr $ 133.06 Porfimer Sodium 75 Mg Iv Solr $ 254,499.84 Posaconazole 100 Mg Po Tbec $ 828.94 Potassium & Sodium Phosphates 280-160-250 Mg Po Pack $ 6.58 Potassium Bicarbonate 25 Meq Po Tbef $ 3.05 Potassium Chloride 25 Meq Po Pack $ 144.57 Potassium Chloride Crys Er 10 Meq Po Tbcr $ 6.23 Potassium Chloride Er 10 Meq Po Cpcr $ 9.64 Potassium Chloride Er 10 Meq Po Tb Cr $ 3.93 Potassium Chloride Er 10 Meq Po Tbcr $ 9.64 Potassium Chloride Er 10 Meq Po Tbcr $ 5.70 Potassium Chloride Er 10 Meq Po Tbcr $ 5.70 Pralidoxime Chloride 1 G Iv Solr $ 1,048.72 Pramipexole Dihydrochloride 0.125 Mg Po Tabs $ 84.92 Pramipexole Dihydrochloride 0.125 Mg Po Tabs $ 29.74 Pramipexole Dihydrochloride 0.25 Mg Po Tabs $ 29.74 Pramipexole Dihydrochloride 0.5 Mg Po Tabs $ 33.69 Pramipexole Dihydrochloride 1 Mg Po Tabs $ 84.92 Pramipexole Dihydrochloride 1 Mg Po Tabs $ 29.70 Prasugrel Hcl 10 Mg Po Tabs $ 77.17 Prasugrel Hcl 5 Mg Po Tabs $ 185.07 Pravastatin Sodium 10 Mg Po Tabs $ 29.16 Pravastatin Sodium 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 7.29 Pravastatin Sodium 20 Mg Po Tabs $ 25.15 Pravastatin Sodium 20 Mg Po Tabs $ 32.77 Pravastatin Sodium 40 Mg Po Tabs $ 48.09 Pravastatin Sodium 5 Mg (1/2 X 10 Mg) Po Tabs $ 14.62 Pravastatin Sodium 80 Mg Po Tabs $ 48.32 Praziquantel 600 Mg Po Tabs $ 1,004.44 Prazosin Hcl 1 Mg Po Caps $ 18.26 Prazosin Hcl 2 Mg Po Caps $ 25.44 Prazosin Hcl 5 Mg Po Caps $ 43.42 Prednisone 0.25 Mg (1/4 X 1 Mg) Po Tabs $ 0.64 Prednisone 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 1.28

Page 25 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Prednisone 1 Mg Po Tabs $ 2.55 Prednisone 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 9.12 Prednisone 10 Mg Po Tabs $ 2.69 Prednisone 2.5 Mg Po Tabs $ 1.82 Prednisone 20 Mg Po Tabs $ 2.87 Prednisone 5 Mg Po Tabs $ 2.09 Prednisone 50 Mg Po Tabs $ 4.22 Pregabalin 100 Mg Po Caps $ 94.39 Pregabalin 200 Mg Po Caps $ 94.39 Pregabalin 25 Mg Po Caps $ 94.39 Pregabalin 50 Mg Po Caps $ 94.39 Pregabalin 75 Mg Po Caps $ 94.39 Prenatal 27-1 Mg Po Tabs $ 3.63 Prenatal Formula 27-1 Mg Po Tabs $ 3.63 Prenatal Plus 27-1 Mg Po Tabs $ 3.40 Primaquine Phosphate 26.3 Mg Po Tabs $ 20.37 Primidone 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 1.27 Primidone 125 Mg (1/2 X 250 Mg) Po Tabs $ 5.02 Primidone 250 Mg Po Tabs $ 10.04 Primidone 50 Mg Po Tabs $ 5.07 Probenecid 250 Mg (1/2 X 500 Mg) Po Tabs $ 4.96 Probenecid 500 Mg Po Tabs $ 9.91 Procarbazine Hcl 50 Mg Po Caps $ 1,184.44 Prochlorperazine 25 Mg Pr Supp $ 123.56 Prochlorperazine Maleate 10 Mg Po Tabs $ 9.80 Prochlorperazine Maleate 2.5 Mg(1/2 X 5 Mg) Tab $ 3.13 Prochlorperazine Maleate 5 Mg Po Tabs $ 10.55 Progesterone 200 Mg Va Supp $ 68.01 Progesterone Micronized 100 Mg Po Caps $ 21.17 Progesterone Micronized 200 Mg Po Caps $ 40.82 Promethazine Hcl 12.5 Mg Po Tabs $ 4.94 Promethazine Hcl 12.5 Mg Pr Supp $ 178.47 Promethazine Hcl 25 Mg Po Tabs $ 5.30 Promethazine Hcl 25 Mg Pr Supp $ 44.83 Promethazine Hcl 6.25 Mg (1/2 X 12.5 Mg) Po Tabs $ 2.47 Propafenone Hcl 150 Mg Po Tabs $ 4.40 Propafenone Hcl 75 Mg (1/2 X 150 Mg) Po Tabs $ 2.21 Propranolol Hcl 10 Mg Po Tabs $ 3.22 Propranolol Hcl 20 Mg Po Tabs $ 2.73 Propranolol Hcl 40 Mg Po Tabs $ 4.13 Propranolol Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 1.38 Propranolol Hcl 60 Mg Po Tabs $ 17.56 Propranolol Hcl 80 Mg Po Tabs $ 9.04 Propranolol Hcl Er 60 Mg Po Cp24 $ 21.98 Propranolol Hcl Er 80 Mg Po Cp24 $ 24.04 Propylthiouracil 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 1.89 Propylthiouracil 25 Mg (1/2 X 50 Mg) Po Tabs $ 3.76 Propylthiouracil 50 Mg Po Tabs $ 9.07 Prosource Po Pack $ 6.05 Pseudoephedrine Hcl 30 Mg Po Tabs $ 0.32 Pseudoephedrine Hcl 60 Mg Po Tabs $ 0.49 Pyrazinamide 250 Mg (1/2 X 500 Mg) Po Tabs $ 14.42 Pyrazinamide 500 Mg Po Tabs $ 62.04 Pyridostigmine Bromide 15 Mg (1/4 X 60 Mg) Po Tabs $ 22.97 Pyridostigmine Bromide 30 Mg (1/2 X 60 Mg) Po Tabs $ 45.95 Pyridostigmine Bromide 60 Mg Po Tabs $ 184.70 Pyridostigmine Bromide 90 Mg (1/2 X 180 Mg) Po Tbcr $ 125.03 Pyridostigmine Bromide Er 180 Mg Po Tbcr $ 250.06 Pyridoxine Hcl 25 Mg Po Tabs $ 0.19 Pyridoxine Hcl 25 Mg Po Tabs $ 0.34 Pyrimethamine 25 Mg Po Tabs $ 9,072.00

Page 26 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Quetiapine Fumarate 100 Mg Po Tabs $ 5.69 Quetiapine Fumarate 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 20.14 Quetiapine Fumarate 200 Mg Po Tabs $ 130.40 Quetiapine Fumarate 25 Mg Po Tabs $ 40.28 Quetiapine Fumarate 300 Mg Po Tabs $ 5.45 Quetiapine Fumarate 50 Mg Po Tabs $ 66.20 Quetiapine Fumarate 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 40.28 Quetiapine Fumarate Er 300 Mg Po Tb24 $ 257.40 Quetiapine Fumarate Er 50 Mg Po Tb24 $ 99.34 Quikclot Combat Gauze 3Inx4Yd Roll $ 432.03 Quikclot Control 12In X 12In Hemostat Dressing $ 2,889.53 Quikclot Control 8Inx8In Hemostat Dressing $ 1,777.71 Quikclot Control Zfold 3In X 2Yards Hemostat Dressing $ 1,599.90 Quikclot Gauze 4Inx4In Hemostat Dressing $ 201.50 Quinapril Hcl 10 Mg Po Tabs $ 12.33 Quinapril Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 6.16 Quinapril Hcl 20 Mg Po Tabs $ 12.32 Quinapril Hcl 40 Mg Po Tabs $ 12.33 Quinapril Hcl 5 Mg Po Tabs $ 12.32 Quinidine Gluconate Er 324 Mg Po Tbcr $ 91.36 Quinidine Sulfate 100 Mg (1/2 X 200 Mg) Po Tabs $ 1.02 Quinidine Sulfate 200 Mg Po Tabs $ 2.03 Quinidine Sulfate 300 Mg Po Tabs $ 3.90 Quinine Sulfate 324 Mg Po Caps $ 73.85 Quinupristin-Dalfopristin 500 Mg Iv Solr $ 5,656.85 Rabies Vaccine, Pcec Im Susr $ 4,076.35 Rabies Virus Vaccine, Hdc Im Inj $ 4,310.41 Racepinephrine Hcl 2.25 % In Nebu $ 18.14 Raloxifene Hcl 60 Mg Po Tabs $ 71.85 Raltegravir Potassium 400 Mg Po Tabs $ 317.40 Ramelteon 8 Mg Po Tabs $ 149.01 Ramipril 1.25 Mg Po Caps $ 61.12 Ramipril 2.5 Mg Po Caps $ 19.53 Ramipril 5 Mg Po Caps $ 19.10 Ranolazine Er 500 Mg Po Tb12 $ 75.47 Rasagiline Mesylate 0.5 Mg (1/2 X 1 Mg) Po Tabs $ 74.39 Rasagiline Mesylate 1 Mg Po Tabs $ 148.73 Rasburicase 1.5 Mg Iv Solr $ 10,488.78 Rasburicase 7.5 Mg Iv Solr $ 52,443.82 Remifentanil Hcl 1 Mg Iv Solr $ 741.37 Remifentanil Hcl 2 Mg Iv Solr $ 1,482.74 Remifentanil Hcl 5 Mg Iv Solr $ 3,154.82 Repaglinide 0.25 Mg (1/2 X 0.5 Mg) Po Tabs $ 3.41 Repaglinide 0.5 Mg Po Tabs $ 6.80 Repaglinide 1 Mg Po Tabs $ 36.89 Repaglinide 2 Mg Po Tabs $ 33.57 Reserpine 0.1 Mg Po Tabs $ 12.04 Reserpine 0.25 Mg Po Tabs $ 16.60 Rifabutin 150 Mg Po Caps $ 383.91 Rifampin 150 Mg Po Caps $ 32.68 Rifampin 300 Mg Po Caps $ 66.21 Rifampin 600 Mg Iv Solr $ 2,489.82 Rifaximin 200 Mg Po Tabs $ 250.50 Rifaximin 550 Mg Po Tabs $ 477.49 Riluzole 50 Mg Po Tabs $ 418.52 Risperidone 0.125 Mg (1/2 X 0.25 Mg) Po Tabs $ 19.66 Risperidone 0.25 Mg Po Tabs $ 39.24 Risperidone 0.25 Mg Po Tbdp $ 45.16 Risperidone 0.25 Mg Po Tbdp $ 45.16 Risperidone 0.5 Mg Po Tabs $ 43.06 Risperidone 0.5 Mg Po Tbdp $ 49.55

Page 27 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Risperidone 1 Mg Po Tabs $ 45.78 Risperidone 1 Mg Po Tbdp $ 55.47 Risperidone 2 Mg Po Tabs $ 230.38 Risperidone 2 Mg Po Tbdp $ 94.14 Risperidone Microspheres Er 25 Mg Im Srer $ 5,863.54 Risperidone Microspheres Er 37.5 Mg Im Srer $ 8,795.71 Risperidone Microspheres Er 50 Mg Im Srer $ 11,727.78 Ritonavir 100 Mg Po Tabs $ 103.69 Rivaroxaban 10 Mg Po Tabs $ 180.63 Rivaroxaban 15 Mg Po Tabs $ 180.63 Rivaroxaban 2.5 Mg Po Tabs $ 90.32 Rivaroxaban 20 Mg Po Tabs $ 180.63 Rivastigmine 13.3 Mg/24Hr Td Pt24 $ 276.60 Rivastigmine 4.6 Mg/24Hr Td Pt24 $ 276.60 Rivastigmine 9.5 Mg/24Hr Td Pt24 $ 276.60 Rivastigmine Tartrate 1.5 Mg Po Caps $ 42.78 Rivastigmine Tartrate 3 Mg Po Caps $ 42.78 Roflumilast 250 Mcg (1/2 X 500 Mcg) Po Tabs $ 56.65 Roflumilast 500 Mcg Po Tabs $ 145.63 Rolapitant Hcl 90 Mg Po Tabs $ 3,817.70 Romidepsin 10 Mg Iv Solr $ 46,121.10 Romiplostim 250 Mcg Subq Solr $ 22,481.42 Ropinirole Hcl 0.125 Mg (1/2 X 0.25 Mg) Po Tabs $ 20.41 Ropinirole Hcl 0.25 Mg Po Tabs $ 67.97 Ropinirole Hcl 0.5 Mg Po Tabs $ 25.22 Ropinirole Hcl 1 Mg Po Tabs $ 25.25 Ropinirole Hcl 2 Mg Po Tabs $ 25.20 Rosuvastatin Calcium 10 Mg Po Tabs $ 72.01 Rosuvastatin Calcium 2.5 Mg (1/2 X 5 Mg) Po Tab $ 36.01 Rosuvastatin Calcium 20 Mg Po Tabs $ 105.19 Rosuvastatin Calcium 40 Mg Po Tabs $ 105.19 Rosuvastatin Calcium 5 Mg Po Tabs $ 72.01 Rufinamide 100 Mg (1/2 X 200 Mg) Po Tabs $ 34.12 Rufinamide 200 Mg Po Tabs $ 145.35 Rufinamide 50 Mg (1/4 X 200 Mg) Po Tabs $ 17.07 Sacubitril-Valsartan 24-26 Mg Po Tabs $ 102.63 Sacubitril-Valsartan 49-51 Mg Po Tabs $ 102.63 Sacubitril-Valsartan 97-103 Mg Po Tabs $ 102.63 Salmeterol Xinafoate 50 Mcg/Dose In Aepb $ 98.83 Saquinavir Mesylate 200 Mg Po Caps $ 52.68 Sargramostim 250 Mcg Ij Solr $ 3,332.13 Scopolamine 1 Mg/3Days Td Pt72 $ 215.71 Secretin Acetate (Human) 16 Mcg Iv Solr $ 6,350.40 Selegiline 6 Mg/24Hr Td Pt24 $ 665.11 Selegiline Hcl 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 7.47 Selegiline Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 14.93 Selegiline Hcl 5 Mg Po Caps $ 23.20 Selegiline Hcl 5 Mg Po Tabs $ 29.86 Selenium 50 Mcg Po Tabs $ 0.47 Selexipag 200 Mcg Po Tabs $ 2,268.36 Sennosides 8.6 Mg Po Tabs $ 0.78 Sennosides-Docusate Sodium 8.6-50 Mg Po Tabs $ 0.50 Sertraline Hcl 100 Mg Po Tabs $ 27.34 Sertraline Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 2.03 Sertraline Hcl 25 Mg Po Tabs $ 28.71 Sertraline Hcl 50 Mg Po Tabs $ 27.34 Sevelamer Carbonate 800 Mg Po Tabs $ 61.44 Sevelamer Hcl 400 Mg Po Tabs $ 42.68 Sevelamer Hcl 800 Mg Po Tabs $ 85.35 Sildenafil Citrate 10 Mg ( 1/2 X 20 Mg) Po Tab $ 141.31 Sildenafil Citrate 20 Mg Po Tabs $ 576.92

Page 28 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Sildenafil Citrate 5 Mg (1/4 X 20 Mg) Po Tab $ 77.01 Silver Nitrate-Pot Nitrate 75-25 % Ex Misc $ 7.32 Simethicone 20 Mg (1/4 X 80 Mg) Po Chew $ 0.16 Simethicone 40 Mg (1/2 X 80 Mg) Po Chew $ 0.33 Simethicone 80 Mg Po Chew $ 0.64 Simvastatin 10 Mg Po Tabs $ 28.11 Simvastatin 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 1.24 Simvastatin 20 Mg Po Tabs $ 49.60 Simvastatin 40 Mg Po Tabs $ 49.42 Simvastatin 5 Mg Po Tabs $ 2.48 Simvastatin 80 Mg Po Tabs $ 49.60 Sincalide 5 Mcg Ij Solr $ 1,223.75 Sinus Rinse Kit Na Pack $ 6.65 Sirolimus 0.5 Mg Po Tabs $ 85.42 Sirolimus 1 Mg Po Tabs $ 171.83 Sitagliptin Phosphate 100 Mg Po Tabs $ 181.92 Sitagliptin Phosphate 25 Mg Po Tabs $ 181.92 Sitagliptin Phosphate 50 Mg Po Tabs $ 181.92 Sodium Bicarbonate 150 Meq In D5W 1000 Ml Infusion $ 352.67 Sodium Bicarbonate 162.5 Mg (1/2 X 325 Mg) Po Tabs $ 0.25 Sodium Bicarbonate 325 Mg Po Tabs $ 0.28 Sodium Bicarbonate 650 Mg Po Tabs $ 0.55 Sodium Chloride 1 G Po Tabs $ 0.76 Sodium Chloride 250 Mg (1/4 X 1 Gm) Po Tabs $ 0.13 Sodium Zirconium Cyclosilicate 10 G Po Pack $ 264.10 Sodium Zirconium Cyclosilicate 10 G Po Pack $ 264.10 Sodium Zirconium Cyclosilicate 10 G Po Pack $ 264.09 Sodium Zirconium Cyclosilicate 5 G Po Pack $ 264.09 Sorbsan Wound Dressing Ex Pads $ 179.65 Sotalol Hcl 10 Mg (1/8 X 80 Mg) Po Tabs $ 6.26 Sotalol Hcl 160 Mg Po Tabs $ 43.08 Sotalol Hcl 20 Mg (1/4 X 80 Mg) Po Tabs $ 12.53 Sotalol Hcl 40 Mg (1/2 X 80 Mg) Po Tabs $ 25.10 Sotalol Hcl 80 Mg Po Tabs $ 25.82 Spironolactone 100 Mg Po Tabs $ 14.89 Spironolactone 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 2.16 Spironolactone 25 Mg Po Tabs $ 5.27 Spironolactone 50 Mg Po Tabs $ 8.23 Spironolactone 6.25 Mg (1/4 X 25 Mg) Po Tabs $ 1.08 Spironolactone-Hctz 25-25 Mg Po Tabs $ 21.77 Spy-Elite Kit 1 Each $ 8,013.60 Stavudine 20 Mg Po Caps $ 85.89 Stavudine 30 Mg Po Caps $ 91.24 Stavudine 40 Mg Po Caps $ 92.93 Streptomycin Sulfate 1 G Im Solr $ 1,089.38 Streptozocin 1 G Iv Solr $ 969.13 Succimer 100 Mg Po Caps $ 99.70 Sucralfate 1 G Po Tabs $ 3.83 Sucralfate 250 Mg (1/4 X 1 Gm) Po Tabs $ 1.01 Sucralfate 500 Mg (1/2 X 1 Gm) Po Tabs $ 1.92 Sulfadiazine 500 Mg Po Tabs $ 50.87 Sulfamethoxazole-Trimethoprim 100-20 Mg (1/4 X 400-80 Mg) Po Tabs $ 1.67 Sulfamethoxazole-Trimethoprim 200-40 Mg (1/2 X 400-80 Mg) Po Tabs $ 3.36 Sulfamethoxazole-Trimethoprim 400-80 Mg Po Tabs $ 7.83 Sulfamethoxazole-Trimethoprim 800-160 Mg Po Tabs $ 2.96 Sulfasalazine 125 Mg (1/4 X 500 Mg) Po Tabs $ 0.65 Sulfasalazine 250 Mg (1/2 X 500 Mg) Po Tabs $ 1.29 Sulfasalazine 500 Mg Po Tabs $ 2.45 Sulfasalazine 500 Mg Po Tbec $ 23.85 Sumatriptan 20 Mg/Act Na Soln $ 986.10 Sumatriptan 5 Mg/Act Na Soln $ 986.10

Page 29 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Sumatriptan Succinate 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 142.38 Sumatriptan Succinate 25 Mg Po Tabs $ 284.76 Sumatriptan Succinate 50 Mg Po Tabs $ 253.41 Sunitinib Malate 12.5 Mg Po Caps $ 2,217.27 Sunitinib Malate 25 Mg Po Caps $ 4,434.54 Sunitinib Malate 50 Mg Po Caps $ 7,719.91 Surgifoam Adsorbable Gelatin Powder $ 583.83 Sweet Orange Essential Oil Ud $ 54.43 T.E.D. Knee Length 2X-Large $ 98.08 T.E.D. Knee Length 3X-Large $ 101.71 T.E.D. Knee Length/L-Long Misc $ 32.28 T.E.D. Knee Length/L-Regular Misc $ 82.20 T.E.D. Knee Length/M-Regular Misc $ 29.19 T.E.D. Knee Length/S-Regular Misc $ 32.27 T.E.D. Knee Length/Xl-Regular Misc $ 94.93 T.E.D. Thigh Belted/Xl-Long Misc $ 80.40 T.E.D. Thigh Belted/Xl-Regular Misc $ 95.76 T.E.D. Thigh Length/L-Regular Misc $ 80.39 T.E.D. Thigh Length/M-Regular Misc $ 135.63 T.E.D. Thigh Length/S-Regular Misc $ 135.63 Tacrolimus 0.5 Mg Po Caps $ 22.48 Tacrolimus 0.5 Mg Po Cp24 $ 28.49 Tacrolimus 0.75 Mg Po Tb24 $ 47.03 Tacrolimus 1 Mg Po Caps $ 44.96 Tacrolimus 1 Mg Po Cp24 $ 56.97 Tacrolimus 1 Mg Po Tb24 $ 62.72 Tacrolimus 4 Mg Po Tb24 $ 250.85 Tacrolimus 5 Mg Po Caps $ 224.76 Tacrolimus 5 Mg Po Cp24 $ 284.84 Tacrolimus For Sublingual Use 0.5 Mg Po Caps $ 22.48 Tacrolimus For Sublingual Use 1 Mg Po Caps $ 44.96 Tacrolimus For Sublingual Use 5 Mg Po Caps $ 224.76 Talc 2 G Pl Powd $ 1,209.60 Talc 2 G Pl Powd $ 1,209.60 Talc 4 G Pl Powd $ 1,693.44 Taliglucerase Alfa 200 Units Iv Solr $ 9,428.23 Tamoxifen Citrate 10 Mg Po Tabs $ 5.79 Tamoxifen Citrate 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 1.45 Tamoxifen Citrate 5 Mg (1/2 X 10 Mg) Po Tabs $ 2.89 Tamsulosin Hcl 0.4 Mg Po Caps $ 42.43 Telmisartan 20 Mg Po Tabs $ 55.65 Telmisartan 40 Mg Po Tabs $ 55.65 Telmisartan 80 Mg Po Tabs $ 55.65 Temazepam 15 Mg Po Caps $ 7.41 Temazepam 30 Mg Po Caps $ 8.40 Temazepam 7.5 Mg Po Caps $ 100.20 Temozolomide 20 Mg Po Caps $ 703.39 Temozolomide 5 Mg Po Caps $ 121.34 Tenecteplase 50 Mg Iv Kit $ 73,032.42 Tenofovir Disoproxil Fumarate 300 Mg Po Tabs $ 482.27 Terazosin Hcl 1 Mg Po Caps $ 16.18 Terazosin Hcl 5 Mg Po Caps $ 16.19 Terbinafine Hcl 250 Mg Po Tabs $ 131.27 Terbutaline Sulfate 2.5 Mg Po Tabs $ 54.86 Terbutaline Sulfate 5 Mg Po Tabs $ 66.99 Testosterone 2 Mg/24Hr Td Pt24 $ 124.17 Testosterone 4 Mg/24Hr Td Pt24 $ 248.33 Tetanus Immune Globulin 250 Unit/Ml Im Inj $ 6,409.67 Tetracycline Hcl 250 Mg Po Caps $ 79.38 Tetracycline Hcl 500 Mg Po Caps $ 158.76 Theophylline 200 Mg (1/2 X 400 Mg) Po Tb24 $ 6.85

Page 30 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Theophylline Er 100 Mg Po Cp24 $ 18.19 Theophylline Er 150 Mg (1/2 X 300 Mg) Po Tab Tb12 $ 2.09 Theophylline Er 200 Mg Po Cp24 $ 27.03 Theophylline Er 225 Mg (1/2 X 450 Mg) Po Tab Tb12 $ 4.78 Theophylline Er 300 Mg Po Tb12 $ 43.30 Theophylline Er 400 Mg Po Tb24 $ 13.69 Theophylline Er 450 Mg Po Tb12 $ 60.93 Therapeutic-M Po Tabs $ 1.08 Thiamine Hcl 100 Mg Po Tabs $ 0.51 Thioguanine 10 Mg (1/4 X 40 Mg) Po Tabs $ 76.44 Thioguanine 20 Mg (1/2 X 40 Mg) Po Tabs $ 75.96 Thioguanine 40 Mg Po Tabs $ 305.76 Thioridazine Hcl 25 Mg Po Tabs $ 8.45 Thioridazine Hcl 50 Mg Po Tabs $ 9.61 Thiotepa 15 Mg Ij Solr $ 9,374.82 Thiothixene 1 Mg Po Caps $ 11.98 Thiothixene 10 Mg Po Caps $ 51.49 Thiothixene 5 Mg Po Caps $ 24.01 Thrombin (Recomb)Spray Applicator Device $ 60.48 Thrombin (Recombinant) 5000 Units Ex Solr $ 1,040.26 Thrombin (Recombinant) 5000 Units Ex Solr $ 1,040.26 Thrombin 20000 Units Ex Solr $ 3,423.67 Thrombin 5000 Units Ex Solr $ 868.09 Thyroid 15 Mg Po Tabs $ 7.77 Thyroid 30 Mg Po Tabs $ 9.12 Thyroid 60 Mg Po Tabs $ 10.14 Thyrotropin Alfa 1.1 Mg Im Solr $ 17,986.10 Thyrotropin Alfa 1.1 Mg Im Solr $ 19,662.05 Tiagabine Hcl 12 Mg Po Tabs $ 96.28 Tiagabine Hcl 2 Mg (1/2 X 4 Mg) Po Tabs $ 33.75 Tiagabine Hcl 4 Mg Po Tabs $ 67.50 Ticagrelor 60 Mg Po Tabs $ 75.42 Ticagrelor 90 Mg Po Tabs $ 75.42 Tigecycline 50 Mg Iv Solr $ 2,182.26 Tiotropium Bromide Monohydrate 18 Mcg In Caps $ 205.77 Tisseel Duplocath Drip Applicator 921020 $ 562.87 Tisseel Duplospray Applicator 40Cm Kit 0601130Mr $ 9,538.50 Tisseel Tip Spray Dupl 40Cm 0601130 $ 953.85 Tisseel Tip Spray Kit 0600065Pr $ 5,308.53 Tisseel Tip Spray Set 0600065 $ 530.85 Tisseel Vh 4 Ml Ex Kit $ 3,098.19 Tizanidine Hcl 0.5 Mg (1/4 X 2 Mg) Po Tabs $ 5.44 Tizanidine Hcl 1 Mg (1/4 X 4 Mg) Po Tabs $ 3.69 Tizanidine Hcl 2 Mg (1/2 X 4 Mg) Po Tabs $ 7.39 Tizanidine Hcl 2 Mg Po Tabs $ 12.32 Tizanidine Hcl 4 Mg Po Tabs $ 14.77 To Go Amoxicillin 250 Mg/5Ml 150Ml $ 90.72 To Go Ofloxacin Ophth Soln $ 226.80 To Go Ondansetron Odt 4Mg #2 $ 224.28 To Go Ondansetron Odt 8Mg #2 $ 748.54 To Go Oxycodone 5 Mg Immed Release Tab/Cap $ 20.46 To Go Polytrim Ophthalmic Solution $ 135.48 To Go Tramadol 50 Mg #3 Tabs $ 24.07 Tobramycin Sulfate 1.2 G Ij Solr $ 2,116.80 Tolmetin Sodium 200 Mg Po Tabs $ 7.56 Tolterodine Tartrate 0.5 Mg (1/2 Of 1 Mg) Po Tabs $ 16.85 Tolterodine Tartrate 1 Mg Po Tabs $ 33.71 Tolterodine Tartrate 2 Mg Po Tabs $ 88.88 Tolterodine Tartrate Er 2 Mg Po Cp24 $ 121.97 Tolterodine Tartrate Er 4 Mg Po Cp24 $ 122.30 Tolvaptan 15 Mg Po Tabs $ 5,452.84

Page 31 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Tolvaptan 30 Mg Po Tabs $ 5,656.68 Topiramate 100 Mg Po Tabs $ 70.06 Topiramate 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 12.88 Topiramate 15 Mg Po Cpsp $ 24.38 Topiramate 200 Mg Po Tabs $ 82.26 Topiramate 25 Mg Po Tabs $ 25.75 Topiramate 25 Mg Tab For Qsymia Discontinuation $ 25.75 Topotecan Hcl 4 Mg Iv Solr $ 3,702.66 Topotecan Hcl 4 Mg Iv Solr $ 1,890.72 Torsemide 10 Mg Po Tabs $ 7.09 Torsemide 100 Mg Po Tabs $ 30.64 Torsemide 2.5 Mg (1/2 Of 5 Mg) Po Tabs $ 3.21 Torsemide 20 Mg Po Tabs $ 8.28 Torsemide 5 Mg Po Tabs $ 6.40 Trabectedin 1 Mg Iv Solr $ 46,905.74 Tramadol 25 Mg (1/2 X 50Mg) Po Tabs $ 0.43 Tramadol Hcl 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 0.22 Tramadol Hcl 50 Mg Po Tabs $ 0.87 Tramadol Hcl Er 100 Mg Po Tb24 $ 36.68 Tramadol Hcl Er 200 Mg Po Tb24 $ 60.65 Tranylcypromine Sulfate 10 Mg Po Tabs $ 67.86 Trastuzumab 150 Mg Iv Solr $ 18,850.61 Trastuzumab 440 Mg Iv Solr $ 55,295.25 Trazodone Hcl 100 Mg Po Tabs $ 7.90 Trazodone Hcl 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 1.10 Trazodone Hcl 25 Mg (1/2 X 50 Mg) Po Tabs $ 2.20 Trazodone Hcl 50 Mg Po Tabs $ 4.38 Tretinoin 10 Mg Po Caps $ 376.51 Triamterene-Hctz 18.75-12.5 Mg (1/4 X 75-50 Mg) Po Tabs $ 2.30 Triamterene-Hctz 37.5-25 Mg Po Tabs $ 3.96 Triamterene-Hctz 75-50 Mg Po Tabs $ 9.17 Triamterene-Hctz 75-50 Mg Po Tabs $ 9.21 Trifluoperazine Hcl 1 Mg Po Tabs $ 8.82 Trifluoperazine Hcl 10 Mg Po Tabs $ 19.17 Trifluoperazine Hcl 2 Mg Po Tabs $ 12.99 Trifluoperazine Hcl 5 Mg Po Tabs $ 16.36 Trihexyphenidyl Hcl .5 Mg (1/4 X 2 Mg) Po Tabs $ 0.46 Trihexyphenidyl Hcl 1 Mg (1/2 X 2 Mg) Po Tabs $ 0.93 Trihexyphenidyl Hcl 2 Mg Po Tabs $ 1.84 Trihexyphenidyl Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 1.84 Trihexyphenidyl Hcl 5 Mg Po Tabs $ 3.67 Trimethobenzamide Hcl 300 Mg Po Caps $ 54.90 Trimethoprim 100 Mg Po Tabs $ 6.89 Triptorelin Pamoate 11.25 Mg Im Susr $ 29,510.81 Triptorelin Pamoate 3.75 Mg Im Susr $ 9,836.97 Tucks 50 % Ex Pads $ 0.95 Ulipristal Acetate 30 Mg Po Tabs $ 432.43 Umeclidinium Bromide 62.5 Mcg/Inh In Aepb $ 122.24 Umeclidinium-Vilanterol 62.5-25 Mcg/Inh In Aepb $ 85.07 Urea 15 G Po Pack $ 42.34 Ursodiol 300 Mg Po Caps $ 74.10 Valacyclovir Hcl 1 G Po Tabs $ 127.43 Valacyclovir Hcl 250 Mg (1/2 X 500 Mg) Po Tabs $ 36.41 Valacyclovir Hcl 500 Mg Po Tabs $ 72.82 Valacyclovir Hcl 500 Mg Po Tabs $ 72.82 Valganciclovir Hcl 450 Mg Po Tabs $ 649.12 Valproic Acid 250 Mg Po Caps $ 8.32 Valsartan 10 Mg (1/4 X 40 Mg) Po Tabs $ 9.92 Valsartan 160 Mg Po Tabs $ 102.16 Valsartan 20 Mg (1/2 X 40 Mg) Po Tabs $ 19.84 Valsartan 40 Mg Po Tabs $ 79.47

Page 32 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Valsartan 80 Mg Po Tabs $ 48.87 Valsartan-Hydrochlorothiazide 160-12.5 Mg Po Tabs $ 43.13 Valsartan-Hydrochlorothiazide 40-6.25 Mg (1/2 X 80-12.5 Mg) Po Tabs $ 39.60 Valsartan-Hydrochlorothiazide 80-12.5 Mg Po Tabs $ 39.64 Vancomycin Hcl 1 G Iv Solr $ 192.33 Vancomycin Hcl 10 G Iv Solr $ 2,570.40 Vancomycin Hcl 125 Mg Po Caps $ 315.56 Vancomycin Hcl 5 G Iv Solr $ 1,108.55 Vancomycin Hcl 500 Mg Iv Solr $ 112.11 Varicella Virus Vaccine Live 1350 Pfu/0.5Ml Subq Inj $ 1,640.22 Vecuronium Bromide 10 Mg Iv Solr $ 60.48 Vecuronium Bromide 20 Mg Iv Solr $ 120.96 Vedolizumab 300 Mg Iv Solr $ 78,247.82 Venetoclax 10 Mg Po Tabs $ 117.99 Venetoclax 100 Mg Po Tabs $ 1,180.07 Venlafaxine Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 9.80 Venlafaxine Hcl 18.75 Mg (1/4 X 75 Mg) Po Tabs $ 5.50 Venlafaxine Hcl 25 Mg Po Tabs $ 19.59 Venlafaxine Hcl 37.5 Mg Po Tabs $ 20.16 Venlafaxine Hcl 50 Mg Po Tabs $ 20.77 Venlafaxine Hcl 75 Mg Po Tabs $ 22.02 Venlafaxine Hcl Er 150 Mg Po Cp24 $ 7.08 Venlafaxine Hcl Er 37.5 Mg Po Cp24 $ 41.97 Venlafaxine Hcl Er 75 Mg Po Cp24 $ 42.31 Verapamil Hcl 10 Mg (1/4 X 40 Mg) Po Tabs $ 0.70 Verapamil Hcl 120 Mg Po Tabs $ 7.56 Verapamil Hcl 20 Mg (1/2 X 40 Mg) Po Tabs $ 1.39 Verapamil Hcl 40 Mg Po Tabs $ 2.79 Verapamil Hcl 60 Mg (1/2 X 120 Mg) Po Tabs $ 3.78 Verapamil Hcl 80 Mg Po Tabs $ 5.75 Verapamil Hcl Cr 60 Mg (1/2 X 120 Mg) Po Tbcr $ 4.73 Verapamil Hcl Cr 90 Mg (1/2 X 180 Mg) Po Tbcr $ 7.26 Verapamil Hcl Er 120 Mg Po Tbcr $ 23.36 Verapamil Hcl Er 180 Mg Po Tbcr $ 14.52 Verapamil Hcl Er 240 Mg Po Tbcr $ 25.55 Verteporfin 15 Mg Iv Solr $ 20,455.65 V-Go 20 Kit $ 152.89 Vigabatrin 500 Mg Po Pack $ 1,767.44 Vigabatrin 500 Mg Po Tabs $ 1,767.44 Vincristine Sulfate Liposome 5 Mg/31Ml Iv Susp $ 237,513.17 Vitamin A 10000 Units Po Caps $ 0.37 Vitamin B-1 50 Mg Po Tabs $ 0.22 Vitamin B-12 100 Mcg Po Tabs $ 0.23 Vitamin B-12 25 Mcg (1/4 X 100 Mcg) Po Tab $ 0.13 Vitamin B-12 250 (1/2 X 500 Mcg) Po Tabs $ 0.18 Vitamin B-12 50 Mcg (1/2 X 100Mcg) Po Tabs $ 0.26 Vitamin B-12 500 Mcg Po Tabs $ 0.36 Vitamin B-2 100 Mg Po Tabs $ 0.62 Vitamin B-2 100 Mg Po Tabs $ 0.89 Vitamin B-2 25 Mg (1/4 X 100 Mg) Po Tabs $ 0.20 Vitamin B-2 50 Mg (1/2 X 100 Mg) Po Tabs $ 0.44 Vitamin B-6 100 Mg Po Tabs $ 0.33 Vitamin C 125 Mg (1/2 X 250 Mg) Po Tabs $ 0.14 Vitamin C 250 Mg Po Tabs $ 0.31 Vitamin C 500 Mg Po Tabs $ 0.47 Vitamin D2 (Ergocalciferol)50000 Unit Po Caps $ 19.88 Vitamin D3 10 Mcg (400 Unit) Po Tabs $ 0.25 Vitamin D3 25 Mcg (1000 Ut) Po Tabs $ 0.57 Vitamin E 100 Units Po Caps $ 0.32 Vitamin E 400 Units Po Caps $ 1.01 Vivonex Pediatric Po Pack $ 60.58

Page 33 of 34 Geisinger Community Medical Center Medications Published: February 1, 2020

MEDICATION CHARGE

Voriconazole 100 Mg (1/2 X 200 Mg ) Po Tabs $ 236.41 Voriconazole 200 Mg Iv Solr $ 2,080.33 Voriconazole 200 Mg Po Tabs $ 506.47 Voriconazole 50 Mg Po Tabs $ 97.94 Voriconazole 50 Mg Po Tabs $ 126.61 Warfarin Sodium 0.5 Mg (1/2 X 1Mg) Po Tabs $ 3.06 Warfarin Sodium 1 Mg Po Tabs $ 6.13 Warfarin Sodium 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 3.30 Warfarin Sodium 1.5 Mg (1/2 X 3 Mg) Po Tabs $ 3.32 Warfarin Sodium 10 Mg Po Tabs $ 10.05 Warfarin Sodium 2 Mg Po Tabs $ 6.40 Warfarin Sodium 2.5 Mg Po Tabs $ 6.59 Warfarin Sodium 3 Mg Po Tabs $ 6.62 Warfarin Sodium 3.75 Mg (1/2 X 7.5 Mg) Po Tabs $ 4.82 Warfarin Sodium 4 Mg Po Tabs $ 6.64 Warfarin Sodium 5 Mg Po Tabs $ 6.79 Warfarin Sodium 6 Mg Po Tabs $ 36.06 Warfarin Sodium 7.5 Mg Po Tabs $ 9.29 Warfarin Sodium 7.5 Mg Po Tabs $ 9.63 Xeroform Petrolatum Dressing Ex Pads 1X8 $ 25.77 Xeroform Petrolatum Dressing Ex Pads 1X8 $ 7.20 Xeroform Petrolatum Dressing Ex Pads 1X8 $ 7.20 Xeroform Petrolatum Dressing Ex Pads 5X9 $ 10.57 Yellow Fever Vaccine Ij Susr $ 1,701.40 Yellow Fever Vaccine Subq Inj $ 1,786.50 Zafirlukast 10 Mg (1/2 X 20 Mg) Po Tabs $ 10.90 Zafirlukast 20 Mg Po Tabs $ 30.15 Zanamivir 5 Mg/Blister In Aepb $ 35.68 Zileuton Er 600 Mg Po Tb12 $ 378.91 Zinc 50 Mg Po Tabs $ 0.43 Zinc Gluconate 12.5 Mg (1/4 X 50 Mg) Po Tabs $ 0.08 Zinc Gluconate 25 Mg (1/2 X 50 Mg) Po Tabs $ 0.22 Zinc Gluconate 25 Mg (1/2 X 50 Mg) Po Tabs $ 0.17 Zinc Gluconate 50 Mg Po Tabs $ 0.28 Zinc Sulfate 220 (50 Zn) Mg Po Caps $ 1.18 Ziprasidone Hcl 20 Mg Po Caps $ 85.34 Ziprasidone Hcl 40 Mg Po Caps $ 85.34 Ziprasidone Hcl 60 Mg Po Caps $ 103.55 Ziprasidone Hcl 80 Mg Po Caps $ 103.55 Ziprasidone Mesylate 20 Mg Im Solr $ 600.93 Zolpidem Tartrate 1.25 Mg (1/4 X 5 Mg) Po Tabs $ 11.69 Zolpidem Tartrate 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 23.32 Zolpidem Tartrate 5 Mg Po Tabs $ 46.57 Zonisamide 100 Mg Po Caps $ 9.11 Zonisamide 25 Mg Po Caps $ 132.98 Zoster Vac Recomb Adjuvanted 50 Mcg/0.5Ml Im Susr $ 1,744.24 Zoster Vaccine Live 19400 Unt/0.65Ml Subq Susr $ 2,572.41 Zosyn 4.5 Gm Piggyback In Acudose $ 355.92

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