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Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE ABATACEPT 250 MG IV SOLR $11,952.31 ACARBOSE 50 MG PO TABS $13.45 ACEBUTOLOL HCL 200 MG PO CAPS $11.53 ACETAMINOPHEN 120 MG PR SUPP $7.71 ACETAMINOPHEN 162.5 MG (1/2 X 325 MG) PO TABS $2.03 ACETAMINOPHEN 325 MG PO TABS $2.47 ACETAMINOPHEN 325 MG PR SUPP $8.18 ACETAMINOPHEN 650 MG PR SUPP $8.67 ACETAMINOPHEN 80 MG PO CHEW $2.66 ACETAMINOPHEN 80 MG PR SUPP $9.58 ACETATE ION INJ FOR TPN $10.00 ACETAZOLAMIDE 125 MG PO TABS $22.68 ACETAZOLAMIDE 250 MG PO TABS $41.78 ACETAZOLAMIDE 31.25 MG (1/4 X 125 MG) PO TABS $7.13 ACETAZOLAMIDE 62.5 MG (1/2 X 125 MG) PO TABS $12.32 ACETAZOLAMIDE ER 500 MG PO CP12 $42.74 ACETONE (URINE) TEST VI TABS $5.03 ACETYLCHOLINE CHLORIDE 20 MG IO SOLR $1,076.87 ACLIDINIUM BROMIDE 400 MCG/ACT IN AEPB $3,213.29 ACYCLOVIR 200 MG PO CAPS $11.19 ACYCLOVIR 400 MG PO TABS $22.59 ACYCLOVIR 800 MG PO TABS $36.82 ADALIMUMAB 40 MG/0.8ML SUBQ PSKT $27,812.32 ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR $44,448.77 ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR $71,103.38 AGALSIDASE BETA 35 MG IV SOLR $67,274.83 AGALSIDASE BETA 5 MG IV SOLR $9,621.40 ALBENDAZOLE 200 MG PO TABS $30.13 (URINE) TEST VI STRP $6.29 ALBUTEROL SULFATE 2 MG PO TABS $57.82 ALBUTEROL SULFATE ER 4 MG PO TB12 $24.09 ALDESLEUKIN 22000000 UNITS IV SOLR $58,067.98 ALENDRONATE SODIUM 70 MG PO TABS $366.69 ALGLUCOSIDASE ALFA 50 MG IV SOLR $8,960.37 ALLOPURINOL 100 MG PO TABS $5.54 ALLOPURINOL 150 MG (1/2 X 300 MG) PO TABS $5.56 ALLOPURINOL 25 MG (1/4 X 100 MG) PO TABS $2.48 ALLOPURINOL 300 MG PO TABS $9.16 ALLOPURINOL 50 MG (1/2 X 100 MG) PO TABS $3.02 ALLOPURINOL 75 MG (1/4 X 300 MG) PO TABS $3.76 ALLOPURINOL SODIUM 500 MG IV SOLR $45,512.81 ALPRAZOLAM 0.125 MG (1/2 X 0.25 MG) PO TABS $4.98 ALPRAZOLAM 0.25 MG PO TABS $7.99 ALPRAZOLAM 0.5 MG PO TABS $8.97 ALPRAZOLAM 1 MG PO TABS $10.49 ALTEPLASE 100 MG IV SOLR $100,442.19 ALTEPLASE 1MG/ML FOR NEUROSURGERY INTRAVENTRICULAR $1,759.20 ALTEPLASE 2 MG IJ SOLR $1,759.20 ALTEPLASE 2 MG INJ SOLUTION $1,759.20 ALTEPLASE 50 MG IV SOLR $50,227.39 ALTEPLASE FOR PE WITHOUT CARDIAC ARREST $100,442.19 ALTEPLASE INJ BOLUS FOR CARDIAC ARREST WITH PE $50,227.39 ALTEPLASE INJ BOLUS FOR ISCHEMIC STROKE $100,442.19 ALTEPLASE IV SOLN FOR ISCHEMIC STROKE $100,442.19 ALUM SULFATE-CA ACETATE EX PACK $12.72 ALVIMOPAN 12 MG PO CAPS $962.18 AMANTADINE HCL 100 MG PO CAPS $27.15 10 MG PO TABS $3,522.40 AMBRISENTAN 5 MG PO TABS $3,522.40

Page 1 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE AMIFOSTINE 500 MG IV SOLR $12,142.34 AMILORIDE HCL 2.5 MG (1/2 X 5 MG) PO TABS $8.08 AMILORIDE HCL 2.5 MG (1/2 X 5 MG) PO TABS $8.08 AMILORIDE HCL 5 MG PO TABS $14.22 AMINOCAPROIC ACID 125 MG (1/4 X 500 MG) PO TABS $9.88 AMINOCAPROIC ACID 250 MG (1/2 X 500 MG) PO TABS $17.81 AMINOCAPROIC ACID 500 MG PO TABS $33.67 150 MG IN D5W 100 ML IVPB $43.79 AMIODARONE HCL 100 MG PO TABS $72.61 AMIODARONE HCL 200 MG PO TABS $7.71 AMIODARONE HCL 25 MG (1/4 X 100) PO TABS $19.62 AMIODARONE HCL 50 MG (1/2 X 100 MG) PO TABS $37.28 HCL 10 MG PO TABS $4.82 AMITRIPTYLINE HCL 100 MG PO TABS $26.11 AMITRIPTYLINE HCL 12.5 MG (1/2 X 25 MG) PO TABS $3.69 AMITRIPTYLINE HCL 2.5 MG (1/4 X 10 MG) PO TABS $2.38 AMITRIPTYLINE HCL 25 MG PO TABS $5.43 AMITRIPTYLINE HCL 5 MG (1/2 X 10 MG) PO TABS $2.80 AMITRIPTYLINE HCL 50 MG PO TABS $13.04 AMITRIPTYLINE HCL 75 MG PO TABS $20.10 BESY-BENAZEPRIL HCL 10-20 MG PO CAPS $127.35 AMLODIPINE BESY-BENAZEPRIL HCL 2.5-10 MG PO CAPS $81.63 AMLODIPINE BESY-BENAZEPRIL HCL 5-10 MG PO CAPS $27.69 AMLODIPINE BESY-BENAZEPRIL HCL 5-20 MG PO CAPS $29.14 AMLODIPINE BESYLATE 0.625 MG (1/4 X 2.5 MG) PO TABS $17.10 AMLODIPINE BESYLATE 1.25 MG (1/2 X 2.5 MG) PO TABS $10.18 AMLODIPINE BESYLATE 10 MG PO TABS $23.40 AMLODIPINE BESYLATE 2.5 MG PO TABS $18.39 AMLODIPINE BESYLATE 5 MG PO TABS $17.57 AMMONIA AROMATIC IN INHA $6.94 AMOBARBITAL SODIUM 500 MG IJ SOLR $8,367.52 AMOXICILLIN 250 MG PO CAPS $4.32 AMOXICILLIN 500 MG PO CAPS $6.08 AMOXICILLIN-POT CLAVULANATE 250-125 MG PO TABS $58.23 AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS $37.95 AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS $49.99 AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24 $60.27 AMPHETAMINE-DEXTROAMPHET ER 20 MG PO CP24 $60.27 AMPHETAMINE-DEXTROAMPHET ER 25 MG PO CP24 $60.27 AMPHETAMINE-DEXTROAMPHET ER 30 MG PO CP24 $69.00 AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS $75.34 AMPHETAMINE-DEXTROAMPHETAMINE 2.5 MG (1/2 X 5 MG) PO TABS $11.74 AMPHETAMINE-DEXTROAMPHETAMINE 20 MG PO TABS $18.25 AMPHETAMINE-DEXTROAMPHETAMINE 30 MG PO TABS $21.51 AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS $21.51 AMPHOTERICIN B 50 MG IJ SOLR $512.28 AMPHOTERICIN B LIPOSOME 50 MG IV SUSR $3,262.91 AMPICILLIN SODIUM 1 G IV SOLR $191.92 AMPICILLIN SODIUM 2 G IJ SOLR $196.11 AMPICILLIN SODIUM 500 MG IJ SOLR $58.37 AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR $112.43 AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR $113.90 ANAGRELIDE HCL 0.5 MG PO CAPS $108.12 ANASTROZOLE 1 MG PO TABS $116.03 ANTIHEMOPHILIC FACTOR (RECOMB) KOGENATE FS IV KIT $30.57 ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR $9,122.70 ANTIVENIN LATRODECTUS MACTANS IJ KIT $328.71 APIXABAN 2.5 MG PO TABS $81.65 APIXABAN 2.5 MG PO TABS $81.65

Page 2 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE APIXABAN 5 MG PO TABS $81.65 APIXABAN 5 MG PO TABS $81.65 APRACLONIDINE HCL 1 % OP SOLN $318.38 125 MG PO CAPS $3,902.92 APREPITANT 40 MG PO CAPS $1,349.04 APREPITANT 80 MG PO CAPS $1,939.71 AQUACEL EXTRA HYDROFIBER EX PADS $85.77 ARIPIPRAZOLE 1 MG (1/2 X 2 MG) PO TABS $154.47 ARIPIPRAZOLE 10 MG PO TABS $306.79 ARIPIPRAZOLE 15 MG PO TABS $294.30 ARIPIPRAZOLE 2 MG PO TABS $307.32 ARIPIPRAZOLE 2.5 MG (1/2 X 5 MG) PO TABS $129.23 ARIPIPRAZOLE 3.75 MG (1/4 X 15 MG) PO TABS $65.59 ARIPIPRAZOLE 5 MG PO TABS $306.79 ARIPIPRAZOLE 7.5 MG (1/2 X 15 MG) PO TABS $129.23 ARIPIPRAZOLE ER 300 MG IM SRER $18,554.81 ARIPIPRAZOLE ER 400 MG IM SRER $24,735.55 ASPARAGINASE ERWINIA CHRYSANTH 10000 UNITS IJ SOLR $58,209.58 ASPIRIN 162.5 MG (1/2 X 325 MG) PO TABS $2.08 ASPIRIN 20 MG (1/4 X 81 MG) PO CHEW $2.18 ASPIRIN 300 MG PR SUPP $15.82 ASPIRIN 325 MG PO TABS $2.22 ASPIRIN 40.5 MG (1/2 X 81 MG) PO CHEW $2.32 ASPIRIN 600 MG PR SUPP $16.29 ASPIRIN 81 MG PO CHEW $2.85 ASPIRIN EC 325 MG PO TBEC $2.21 ASPIRIN EC 81 MG PO TBEC $2.08 ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 $101.25 ATAZANAVIR SULFATE 150 MG PO CAPS $280.26 ATENOLOL 100 MG PO TABS $16.15 ATENOLOL 12.5 MG ( 1/2 X 25 MG) PO TABS $5.75 ATENOLOL 25 MG PO TABS $8.90 ATENOLOL 50 MG PO TABS $4.31 ATENOLOL 6.25 MG (1/4 X 25 MG) PO TABS $3.85 HCL 25 MG PO CAPS $152.36 ATOMOXETINE HCL 40 MG PO CAPS $165.37 ATORVASTATIN CALCIUM 10 MG PO TABS $7.95 ATORVASTATIN CALCIUM 20 MG PO TABS $6.94 ATORVASTATIN CALCIUM 40 MG PO TABS $8.52 ATORVASTATIN CALCIUM 5 MG (1/2 X 10 MG) PO TABS $4.95 ATORVASTATIN CALCIUM 80 MG PO TABS $20.60 ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS $78.75 AZACITIDINE 10 MG/ML INJ $5,971.75 AZACITIDINE 100 MG IJ SUSR $5,971.75 AZATHIOPRINE 12.5 MG (1/4 X 50 MG) PO TABS $5.07 AZATHIOPRINE 25 MG (1/2 X 50 MG) PO TABS $8.18 AZATHIOPRINE 50 MG PO TABS $14.42 AZITHROMYCIN 125 MG (1/2 X 250 MG) PO TABS $37.14 AZITHROMYCIN 250 MG PO TABS $29.77 AZITHROMYCIN 500 MG IV SOLR $110.22 AZITHROMYCIN 500 MG PO TABS $182.45 AZTREONAM 1 G IJ SOLR $445.86 B & B A-3 ATHLETIC SUPPORTER MISC $50.93 B & B A-3 ATHLETIC SUPPORTER MISC $50.93 B & B A-3 ATHLETIC SUPPORTER MISC $50.93 B & B A-3 ATHLETIC SUPPORTER MISC $52.54 B & B A-3 ATHLETIC SUPPORTER MISC $52.54 B & B S-10 SWIMMER SUPPORTER MISC $46.46 BACITRACIN 50000 UNITS IM SOLR $158.36

Page 3 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE BACITRACIN-NEOMYCIN-POLYMYXIN 400-5-5000 EX OINT $4.59 BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM EX OINT $5.67 BACLOFEN 10 MG PO TABS $25.45 BACLOFEN 2.5 MG (1/4 X 10 MG) PO TABS $3.00 BACLOFEN 5 MG (1/2 X 10 MG) PO TABS $4.04 BASILIXIMAB 20 MG IV SOLR $40,917.10 BCG LIVE 50 MG IS SUSR $1,804.95 BCG LIVE 81 MG/VIAL IS SUSR $2,561.90 B-COMPLEX/VITAMIN C PO TABS $2.45 BELATACEPT 250 MG IV SOLR $10,810.73 BELIMUMAB 120 MG IV SOLR $5,838.90 BELIMUMAB 400 MG IV SOLR $19,433.25 BELINOSTAT 500 MG IV SOLR $27,232.87 BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG PR SUPP $320.09 BENAZEPRIL HCL 10 MG PO TABS $11.00 BENAZEPRIL HCL 2.5 MG (1/4 X 10 MG) PO TABS $4.21 BENAZEPRIL HCL 20 MG PO TABS $11.00 BENAZEPRIL HCL 5 MG (1/2 X 10 MG) PO TABS $6.48 BENDAMUSTINE HCL 100 MG IV SOLR $44,209.27 BENDAMUSTINE HCL 25 MG IV SOLR $11,070.73 BENZOCAINE 20 % MT SOLN $123.54 BENZONATATE 100 MG PO CAPS $25.75 BENZTROPINE MESYLATE 0.125 MG (1/4 X 0.5 MG) PO TABS $2.87 BENZTROPINE MESYLATE 0.25 MG (1/2 X 0.5 MG) PO TABS $3.80 BENZTROPINE MESYLATE 0.5 MG PO TABS $13.36 BENZTROPINE MESYLATE 1 MG PO TABS $6.72 BENZTROPINE MESYLATE 2 MG PO TABS $9.61 BETHANECHOL CHLORIDE 12.5 MG (1/2 X 25 MG) PO TABS $14.65 BETHANECHOL CHLORIDE 2.5 MG (1/2 X 5 MG) PO TABS $5.35 BETHANECHOL CHLORIDE 25 MG PO TABS $27.34 BETHANECHOL CHLORIDE 5 MG PO TABS $10.52 BICALUTAMIDE 50 MG PO TABS $178.46 BIOTIN 10 MG PO CAPS $5.78 BIOTIN 5 MG PO TABS $3.39 BISACODYL 10 MG PR SUPP $3.66 BISACODYL 5 MG PO TBEC $2.63 1.25 MG (1/4 X 5 MG) PO TAB $4.90 BISOPROLOL FUMARATE 10 MG PO TABS $15.29 BISOPROLOL FUMARATE 2.5 MG (1/2 X 5 MG) PO TABS $7.75 BISOPROLOL FUMARATE 5 MG PO TABS $15.29 BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS $12.81 BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MG PO TABS $12.81 BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG PO TABS $69.38 BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR $5,809.80 BLEOMYCIN SULFATE 15 UNITS IJ SOLR $537.50 BLEOMYCIN SULFATE 30 UNITS IJ SOLR $1,158.73 BLINATUMOMAB 35 MCG IV SOLR $42,321.73 BORTEZOMIB 3.5 MG IJ SOLR $23,857.95 BORTEZOMIB IV 1 MG/ML INJ $23,857.95 125 MG PO TABS $2,071.52 BOSENTAN 62.5 MG PO TABS $2,071.52 BRENTUXIMAB VEDOTIN 50 MG IV SOLR $109,676.05 BRENTUXIMAB VEDOTIN 50 MG IV SOLR (STUDY MED) $109,676.05 BROMOCRIPTINE MESYLATE 0.625 MG (1/4 X 2.5 MG) PO TABS $10.89 BROMOCRIPTINE MESYLATE 1.25 MG (1/2 X 2.5 MG) PO TABS $19.83 BROMOCRIPTINE MESYLATE 2.5 MG PO TABS $37.66 BUDESONIDE 180 MCG/ACT IN AEPB $2,621.00 BUDESONIDE 3 MG PO CPEP $181.17 BUMETANIDE 0.125 MG (1/4 X 0.5 MG) PO TABS $2.65

Page 4 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE BUMETANIDE 0.25 MG (1/2 X 0.5 MG) PO TABS $3.33 BUMETANIDE 0.5 MG PO TABS $11.43 BUMETANIDE 1 MG PO TABS $5.84 10 MCG/HR TD PTWK $1,448.37 BUPRENORPHINE 5 MCG/HR TD PTWK $968.86 BUPRENORPHINE HCL 1 MG (1/2 OF 2 MG) SL SUBL $21.64 BUPRENORPHINE HCL 150 MCG BU FILM $59.70 BUPRENORPHINE HCL 2 MG SL SUBL $41.32 BUPRENORPHINE HCL 300 MCG BU FILM $92.66 BUPRENORPHINE HCL 450 MCG BU FILM $125.20 BUPRENORPHINE HCL 600 MCG BU FILM $133.46 BUPRENORPHINE HCL 75 MCG BU FILM $59.70 BUPRENORPHINE HCL 750 MCG BU FILM $140.24 BUPRENORPHINE HCL 8 MG SL SUBL $75.56 BUPRENORPHINE HCL 900 MCG BU FILM $144.31 HCL 100 MG PO TABS $20.63 BUPROPION HCL 25 MG (1/4 X 100 MG) PO TABS $4.81 BUPROPION HCL 37.5 MG (1/2 X 75 MG) PO TABS $7.61 BUPROPION HCL 50 MG (1/2 X 100 MG) PO TABS $7.67 BUPROPION HCL 75 MG PO TABS $16.66 BUPROPION HCL ER (SR) 100 MG PO TB12 $18.01 BUPROPION HCL ER (SR) 150 MG PO TB12 $20.37 HCL 1.25 (1/4 X 5 MG) PO TABS $3.78 BUSPIRONE HCL 1.25 (1/4 X 5 MG) PO TABS $3.85 BUSPIRONE HCL 10 MG PO TABS $14.74 BUSPIRONE HCL 15 MG PO TABS $21.15 BUSPIRONE HCL 2.5 MG (1/2 X 5 MG) PO TABS $5.61 BUSPIRONE HCL 5 MG PO TABS $9.28 BUSPIRONE HCL 7.5 MG PO TABS $16.98 BUSULFAN 2 MG PO TABS $269.26 BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS $18.00 C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT $32,137.28 CABERGOLINE 0.25 MG (1/2 X 0.5 MG) PO TABS $176.27 CABERGOLINE 0.5 MG PO TABS $331.13 CAFFEINE 100 MG (1/2 X 200 MG) PO TABS $2.48 CAFFEINE 200 MG PO TABS $3.04 0.25 MCG PO CAPS $13.46 CALCITRIOL 0.5 MCG PO CAPS $20.34 CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS $9.46 CALCIUM ACETATE 667 MG PO CAPS $11.72 CALCIUM CARBONATE 1250 (500 CA) MG PO TABS $2.82 CALCIUM CARBONATE 187.5 MG (1/4 X 750 MG) PO TABS $2.09 CALCIUM CARBONATE ANTACID 375 MG (1/2 X 750 MG) PO CHEW $2.23 CALCIUM CARBONATE ANTACID 500 MG PO CHEW $2.07 CALCIUM CARBONATE ANTACID 750 MG PO CHEW $2.51 CALCIUM CARBONATE-VITAMIN D 250-100 MG-UNIT (1/2 X 500-200 MG-UNIT) PO TABS $2.42 CALCIUM CARBONATE-VITAMIN D 500-200 MG-UNIT PO TABS $2.24 CALCIUM ION INJ FOR TPN $10.00 CALMOL-4 76-10 % PR SUPP $7.66 CANAGLIFLOZIN 100 MG PO TABS $178.67 CANAGLIFLOZIN 300 MG PO TABS $178.67 CANDESARTAN CILEXETIL 16 MG PO TABS $31.01 CANDESARTAN CILEXETIL 32 MG PO TABS $41.58 CANDESARTAN CILEXETIL 8 MG PO TABS $31.01 CANGRELOR TETRASODIUM 50 MG IV SOLR $8,560.09 CAPECITABINE 150 MG PO TABS $156.67 CAPSAICIN-CLEANSING GEL 8 % EX KIT $8,013.17 CAPTOPRIL 12.5 MG PO TABS $18.27 CAPTOPRIL 25 MG PO TABS $19.67

Page 5 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE CAPTOPRIL 3.125 MG (1/4 X 12.5 MG)PO TABS $5.66 CAPTOPRIL 50 MG PO TABS $21.26 CAPTOPRIL 6.25 MG (1/2 X 12.5 MG) PO TABS $9.36 100 MG (1/2 X 200 MG) PO TABS $4.14 CARBAMAZEPINE 100 MG PO CHEW $8.22 CARBAMAZEPINE 200 MG PO TABS $12.59 CARBAMAZEPINE 25 MG (1/4 X 100 MG) PO CHEW $3.47 CARBAMAZEPINE 50 MG (1/2 X 100 MG) PO CHEW $4.99 CARBAMAZEPINE 50 MG (1/4 X 200 MG) PO TABS $2.23 CARBAMAZEPINE ER 100 MG PO CP12 $18.94 CARBAMAZEPINE ER 200 MG PO CP12 $18.94 CARBAMAZEPINE ER 300 MG PO CP12 $18.94 CARBIDOPA-LEVODOPA 10-100 MG PO TABS $13.49 CARBIDOPA-LEVODOPA 12.5-125 MG ( 1/2 X 25-250 MG) PO TABS $6.03 CARBIDOPA-LEVODOPA 12.5-50 MG (1/2 X 25-100 MG) PO TABS $7.98 CARBIDOPA-LEVODOPA 2.5-25 MG (1/4 X 10-100 MG) PO TABS $4.83 CARBIDOPA-LEVODOPA 25-100 MG PO TABS $10.24 CARBIDOPA-LEVODOPA 25-100 MG PO TABS $14.00 CARBIDOPA-LEVODOPA 25-250 MG PO TABS $10.10 CARBIDOPA-LEVODOPA 25-250 MG PO TABS $17.31 CARBIDOPA-LEVODOPA 5-50 MG (1/2 X 10-100 MG) PO TABS $7.72 CARBIDOPA-LEVODOPA 6.25-25 MG (1/4 X 25-100) PO TABS $4.83 CARBIDOPA-LEVODOPA 6.25-62.5 MG (1/4 X 25-250 MG) PO TAB $3.99 CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR $9.89 CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR $18.52 CARBOXYMETHYLCELL-GLYCERIN PF 0.5-0.9 % OP SOLN $5.63 CARFILZOMIB (KYPROLIS) 2MG/ML INJ VIAL $33,537.64 CARFILZOMIB 60 MG IV SOLR $33,537.64 CARFILZOMIB 60 MG IV SOLR (STUDY MED) $33,537.64 CARISOPRODOL 175 MG (1/2 X 350 MG) PO TABS $4.80 CARISOPRODOL 350 MG PO TABS $7.66 CARISOPRODOL 87.5 MG (1/4 X 350MG) PO TAB $3.38 CARMUSTINE 100 MG IV SOLR $57,321.36 CARMUSTINE IN POLIFEPROSAN 7.7 MG IL WAFR $43,490.56 1.5625 (1/2 X 3.125 MG) PO TABS $11.95 CARVEDILOL 12.5 MG PO TABS $22.27 CARVEDILOL 25 MG PO TABS $22.27 CARVEDILOL 3.125 MG PO TABS $21.93 CARVEDILOL 6.25 MG PO TABS $22.27 CARVEDILOL 6.25 MG PO TABS $56.70 CASPOFUNGIN ACETATE 50 MG IV SOLR $4,444.72 CASPOFUNGIN ACETATE 70 MG IV SOLR $4,615.70 CEFAZOLIN 1 GM IN NSS IVPB ADS $87.36 CEFAZOLIN 3 GM IVPB ADS $101.57 CEFAZOLIN SODIUM 1 G IJ SOLR $26.97 CEFAZOLIN SODIUM 1 G IJ SOLR $94.70 CEFAZOLIN SODIUM 10 G IJ SOLR $275.54 CEFAZOLIN SODIUM 300 G IJ SOLR $3,826.58 CEFAZOLIN SODIUM 500 MG IJ SOLR $50.86 CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR $135.24 CEFDINIR 300 MG PO CAPS $50.58 CEFEPIME HCL 1 G IJ SOLR $91.41 CEFEPIME HCL 1 G IJ SOLR $235.36 CEFEPIME HCL 2 G IJ SOLR $144.02 CEFOTAXIME SODIUM 1 G IJ SOLR $37.61 CEFOTETAN DISODIUM 1 G IJ SOLR $265.41 CEFOTETAN DISODIUM 2 G IJ SOLR $518.46 CEFOXITIN SODIUM 1 G IV SOLR $54.72 CEFOXITIN SODIUM 2 G IV SOLR $180.19

Page 6 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE CEFOXITIN SODIUM-DEXTROSE 1-4 GM-%(50ML) IV SOLR $156.19 CEFOXITIN SODIUM-DEXTROSE 2-2.2 GM-% IV SOLR $278.31 CEFOXITIN SODIUM-DEXTROSE 2-2.2 GM-%(50ML) IV SOLR $278.31 CEFPROZIL 250 MG PO TABS $43.59 CEFTAROLINE FOSAMIL 600 MG IV SOLR $2,320.06 CEFTAZIDIME 1 G IJ SOLR $127.18 CEFTAZIDIME 2 G IJ SOLR $136.26 CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR $4,322.19 CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR $1,399.25 CEFTRIAXONE SODIUM 1 G IJ SOLR $516.66 CEFTRIAXONE SODIUM 1 G IJ SOLR $516.66 CEFTRIAXONE SODIUM 2 G IJ SOLR $49.98 CEFTRIAXONE SODIUM 250 MG IJ SOLR $21.06 CEFTRIAXONE SODIUM 500 MG IJ SOLR $33.04 CEFUROXIME AXETIL 250 MG PO TABS $189.84 CELECOXIB 100 MG PO CAPS $43.47 CELECOXIB 200 MG PO CAPS $73.97 CEPHALEXIN 250 MG PO CAPS $8.55 CEPHALEXIN 500 MG PO CAPS $15.04 CEROVITE JR 30 MG (1/2 X 60 MG) PO CHEW $2.26 CEROVITE JR 60 MG PO CHEW $2.56 CERTOLIZUMAB PEGOL 2 X 200 MG SUBQ KIT $46,166.24 CERTOLIZUMAB PEGOL 2 X 200 MG/ML SUBQ KIT $46,166.24 CHILDRENS CHEWABLE VITAMINS PO CHEW $2.45 CHLORAMBUCIL 2 MG PO TABS $279.58 CHLORDIAZEPOXIDE HCL 10 MG PO CAPS $5.73 CHLORDIAZEPOXIDE HCL 25 MG PO CAPS $6.02 CHLORDIAZEPOXIDE HCL 5 MG PO CAPS $5.31 CHLOROQUINE PHOSPHATE 500 MG PO TABS $116.60 CHLOROTHIAZIDE 125 MG (1/2 X 250) PO TABS $5.24 CHLOROTHIAZIDE 250 MG PO TABS $8.53 CHLOROTHIAZIDE 62.5 MG (1/4 X 250) PO TABS $3.60 CHLOROTHIAZIDE SODIUM 500 MG IV SOLR $697.22 CHLORPHENIRAMINE MALEATE 4 MG PO TABS $2.55 HCL 10 MG PO TABS $42.84 CHLORPROMAZINE HCL 100 MG PO TABS $143.53 CHLORPROMAZINE HCL 12.5 MG (1/2 X 25 MG) PO TABS $8.88 CHLORPROMAZINE HCL 25 MG PO TABS $60.37 CHLORPROMAZINE HCL 5 MG (1/2 X 10 MG) PO TABS $7.66 CHLORPROPAMIDE 100 MG PO TABS $13.38 CHLORPROPAMIDE 125 MG (1/2 X 250 MG) PO TABS $14.03 CHLORPROPAMIDE 250 MG PO TABS $26.11 CHLORTHALIDONE 12.5 MG (1/2 X 25 MG) PO TABS $4.58 CHLORTHALIDONE 25 MG PO TABS $13.43 CHOLESTYRAMINE LIGHT 4 G PO PACK $50.57 CHORIONIC GONADOTROPIN 10000 UNITS IM SOLR $1,170.72 CILOSTAZOL 100 MG PO TABS $19.31 CILOSTAZOL 100 MG PO TABS $19.31 CILOSTAZOL 25 MG (1/2 X 50 MG) PO TABS $115.96 CILOSTAZOL 50 MG PO TABS $19.31 CINACALCET HCL 15 MG (1/2 X 30 MG) PO TABS $90.57 CINACALCET HCL 30 MG PO TABS $308.82 CINACALCET HCL 7.5 MG (1/4 X 30 MG) PO TABS $46.26 CIPROFLOXACIN HCL 125 MG (1/2 X 250 MG) PO TABS $23.80 CIPROFLOXACIN HCL 250 MG PO TABS $45.64 CIPROFLOXACIN HCL 500 MG PO TABS $60.69 CIPROFLOXACIN HCL 62.5 MG (1/4 X 250 MG) PO TABS $12.88 CIPROFLOXACIN HCL 750 MG PO TABS $74.80 HYDROBROMIDE 10 MG PO TABS $25.03

Page 7 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE CITALOPRAM HYDROBROMIDE 10 MG PO TABS $25.20 CITALOPRAM HYDROBROMIDE 20 MG PO TABS $27.54 CITALOPRAM HYDROBROMIDE 40 MG PO TABS $35.16 CITALOPRAM HYDROBROMIDE 5 MG (1/2 X 10MG) PO TABS $13.50 CLARITHROMYCIN 250 MG PO TABS $59.15 CLARITHROMYCIN 500 MG PO TABS $113.10 HCL 150 MG PO CAPS $8.90 CLOBAZAM 10 MG PO TABS $210.85 CLOBAZAM 2.5 MG (1/4 X 10MG) PO TAB $28.48 CLOBAZAM 5 MG (1/2 X 10MG) ORAL TAB $62.53 HCL 25 MG PO CAPS $108.86 CLOMIPRAMINE HCL 50 MG PO CAPS $108.86 CLONAZEPAM 0.125 MG (1/4 X 0.5 MG) PO TABS $3.73 CLONAZEPAM 0.25 MG (1/2 X 0.5 MG) PO TABS $5.52 CLONAZEPAM 0.5 MG PO TABS $9.07 CLONAZEPAM 1 MG PO TABS $9.46 CLONAZEPAM 2 MG PO TABS $13.21 CLONIDINE 0.1 MG/24HR TD PTWK $316.95 CLONIDINE 0.2 MG/24HR TD PTWK $532.28 CLONIDINE 0.3 MG/24HR TD PTWK $737.64 CLONIDINE HCL 0.025 MG (1/4 X 0.1 MG) PO TABS $2.51 CLONIDINE HCL 0.05 MG (1/2 X 0.1 MG) PO TABS $3.07 CLONIDINE HCL 0.1 MG PO TABS $4.19 CLONIDINE HCL 0.2 MG PO TABS $5.03 CLOPIDOGREL BISULFATE 18.75 MG (1/4 X 75 MG) PO TABS $2.93 CLOPIDOGREL BISULFATE 37.5 MG (1/2 X 75 MG) PO TABS $3.91 CLOPIDOGREL BISULFATE 75 MG PO TABS $5.87 CLORAZEPATE DIPOTASSIUM 1.875 MG (1/2 X 3.75 MG) PO TABS $8.07 CLORAZEPATE DIPOTASSIUM 15 MG PO TABS $46.41 CLORAZEPATE DIPOTASSIUM 3.75 MG PO TABS $14.17 CLORAZEPATE DIPOTASSIUM 7.5 MG PO TABS $29.00 10 MG MT TROC $17.24 CLOZAPINE 100 MG PO TABS $34.55 CLOZAPINE 12.5 MG (1/2 X 25 MG) PO TABS $8.25 CLOZAPINE 25 MG PO TABS $14.53 CLOZAPINE 25 MG PO TBDP $30.46 COENZYME Q-10 100 MG PO CAPS $6.61 COENZYME Q-10 100 MG PO CAPS $9.99 COENZYME Q10 200 MG PO CAPS $9.16 COENZYME Q10 30 MG PO CAPS $4.36 COLCHICINE 0.3 MG (1/2 X 0.6 MG) PO TABS $29.90 COLCHICINE 0.6 MG PO TABS $66.01 COLESEVELAM HCL 625 MG PO TABS $41.55 COLISTIMETHATE 75 MG/ML ORAL SOLN $332.04 COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR $331.94 COLLAGENASE CLOSTRID HISTOLYT 0.9 MG IJ SOLR $47,060.28 CONSULT PHARMACY MED BRIEF $23.05 CONSULT PHARMACY MED COMPREHENSIVE $92.20 CONSULT PHARMACY MED INTERMEDIATE $46.10 COPPER GLUCONATE 2 MG PO CAPS $2.89 CORTICORELIN OVINE TRIFLUTATE 100 MCG IV SOLR $10,109.65 ACETATE 12.5 MG (1/2 X 25 MG) PO TABS $16.82 CORTISONE ACETATE 25 MG PO TABS $31.67 COSYNTROPIN 0.25 MG IJ SOLR $1,228.79 CROTALIDAE POLYVAL IMMUNE FAB IV SOLR $36,508.08 CULTURELLE PO CAPS $7.71 CYCLOBENZAPRINE HCL 10 MG PO TABS $11.17 CYCLOBENZAPRINE HCL 2.5 MG (1/2 X 5 MG) PO TABS $9.76 CYCLOBENZAPRINE HCL 5 MG PO TABS $17.56

Page 8 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE 2 G IJ SOLR $20,444.88 CYCLOPHOSPHAMIDE 2 G IJ SOLR $21,806.17 CYCLOPHOSPHAMIDE 25 MG PO CAPS $90.98 CYCLOPHOSPHAMIDE 50 MG PO CAPS $165.34 CYCLOPHOSPHAMIDE 500 MG IJ SOLR $5,129.60 CYCLOPHOSPHAMIDE 500 MG IJ SOLR $5,469.96 CYCLOSPORINE 0.05 % OP EMUL $98.82 CYCLOSPORINE 25 MG PO CAPS $42.20 CYCLOSPORINE MODIFIED 100 MG PO CAPS $54.22 CYCLOSPORINE MODIFIED 25 MG PO CAPS $15.03 CYPROHEPTADINE HCL 1 MG (1/4 X 4 MG) PO TABS $5.92 CYPROHEPTADINE HCL 2 MG (1/2 X 4 MG) PO TABS $9.89 CYPROHEPTADINE HCL 4 MG PO TABS $12.10 DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS $78.13 DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS $78.13 DACARBAZINE 100 MG IV SOLR $165.05 DACARBAZINE 200 MG IV SOLR $202.97 DACTINOMYCIN 0.5 MG IV SOLR $25,143.42 DANAZOL 100 MG PO CAPS $53.71 DANAZOL 200 MG PO CAPS $88.20 DANTROLENE 0.33 MG/ML IN STERILE WATER INJ DIL $1,024.06 DANTROLENE SODIUM 20 MG IV SOLR $811.34 DANTROLENE SODIUM 25 MG PO CAPS $14.16 DANTROLENE SODIUM 250 MG IV SUSR $27,306.20 DAPSONE 100 MG PO TABS $33.90 DAPSONE 25 MG PO TABS $27.99 DAPTOMYCIN 500 MG IV SOLR $5,871.61 DAPTOMYCIN 500 MG IV SOLR (PIGGYBACK COMPONENT) $5,085.90 DARUNAVIR ETHANOLATE 600 MG PO TABS $302.59 DARUNAVIR ETHANOLATE 800 MG PO TABS $603.23 DASATINIB 140 MG PO TABS $4,913.70 DECITABINE 50 MG INJ STUDY MED $14,149.15 DECITABINE 50 MG IV SOLR $14,149.15 DEFEROXAMINE MESYLATE (213 MG/ML) IM DILUTION $119.90 DEFEROXAMINE MESYLATE 500 MG IJ SOLR $119.90 DEGARELIX ACETATE 80 MG SUBQ SOLR $5,586.69 DEKAS PLUS PO CAPS $7.37 DEKAS PLUS PO CHEW $7.23 DEMECLOCYCLINE HCL 150 MG PO TABS $103.06 DESMOPRESSIN ACETATE 0.025 MG (1/4 X 0.1 MG) PO TABS $9.13 DESMOPRESSIN ACETATE 0.05 MG (1/2 X 0.1 MG) PO TABS $16.31 DESMOPRESSIN ACETATE 0.1 MG PO TABS $52.22 DESMOPRESSIN ACETATE 0.2 MG PO TABS $74.37 0.125 MG (1/4 X .5 MG) PO TAB $2.45 DEXAMETHASONE 0.1875 MG (1/4 X 0.75 MG) PO TABS $2.83 DEXAMETHASONE 0.25 MG (1/2 X 0.5 MG) PO TABS $2.94 DEXAMETHASONE 0.375 MG (1/2 X 0.75 MG) PO TABS $3.70 DEXAMETHASONE 0.5 MG PO TABS $3.26 DEXAMETHASONE 0.75 MG PO TABS $4.48 DEXAMETHASONE 1.5 MG PO TABS $6.49 DEXAMETHASONE 2 MG PO TABS $9.01 DEXAMETHASONE 4 MG PO TABS $13.26 DEXAMETHASONE 6 MG PO TABS $18.92 DEXMETHYLPHENIDATE HCL 2.5 MG (1/2 X 5 MG) PO TABS $7.10 DEXMETHYLPHENIDATE HCL 5 MG PO TABS $12.24 DEXRAZOXANE 250 MG IV SOLR $2,692.99 DEXRAZOXANE 250 MG IV SOLR $3,142.34 DEXRAZOXANE 500 MG IV SOLR $5,373.48 DEXRAZOXANE 500 MG IV SOLR $6,272.08

Page 9 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE DEXTROAMPHETAMINE SULFATE 5 MG PO TABS $29.53 DIAZEPAM 0.5 MG (1/4 X 2 MG) PO TABS $2.26 DIAZEPAM 1 MG (1/2 X 2 MG) PO TABS $2.55 DIAZEPAM 10 MG PO TABS $5.99 DIAZEPAM 2 MG PO TABS $3.15 DIAZEPAM 2.5 MG (1/2 X 5 MG) PO TABS $3.00 DIAZEPAM 5 MG PO TABS $4.04 DICLOFENAC SODIUM 25 MG PO TBEC $15.47 DICLOFENAC SODIUM 50 MG PO TBEC $10.95 DICLOFENAC SODIUM 75 MG PO TBEC $18.82 SODIUM 250 MG PO CAPS $8.24 DICYCLOMINE HCL 10 MG PO CAPS $7.12 DICYCLOMINE HCL 20 MG PO TABS $5.33 DIFLUNISAL 500 MG PO TABS $21.11 DIGOXIN 0.0625 MG (1/2 X 0.125 MG) PO TABS $8.71 DIGOXIN 125 MCG PO TABS $15.47 DIGOXIN 250 MCG PO TABS $9.18 DIGOXIN IMMUNE FAB 40 MG IV SOLR $40,525.10 DILTIAZEM DRIP KIT $201.19 DILTIAZEM HCL 15 MG (1/2 X 30 MG) PO TABS $4.09 DILTIAZEM HCL 30 MG PO TABS $4.84 DILTIAZEM HCL 45 MG (1/2 X 90 MG) PO TABS $6.03 DILTIAZEM HCL 60 MG PO TABS $16.85 DILTIAZEM HCL 7.5 MG (1/4 X 30 MG) PO TABS $3.03 DILTIAZEM HCL 90 MG PO TABS $10.10 DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 $10.78 DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 $19.13 DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24 $7.72 DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24 $26.99 DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24 $27.44 DIMENHYDRINATE 25 MG (1/2 X 50 MG) PO TAB $2.12 DIMENHYDRINATE 50 MG PO TABS $2.30 DINOPROSTONE 10 MG VA INST $4,281.07 DINOPROSTONE 20 MG VA SUPP $25,201.59 DIPHENHYDRAMINE HCL 25 MG PO CAPS $2.74 DIPHENHYDRAMINE HCL 25 MG PO TABS $3.87 DIPHENOXYLATE-ATROPINE 1.25-0.0125 (1/2 X 2.5-0.025) MG PO TABS $5.28 DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS $10.27 DIPYRIDAMOLE 25 MG PO TABS $16.60 DIPYRIDAMOLE 50 MG PO TABS $8.20 DIPYRIDAMOLE 75 MG PO TABS $9.77 DISOPYRAMIDE PHOSPHATE 100 MG PO CAPS $29.12 DISOPYRAMIDE PHOSPHATE 150 MG PO CAPS $34.06 DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12 $47.71 DISOPYRAMIDE PHOSPHATE ER 150 MG PO CP12 $56.03 DIVALPROEX SODIUM 125 MG PO CSDR $22.46 DIVALPROEX SODIUM 125 MG PO TBEC $10.39 DIVALPROEX SODIUM 250 MG PO TBEC $18.71 DIVALPROEX SODIUM 500 MG PO TBEC $36.20 DIVALPROEX SODIUM 62.5 MG (1/2 X 125MG) PO PACKET $8.92 DIVALPROEX SODIUM ER 250 MG PO TB24 $25.30 DIVALPROEX SODIUM ER 500 MG PO TB24 $65.63 SODIUM 100 MG PO CAPS $2.37 DOCUSATE SODIUM 50 MG PO CAPS $4.75 DOFETILIDE 125 MCG PO CAPS $120.56 DOFETILIDE 250 MCG PO CAPS $120.56 DOFETILIDE 500 MCG PO CAPS $120.56 DONEPEZIL HCL 10 MG PO TABS $62.53 DONEPEZIL HCL 10 MG PO TBDP $84.32

Page 10 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE DONEPEZIL HCL 2.5 MG (1/2 X 5 MG) PO TABS $41.60 DONEPEZIL HCL 5 MG PO TABS $75.97 DOXAZOSIN MESYLATE 0.5 MG (1/2 X 1 MG) PO TABS $8.37 DOXAZOSIN MESYLATE 1 MG PO TABS $37.76 DOXAZOSIN MESYLATE 2 MG PO TABS $10.74 DOXAZOSIN MESYLATE 4 MG PO TABS $57.73 HCL 10 MG PO CAPS $7.89 DOXEPIN HCL 100 MG PO CAPS $20.94 DOXEPIN HCL 25 MG PO CAPS $9.97 DOXEPIN HCL 50 MG PO CAPS $13.06 DOXORUBICIN HCL 50 MG IV SOLR $3,649.62 DOXYCYCLINE FOR SCLEROTHERAPY $288.21 DOXYCYCLINE HYCLATE 100 MG IV SOLR $288.21 DOXYCYCLINE HYCLATE 100 MG PO TABS $54.56 DOXYCYCLINE HYCLATE 25 MG (1/4 X 100 MG) PO TABS $15.10 DOXYCYCLINE HYCLATE 50 MG (1/2 X 100 MG) PO TABS $28.26 DOXYLAMINE SUCCINATE (SLEEP) 12.5 MG (1/2 X 25 MG) PO TABS $3.04 DOXYLAMINE SUCCINATE (SLEEP) 25 MG PO TABS $4.12 2.5 MG PO CAPS $126.55 DRONABINOL 5 MG PO CAPS $118.58 DRONEDARONE HCL 200 MG (1/2 X 400 MG) PO TABS $83.30 DRONEDARONE HCL 400 MG PO TABS $121.90 DRONEDARONE HCL 400 MG PO TABS $121.90 DTAP-IPV-HIB VACCINE IM SUSR $1,061.93 HCL 20 MG PO CPEP $19.07 DULOXETINE HCL 30 MG PO CPEP $58.30 DULOXETINE HCL 60 MG PO CPEP $58.30 DUODERM CGF DRESSING EX MISC $107.26 DUTASTERIDE 0.5 MG PO CAPS $59.50 200 MG PO CAPS $126.29 EFAVIRENZ 600 MG PO TABS $374.98 EFAVIRENZ-EMTRICITAB-TENOFOVIR 600-200-300 MG PO TABS $1,038.19 ELOTUZUMAB 400 MG IV SOLR $36,840.07 EMPAGLIFLOZIN 10 MG PO TABS $178.82 EMPAGLIFLOZIN 25 MG PO TABS $178.82 EMTRICITABINE 200 MG PO CAPS $250.14 EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS $631.80 ENALAPRIL MALEATE 1.25 MG (1/2 X 2.5 MG) PO TABS $6.40 ENALAPRIL MALEATE 10 MG PO TABS $20.44 ENALAPRIL MALEATE 2.5 MG PO TABS $15.81 ENALAPRIL MALEATE 5 MG PO TABS $13.71 ENTACAPONE 100 MG (1/2 X 200 MG) PO TABS $23.54 ENTACAPONE 200 MG PO TABS $45.12 EPINEPHRINE 0.15 MG/0.15ML IJ SOAJ $27,971.90 EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ $1,785.08 EPIPEN 2-PAK 0.3 MG/0.3ML IJ SOAJ $3,485.22 EPIPEN JR 2-PAK 0.15 MG/0.3ML IJ SOAJ $3,474.67 EPIRUBICIN HCL 50 MG IV SOLR $597.59 EPLERENONE 25 MG (1/2 X 50 MG) PO TABS $21.73 EPLERENONE 25 MG (1/2 X 50 MG) PO TABS $21.76 EPLERENONE 50 MG PO TABS $41.57 EPLERENONE 50 MG PO TABS $132.06 EPOPROSTENOL SODIUM 1.5 MG IV SOLR $547.06 ERTAPENEM SODIUM 1 G IJ SOLR $1,552.21 ERTAPENEM SODIUM 1 G IJ SOLR $1,704.64 ERTAPENEM SODIUM 1 G IV SOLR $1,789.07 LACTOBIONATE 500 MG IV SOLR $991.05 ERYTHROMYCIN STEARATE 125 MG (1/2 X 250 MG) PO TABS $64.37 ERYTHROMYCIN STEARATE 250 MG PO TABS $126.78

Page 11 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE OXALATE 10 MG PO TABS $43.03 ESCITALOPRAM OXALATE 2.5 MG (1/2 X 5 MG) PO TAB $21.63 ESCITALOPRAM OXALATE 20 MG PO TABS $51.21 ESCITALOPRAM OXALATE 5 MG PO TABS $41.30 ESLICARBAZEPINE ACETATE 400 MG PO TABS $351.04 ESOMEPRAZOLE SODIUM 40 MG IV SOLR $410.78 0.05 MG/24HR TD PTWK $360.10 ESTRADIOL 0.1 MG/24HR TD PTWK $360.10 ESTRADIOL 0.25 MG (1/4 X 1 MG) PO TABS $2.85 ESTRADIOL 0.5 MG (1/2 X 1 MG) PO TABS $3.76 ESTRADIOL 1 MG PO TABS $5.56 CONJUGATED 0.15 MG (1/2 X 0.3 MG) PO TABS $19.22 ESTROGENS CONJUGATED 0.3 MG PO TABS $63.06 ESTROGENS CONJUGATED 0.45 MG PO TABS $63.06 ESTROGENS CONJUGATED 0.625 MG PO TABS $63.06 ESTROGENS CONJUGATED 0.9 MG PO TABS $63.06 ESTROGENS CONJUGATED 1.25 MG PO TABS $63.06 ESTROGENS CONJUGATED 25 MG IJ SOLR $3,399.58 ESZOPICLONE 3 MG PO TABS $180.89 ETHACRYNATE SODIUM 50 MG IV SOLR $43,378.10 ETHACRYNIC ACID 25 MG PO TABS $280.90 ETHAMBUTOL HCL 100 MG PO TABS $7.58 ETHAMBUTOL HCL 400 MG PO TABS $10.85 ETHOSUXIMIDE 250 MG PO CAPS $23.17 ETIDRONATE DISODIUM 100 MG (1/2 X 200 MG) PO TABS $22.54 ETIDRONATE DISODIUM 200 MG PO TABS $43.04 ETIDRONATE DISODIUM 400 MG PO TABS $84.12 ETODOLAC 200 MG PO CAPS $15.62 ETONOGESTREL 68 MG SUBQ IMPL $9,678.19 ETOPOSIDE 50 MG PO CAPS $957.12 ETOPOSIDE PHOSPHATE 100 MG IV SOLR $2,120.07 ETRAVIRINE 100 MG PO TABS $122.64 EVEROLIMUS 0.25 MG PO TABS $98.40 EVEROLIMUS 0.5 MG PO TABS $194.85 EVEROLIMUS 0.75 MG PO TABS $291.30 EZETIMIBE 10 MG PO TABS $133.19 EZETIMIBE 5 MG (1/2 X 10 MG) PO TABS $51.40 FAMCICLOVIR 250 MG (1/2 X 500 MG) PO TABS $62.31 FAMCICLOVIR 500 MG PO TABS $122.66 FAMOTIDINE 10 MG PO TABS $4.80 FAMOTIDINE 20 MG PO TABS $18.50 FAMOTIDINE 40 MG PO TABS $46.48 FAMOTIDINE 5 MG (1/4 X 20 MG) PO TABS $6.09 FEBUXOSTAT 40 MG PO TABS $123.84 FEBUXOSTAT 80 MG PO TABS $123.84 FELBAMATE 100 MG (1/4 X 400 MG) PO TABS $14.49 FELBAMATE 150 MG (1/4 X 600 MG) PO TABS $16.17 FELBAMATE 200 MG (1/2 X 400 MG) PO TABS $27.01 FELBAMATE 300 MG (1/2 X 600 MG) PO TABS $30.40 FELBAMATE 400 MG PO TABS $51.59 FELBAMATE 600 MG PO TABS $58.85 ER 10 MG PO TB24 $27.77 FELODIPINE ER 2.5 MG PO TB24 $16.32 FELODIPINE ER 5 MG PO TB24 $16.32 FENOFIBRATE 160 MG PO TABS $69.75 FENOFIBRATE 54 MG PO TABS $9.48 FENOFIBRATE 80 MG (1/2 X 160 MG) PO TABS $35.85 100 MCG/HR TD PT72 $509.92 FENTANYL 12 (12.5) MCG/HR TD PT72 $195.02

Page 12 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE FENTANYL 25 MCG/HR TD PT72 $204.19 FENTANYL 50 MCG/HR TD PT72 $252.86 FENTANYL 75 MCG/HR TD PT72 $444.09 FENTANYL CITRATE 100 MCG BU TABS $563.33 FENTANYL CITRATE 200 MCG BU LPOP $180.78 FENTANYL CITRATE 200 MCG BU TABS $711.24 FENTANYL CITRATE 600 MCG BU LPOP $279.45 FENTANYL CITRATE 800 MCG BU LPOP $330.75 FERROUS SULFATE 162.5 (32.5 FE) MG (1/2 X 325 MG) PO TABS $2.27 FERROUS SULFATE 325 (65 FE) MG PO TABS $2.59 FIBRIN SEALANT PATCH 2X4 (EVARREST) $11,413.95 FIDAXOMICIN 200 MG PO TABS $2,102.67 FINASTERIDE 2.5 MG (1/2 X 5 MG) PO TABS $17.79 FINASTERIDE 5 MG PO TABS $33.63 FLECAINIDE ACETATE 100 MG PO TABS $40.13 FLECAINIDE ACETATE 12.5 (1/4 X 50 MG) PO TABS $6.75 FLECAINIDE ACETATE 25 MG (1/2 X 50 MG) PO TABS $11.56 FLECAINIDE ACETATE 50 MG PO TABS $21.16 FLOSEAL APPLICATOR TIPS $182.17 FLOSEAL APPLICATOR TIPS $598.32 FLOSEAL APPLICATOR TIPS $809.06 FLOXURIDINE 0.5 G IJ SOLR $1,793.84 FLUCONAZOLE 100 MG PO TABS $85.67 FLUCONAZOLE 200 MG PO TABS $157.39 FLUCONAZOLE 25 MG (1/2 X 50 MG) PO TABS $28.48 FLUCONAZOLE 50 MG PO TABS $55.23 FLUCYTOSINE 250 MG PO CAPS $222.20 FLUCYTOSINE 500 MG PO CAPS $1,698.85 FLUDARABINE PHOSPHATE 50 MG IV SOLR $1,429.58 FLUDROCORTISONE ACETATE 0.025 MG (1/4 X 0.1 MG) PO TABS $3.73 FLUDROCORTISONE ACETATE 0.05 MG (1/2 X 0.1 MG) PO TABS $5.51 FLUDROCORTISONE ACETATE 0.1 MG PO TABS $9.06 FLUOCINOLONE ACETONIDE 0.19 MG INTRAVITREAL IMPL $100,427.55 FLUORESCEIN SODIUM 0.6 MG OP STRP $3.38 FLUORESCEIN SODIUM 1 MG OP STRP $3.74 HCL 10 MG PO CAPS $26.66 FLUOXETINE HCL 20 MG PO CAPS $25.57 FLUOXYMESTERONE 10 MG PO TABS $56.90 FLUPHENAZINE HCL 1 MG PO TABS $7.94 FLUPHENAZINE HCL 2.5 MG PO TABS $9.16 FLUPHENAZINE HCL 5 MG PO TABS $14.79 FLUTICASONE FUROATE 100 MCG/ACT IN AEPB $66.05 FLUTICASONE FUROATE 100 MCG/ACT IN AEPB $66.05 FLUTICASONE FUROATE 200 MCG/ACT IN AEPB $87.77 FLUTICASONE FUROATE 200 MCG/ACT IN AEPB $87.77 FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/INH IN AEPB $46.08 FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/INH IN AEPB $55.50 FLUTICASONE FUROATE-VILANTEROL 200-25 MCG/INH IN AEPB $55.50 FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN AEPB $125.64 FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN AEPB $125.64 FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB $203.53 FLUTTER DEVI $443.60 FLUVASTATIN SODIUM 20 MG PO CAPS $60.06 MALEATE 100 MG PO TABS $26.91 FLUVOXAMINE MALEATE 25 MG (1/2 X 50 MG) PO TABS $14.19 FLUVOXAMINE MALEATE 50 MG PO TABS $26.43 FOLIC ACID 0.25 MG (1/4 X 1 MG) PO TABS $2.81 FOLIC ACID 0.5 MG (1/2 X 1 MG) PO TABS $3.67 FOLIC ACID 1 MG PO TABS $5.38

Page 13 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE FOLIC ACID 100 MCG (1/4 X 400 MCG) PO TABS $2.04 FOLIC ACID 200 MCG (1/2 X 400 MCG) PO TABS $2.12 FOLIC ACID 400 MCG PO TABS $2.29 FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR $3,831.34 FOSFOMYCIN TROMETHAMINE 3 G PO PACK $907.87 FOSINOPRIL SODIUM 10 MG PO TABS $21.19 FOSINOPRIL SODIUM 2.5 MG (1/4 X 10 MG) PO TABS $4.78 FOSINOPRIL SODIUM 20 MG PO TABS $21.19 FOSINOPRIL SODIUM 40 MG PO TABS $21.19 FOSINOPRIL SODIUM 5 MG (1/2 X 10 MG) PO TABS $7.61 FUROSEMIDE 10 MG (1/2 X 20 MG) PO TABS $2.72 FUROSEMIDE 20 MG PO TABS $3.94 FUROSEMIDE 40 MG PO TABS $3.21 FUROSEMIDE 5 MG (1/4 X 20 MG) PO TABS $2.33 FUROSEMIDE 80 MG PO TABS $5.04 GABAPENTIN 100 MG PO CAPS $3.29 GABAPENTIN 300 MG PO CAPS $3.72 GABAPENTIN 400 MG PO CAPS $3.97 GALANTAMINE HYDROBROMIDE 4 MG PO TABS $30.97 GALANTAMINE HYDROBROMIDE 8 MG PO TABS $62.85 GANCICLOVIR SODIUM 500 MG IV SOLR $959.44 GELATIN ADSORBABLE OP FILM $2,555.74 GEMCITABINE HCL 1 G IV SOLR $753.08 GEMCITABINE HCL 1 G IV SOLR $916.63 GEMCITABINE HCL 200 MG IV SOLR $166.54 GEMCITABINE HCL 200 MG IV SOLR $202.97 GEMCITABINE HCL 200 MG IV SOLR $619.27 GEMFIBROZIL 300 MG (1/2 X 600 MG) PO TABS $23.03 GEMFIBROZIL 600 MG PO TABS $44.09 GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR $121,942.15 GLIMEPIRIDE 0.25 MG (1/4 X 1 MG) PO TABS $2.91 GLIMEPIRIDE 0.5 MG (1/2 X 1 MG) PO TABS $3.87 GLIMEPIRIDE 1 MG PO TABS $5.77 GLIMEPIRIDE 2 MG PO TABS $13.65 GLIMEPIRIDE 4 MG PO TABS $13.63 GLIPIZIDE 1.25 MG (1/4 X 5 MG) PO TABS $2.84 GLIPIZIDE 10 MG PO TABS $8.31 GLIPIZIDE 2.5 MG (1/2 X 5 MG) PO TABS $3.73 GLIPIZIDE 5 MG PO TABS $5.52 GLIPIZIDE ER 10 MG PO TB24 $9.61 GLIPIZIDE ER 2.5 MG PO TB24 $5.82 GLIPIZIDE ER 5 MG PO TB24 $5.82 HCL (RDNA) 1 MG IJ SOLR $1,970.80 GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR $1,970.80 GLUCARPIDASE 1000 UNITS IV SOLR $344,084.30 GLUCOSE 4 G PO CHEW $3.09 GLUCOSE 4 G PO CHEW $4.17 GLYBURIDE 0.625 MG (1/2 X 1.25 MG) PO TABS $3.26 GLYBURIDE 1.25 MG PO TABS $4.57 GLYBURIDE 2.5 MG PO TABS $4.86 GLYBURIDE 5 MG PO TABS $10.55 GLYBURIDE MICRONIZED 1.5 MG PO TABS $5.52 GLYBURIDE MICRONIZED 3 MG PO TABS $36.45 GLYBURIDE MICRONIZED 6 MG PO TABS $12.17 GLYCERIN (LAXATIVE) 1 G PR SUPP $3.14 GLYCERIN (LAXATIVE) 1.2 G PR SUPP $6.12 GLYCERIN (LAXATIVE) 2 G PR SUPP $6.06 GLYCOPYRROLATE 0.25 MG (1/4 X 1 MG) PO TABS $5.07 GLYCOPYRROLATE 0.5 MG (1/2 X 1 MG) PO TABS $8.20

Page 14 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE GLYCOPYRROLATE 1 MG PO TABS $14.44 GOSERELIN ACETATE 10.8 MG SUBQ IMPL $20,725.28 GOSERELIN ACETATE 3.6 MG SUBQ IMPL $6,916.76 GRANISETRON HCL 1 MG PO TABS $563.13 GRANULOTION PACKET $74.23 GUANFACINE HCL 0.25 MG (1/4 X 1 MG) PO TABS $4.02 GUANFACINE HCL 0.5 MG (1/2 X 1 MG) PO TABS $6.10 GUANFACINE HCL 1 MG PO TABS $10.24 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR $180.26 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR $183.69 HALOPERIDOL 0.25 MG (1/2 X 0.5 MG) PO TABS $3.50 HALOPERIDOL 0.5 MG PO TABS $5.05 HALOPERIDOL 1 MG PO TABS $6.33 HALOPERIDOL 10 MG PO TABS $19.00 HALOPERIDOL 2 MG PO TABS $7.96 HALOPERIDOL 2.5 MG (1/2 X 5 MG) PO TABS $6.82 HALOPERIDOL 5 MG PO TABS $11.69 HEMIN 350 MG IV SOLR $85,014.78 HISTRELIN ACETATE (CPP) 50 MG SUBQ KIT $352,771.31 HURRICAINE SPR EXTENSION TUBES MISC $2.73 HYDRALAZINE HCL 10 MG PO TABS $7.02 HYDRALAZINE HCL 12.5 MG (1/2 X 25 MG) PO TABS $4.37 HYDRALAZINE HCL 2.5 MG (1/4 X 10 MG) PO TABS $2.93 HYDRALAZINE HCL 25 MG PO TABS $6.78 HYDRALAZINE HCL 5 MG (1/2 X 10 MG) PO TABS $3.91 HYDRALAZINE HCL 50 MG PO TABS $6.13 HYDRALAZINE HCL 6.25 MG (1/4 X 25 MG) PO TABS $4.66 HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS $5.99 HYDROCHLOROTHIAZIDE 12.5 MG PO TABS $9.79 HYDROCHLOROTHIAZIDE 25 MG PO TABS $3.36 HYDROCHLOROTHIAZIDE 3.125 MG (1/4 X 12.5 MG) PO TABS $3.91 HYDROCHLOROTHIAZIDE 50 MG PO TABS $3.52 HYDROCHLOROTHIAZIDE 6.25 MG (1/2 X 12.5 MG) PO TABS $5.87 HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS $7.10 HYDROCORTISONE 1 % EX CREA $3.09 HYDROCORTISONE 1.25 MG (1/4 X 5 MG) PO TABS $3.28 HYDROCORTISONE 10 MG PO TABS $21.04 HYDROCORTISONE 2.5 MG (1/2 X 5 MG) PO TABS $4.60 HYDROCORTISONE 20 MG PO TABS $12.29 HYDROCORTISONE 5 MG PO TABS $13.25 HYDROCORTISONE ACETATE 25 MG PR SUPP $139.13 HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR $125.96 HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR $165.80 HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR $296.00 HYDROMORPHONE 0.5 MG (1/4 X 2 MG) PO TABS $3.09 HYDROMORPHONE 1 MG (1/2 X 2 MG) PO TABS $8.50 HYDROMORPHONE HCL 2 MG PO TABS $8.75 HYDROMORPHONE HCL 250 MG IJ SOLR $1,158.84 HYDROMORPHONE HCL 4 MG PO TABS $8.77 HYDROXOCOBALAMIN 5 G IV SOLR $9,374.82 HYDROXYCHLOROQUINE SULFATE 100 MG (1/2 X 200 MG) PO TAB $7.81 HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS $40.83 HYDROXYUREA 500 MG PO CAPS $12.45 HYDROXYZINE HCL 10 MG PO TABS $4.66 HYDROXYZINE HCL 2.5 MG (1/4 X 10 MG) PO TABS $3.46 HYDROXYZINE HCL 25 MG PO TABS $10.65 HYDROXYZINE HCL 5 MG ( 1/2 X 10 MG) PO TABS $4.97 HYDROXYZINE HCL 50 MG PO TABS $12.55 HYOSCYAMINE SULFATE 0.125 MG SL SUBL $12.37

Page 15 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE HYOSCYAMINE SULFATE ER 0.375 MG PO TB12 $11.35 IBUPROFEN 100 MG (1/2 X 200 MG) PO TABS $2.27 IBUPROFEN 200 MG PO TABS $2.60 IBUPROFEN 300 MG (1/2 X 600 MG) PO TABS $3.41 IBUPROFEN 400 MG PO TABS $4.00 IBUPROFEN 600 MG PO TABS $4.85 IBUPROFEN 800 MG PO TABS $5.75 ICAPS LUTEIN & ZEAXANTHIN PO TBEC $3.80 IFOSFAMIDE 1 G IV SOLR $887.64 IFOSFAMIDE 3 G IV SOLR $1,580.24 MESYLATE 100 MG PO TABS $1,070.55 IMATINIB MESYLATE 400 MG PO TABS $3,852.52 IMIGLUCERASE 400 UNITS IV SOLR $18,111.93 IMIPENEM-CILASTATIN 250 MG IV SOLR $240.64 IMIPENEM-CILASTATIN 500 MG IV SOLR $441.94 HCL 10 MG PO TABS $6.04 IMIPRAMINE HCL 25 MG PO TABS $8.78 IMIPRAMINE HCL 50 MG PO TABS $13.54 IMIQUIMOD 5 % EX CREA $73.28 IMMUNE GLOBULIN (HUMAN) 10 G IV SOLR $20,419.44 IMMUNE GLOBULIN (HUMAN) 5 G IV SOLR $8,944.10 IMMUNE GLOBULIN (HUMAN) 6 G IV SOLR $6,585.81 INCOBOTULINUMTOXINA 50 UNITS IM SOLR $2,899.74 INDAPAMIDE 1.25 MG (1/2 X 2.5 MG) PO TABS $6.01 INDAPAMIDE 2.5 MG PO TABS $16.69 SULFATE 400 MG PO CAPS $30.91 INDOCYANINE GREEN 25 MG IV SOLR $953.59 INDOMETHACIN 25 MG PO CAPS $5.77 INDOMETHACIN 50 MG PR SUPP $971.97 INDOMETHACIN SODIUM 1 MG IV SOLR $6,123.63 INFLIXIMAB 100 MG IV SOLR $13,339.62 INFLIXIMAB-DYYB 100 MG IV SOLR $10,811.49 INSPIREASE BAGS MISC $35.75 INSUFLON CANNULA $68.52 PEN NEEDLE 29G X 12.7MM MISC $6.76 INSULIN PEN NEEDLE 30G X 8 MM MISC $5.78 INSULIN PEN NEEDLE 30G X 8 MM MISC $5.78 INSULIN PEN NEEDLE 30G X 8 MM MISC $6.72 INSULIN PEN NEEDLE 32G X 6 MM MISC $7.55 INTERFERON ALFA-2B 18000000 UNITS IJ SOLR $4,942.39 INTERFERON ALFA-2B 50000000 UNITS IJ SOLR $13,708.14 INTERLINK PRIMARY INFUSION SET $20.69 INTERLINK SECONDARY INFUSION SET $10.32 IRBESARTAN 150 MG PO TABS $31.16 IRBESARTAN 300 MG PO TABS $37.07 IRBESARTAN 75 MG (1/2 X 150 MG) PO TABS $22.11 IRBESARTAN 75 MG PO TABS $29.72 ISAVUCONAZONIUM SULFATE 186 MG PO CAPS $998.50 ISAVUCONAZONIUM SULFATE 372 MG IV SOLR $3,408.05 ISO MED REFILL KIT $116.07 ISOMETHEPTENE-DICHLORAL-APAP 65-100-325 MG PO CAPS $45.74 ISONIAZID 150 MG (1/2 X 300 MG) PO TABS $3.16 ISONIAZID 300 MG PO TABS $14.20 ISOSORBIDE DINITRATE 10 MG PO TABS $12.26 ISOSORBIDE DINITRATE 2.5 MG (1/2 X 5 MG) PO TABS $6.64 ISOSORBIDE DINITRATE 20 MG PO TABS $13.29 ISOSORBIDE DINITRATE 5 MG PO TABS $15.24 ISOSORBIDE DINITRATE ER 40 MG PO TBCR $24.55 ISOSORBIDE MONONITRATE CR 15 MG (1/2 X 30 MG) PO TB24 $9.93

Page 16 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE ISOSORBIDE MONONITRATE ER 30 MG PO TB24 $17.90 ISOSORBIDE MONONITRATE ER 60 MG PO TB24 $21.51 ISRADIPINE 2.5 MG PO CAPS $14.93 ISRADIPINE 5 MG PO CAPS $20.93 ITRACONAZOLE 100 MG PO CAPS $303.84 IVABRADINE HCL 5 MG PO TABS $83.65 IVABRADINE HCL 7.5 MG PO TABS $83.65 IVACAFTOR 150 MG PO TABS $4,871.64 IXABEPILONE 15 MG IV SOLR $17,067.99 IXABEPILONE 45 MG IV SOLR $51,154.86 K PHOS MONO-SOD PHOS DI & MONO 77.5-426-65 MG (1/2 X 155-852-130 MG) PO TABS $3.04 100 MG (1/2 X 200 MG) PO TABS $16.98 KETOCONAZOLE 200 MG PO TABS $32.00 KETOCONAZOLE 200 MG PO TABS $32.00 KETOCONAZOLE 50 MG (1/4 X 200 MG) PO TABS $9.46 LABETALOL HCL 100 MG PO TABS $23.64 LABETALOL HCL 200 MG PO TABS $35.12 LABETALOL HCL 25 MG (1/4 X 100 MG) PO TABS $7.37 LABETALOL HCL 50 MG (1/2 X 100 MG) PO TABS $12.80 LACOSAMIDE 100 MG PO TABS $155.59 LACOSAMIDE 25 MG (1/4 X 100 MG) PO TABS $120.84 LACOSAMIDE 50 MG (1/2 X 100 MG) PO TABS $61.39 LACTASE 1500 UNIT (1/2 X 3000 UNIT) PO TABS $2.42 LACTASE 3000 UNITS PO TABS $2.88 LACTULOSE 10 G PO PACK $86.26 LACTULOSE 20 G PO PACK $89.32 LAMINARIA $25.00 LAMIVUDINE 150 MG PO TABS $70.05 LAMIVUDINE 75 MG (1/2 X 150 MG) PO TABS $36.00 LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS $173.40 LAMOTRIGINE 100 MG PO TABS $47.13 LAMOTRIGINE 12.5 MG (1/2 X 25 MG) PO TABS $21.73 LAMOTRIGINE 150 MG PO TABS $58.79 LAMOTRIGINE 150 MG PO TABS $179.11 LAMOTRIGINE 200 MG PO TABS $55.71 LAMOTRIGINE 25 MG PO TABS $41.51 LAMOTRIGINE 25 MG PO TABS $41.51 LAMOTRIGINE 6.25 MG (1/4 X 25 MG) PO TAB $11.84 LAMOTRIGINE 75 MG (1/2 X 150 MG) PO TABS $30.39 LANSOPRAZOLE 15 MG PO TBDP $159.85 LANSOPRAZOLE 30 MG PO TBDP $58.09 LANSOPRAZOLE 30 MG PO TBDP $159.85 LANTHANUM CARBONATE 250 MG (1/2 X 500 MG) PO CHEW $51.33 LANTHANUM CARBONATE 500 MG PO CHEW $138.97 LEECH $130.34 LEFLUNOMIDE 10 MG PO TABS $157.97 LEFLUNOMIDE 20 MG PO TABS $59.01 LENALIDOMIDE 10 MG PO CAPS $7,938.75 LENALIDOMIDE 5 MG PO CAPS $7,938.75 LETERMOVIR 240 MG PO TABS $2,227.29 LETERMOVIR 480 MG PO TABS $2,227.29 LETROZOLE 2.5 MG PO TABS $174.22 LEUCOVORIN CALCIUM 1.25 MG (1/4 X 5 MG) PO TABS $6.77 LEUCOVORIN CALCIUM 100 MG IJ SOLR $240.74 LEUCOVORIN CALCIUM 12.5 MG (1/2 X 25 MG) PO TABS $67.00 LEUCOVORIN CALCIUM 2.5 MG (1/2 X 5 MG) PO TABS $11.58 LEUCOVORIN CALCIUM 200 MG IJ SOLR $468.98 LEUCOVORIN CALCIUM 25 MG PO TABS $132.12 LEUCOVORIN CALCIUM 350 MG IJ SOLR $228.76

Page 17 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE LEUCOVORIN CALCIUM 5 MG PO TABS $21.22 LEUCOVORIN CALCIUM 50 MG IJ SOLR $126.62 LEUPROLIDE ACETATE (3 MONTH) 11.25 MG (PED) IM KIT $91,568.60 LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT $41,933.34 LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT $49,967.20 LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT $66,618.83 LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT $99,923.42 LEUPROLIDE ACETATE (6 MONTH) 45 MG SUBQ KIT $28,154.49 LEUPROLIDE ACETATE 1 MG/0.2ML IJ KIT $8,485.91 LEUPROLIDE ACETATE 3.75 MG IM KIT $13,985.92 LEUPROLIDE ACETATE 7.5 MG IM KIT $16,664.13 LEVETIRACETAM 125 MG (1/2 X 250 MG) PO TABS $3.26 LEVETIRACETAM 250 MG PO TABS $27.01 LEVETIRACETAM 500 MG PO TABS $8.79 LEVETIRACETAM 62.5 MG (1/4 X 250 MG) PO TABS $8.22 LEVOFLOXACIN 250 MG PO TABS $161.82 LEVOFLOXACIN 500 MG PO TABS $161.92 LEVOFLOXACIN 62.5 MG (1/4 X 250 MG) PO TABS $71.97 LEVOFLOXACIN 750 MG PO TABS $236.03 LEVOFLOXACIN 750 MG PO TABS $643.79 LEVOLEUCOVORIN CALCIUM 50 MG IV SOLR $572.55 LEVONORGESTREL 13.5 MG IU IUD $8,639.31 LEVONORGESTREL 20 MCG/24HR IU IUD $10,375.08 LEVORPHANOL TARTRATE 1 MG (1/2 X 2 MG) PO TABS $8.50 LEVORPHANOL TARTRATE 2 MG PO TABS $22.31 LEVOTHYROXINE SODIUM 100 MCG IV SOLR $1,217.42 LEVOTHYROXINE SODIUM 100 MCG OR TABS $7.29 LEVOTHYROXINE SODIUM 112 MCG OR TABS $8.39 LEVOTHYROXINE SODIUM 12.5 MCG (1/2 X 25 MCG) OR TABS $3.82 LEVOTHYROXINE SODIUM 125 MCG OR TABS $8.22 LEVOTHYROXINE SODIUM 150 MCG OR TABS $8.40 LEVOTHYROXINE SODIUM 175 MCG OR TABS $9.62 LEVOTHYROXINE SODIUM 18.75 MCG (1/4 X 75 MCG) OR TABS $3.12 LEVOTHYROXINE SODIUM 200 MCG IV SOLR $2,422.24 LEVOTHYROXINE SODIUM 200 MCG OR TABS $9.62 LEVOTHYROXINE SODIUM 25 MCG OR TABS $6.11 LEVOTHYROXINE SODIUM 37.5 MCG (1/2 X 75 MCG) OR TABS $4.30 LEVOTHYROXINE SODIUM 44 MCG (1/2 X 88 MCG) OR TABS $4.60 LEVOTHYROXINE SODIUM 50 MCG OR TABS $6.67 LEVOTHYROXINE SODIUM 56 MCG (1/2 X 112 MCG) OR TABS $5.17 LEVOTHYROXINE SODIUM 6.25 MCG (1/4 X 25 MCG) OR TABS $2.88 LEVOTHYROXINE SODIUM 62.5 MCG (1/2 X 125 MCG) OR TABS $5.08 LEVOTHYROXINE SODIUM 75 MCG OR TABS $7.16 LEVOTHYROXINE SODIUM 88 MCG OR TABS $7.26 LIDOCAINE 4 % EX PTCH $41.83 LINACLOTIDE 72 MCG PO CAPS $149.18 LINAGLIPTIN 5 MG PO TABS $158.48 LINEZOLID 600 MG PO TABS $1,748.67 SODIUM 12.5 MCG (1/2 X 25 MCG) PO TABS $9.29 LIOTHYRONINE SODIUM 2.5 MCG (1/2 X 5 MCG) PO TABS $7.53 LIOTHYRONINE SODIUM 25 MCG PO TABS $30.69 LIOTHYRONINE SODIUM 5 MCG PO TABS $23.83 LISDEXAMFETAMINE DIMESYLATE 60 MG PO CAPS $114.17 LISINOPRIL 1.25 MG (1/2 X 2.5 MG) PO TABS $5.07 LISINOPRIL 10 MG PO TABS $5.32 LISINOPRIL 2.5 MG PO TABS $8.00 LISINOPRIL 2.5 MG PO TABS $8.19 LISINOPRIL 20 MG PO TABS $12.07 LISINOPRIL 5 MG PO TABS $6.51

Page 18 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE CARBONATE 150 MG PO CAPS $3.74 LITHIUM CARBONATE 225 MG (1/2 X 450 MG) PO TBCR $4.51 LITHIUM CARBONATE 300 MG PO CAPS $3.75 LITHIUM CARBONATE ER 300 MG PO TBCR $6.37 LITHIUM CARBONATE ER 450 MG PO TBCR $7.06 LOMUSTINE 10 MG PO CAPS $954.40 LOMUSTINE 100 MG PO CAPS $969.00 LOMUSTINE 40 MG PO CAPS $508.72 LOPERAMIDE HCL 2 MG PO CAPS $6.72 LOPINAVIR- 200-50 MG PO TABS $99.34 10 MG PO TABS $10.75 LORATADINE 5 MG (1/2 X 10 MG) PO TABS $3.39 LORATADINE-PSEUDOEPHEDRINE ER 10-240 MG PO TB24 $7.09 LORAZEPAM 0.125 MG (1/4 X 0.5 MG) PO TABS $2.39 LORAZEPAM 0.25 MG (1/2 X 0.5 MG) PO TABS $2.39 LORAZEPAM 0.5 MG PO TABS $2.82 LORAZEPAM 1 MG PO TABS $3.00 LORAZEPAM 2 MG PO TABS $14.50 LOSARTAN 6.25 MG (1/4 X 25 MG) PO TABS $5.95 LOSARTAN POTASSIUM 100 MG PO TABS $31.26 LOSARTAN POTASSIUM 12.5 MG (1/2 X 25 MG) PO TABS $9.93 LOSARTAN POTASSIUM 25 MG PO TABS $8.57 LOSARTAN POTASSIUM 50 MG PO TABS $23.35 LOSARTAN POTASSIUM 50 MG PO TABS $23.47 LOSARTAN POTASSIUM-HCTZ 100-25 MG PO TABS $45.87 LOSARTAN POTASSIUM-HCTZ 25-6.25 MG (1/2 X 50-12.5 MG) PO TABS $13.85 LOSARTAN POTASSIUM-HCTZ 50-12.5 MG PO TABS $23.70 20 MG PO TABS $24.52 SUCCINATE 25 MG PO CAPS $20.26 LUBIPROSTONE 24 MCG PO CAPS $72.53 LUBIPROSTONE 8 MCG PO CAPS $42.82 LURASIDONE HCL 20 MG (1/2 X 40 MG) PO TABS $194.62 LURASIDONE HCL 40 MG PO TABS $467.33 MAFENIDE ACETATE 5 % EX PACK $2,218.43 CHLORIDE 64 MG PO TBEC $3.32 MAGNESIUM ION INJ FOR TPN $10.00 HCL 25 MG PO TABS $12.92 MEASLES, MUMPS & RUBELLA VAC SUBQ INJ $817.55 MEASLES-MUMPS-RUBELLA-VARICELL SUBQ SUSR $2,317.59 MECHLORETHAMINE HCL 10 MG IJ SOLR $2,238.71 HCL 12.5 MG PO TABS $8.74 MECLIZINE HCL 25 MG PO TABS $10.09 MECLIZINE HCL 3.125 MG (1/4 X 12.5 MG) PO TABS $2.73 MECLIZINE HCL 6.25 MG (1/2 X 12.5 MG) PO TABS $3.50 MEDROXYPROGESTERONE ACETATE 10 MG PO TABS $6.62 MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS $4.93 MEDROXYPROGESTERONE ACETATE 5 MG (1/2 X 10 MG) PO TAB $4.29 MEGESTROL ACETATE 10 MG (1/2 X 20 MG) PO TABS $5.08 MEGESTROL ACETATE 20 MG PO TABS $8.20 MEGESTROL ACETATE 40 MG PO TABS $11.90 0.25 MG (1/4 X 1 MG) PO TABS $2.07 MELATONIN 0.5 MG (1/2 X 1 MG) PO TABS $2.21 MELATONIN 1 MG PO TABS $2.45 MELATONIN 3 MG PO TABS $2.74 MELPHALAN 2 MG PO TABS $131.13 MELPHALAN HCL (PG FREE) 50 MG IV SOLR $29,760.55 MELPHALAN HCL 50 MG IV SOLR $37,289.33 MEMANTINE HCL 10 MG PO TABS $11.02 MEMANTINE HCL 5 MG PO TABS $11.02

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MEDICATION CHARGE MEMANTINE HCL ER 14 MG PO CP24 $149.38 MEMANTINE HCL ER 21 MG PO CP24 $163.41 MEMANTINE HCL ER 28 MG PO CP24 $163.41 MEMANTINE HCL ER 7 MG PO CP24 $163.41 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR $1,407.97 MENTHOL 3 MG MT LOZG $2.46 MENTHOL 9.1 MG MT LOZG $2.74 MEPERIDINE HCL 50 MG PO TABS $15.54 MEPOLIZUMAB 100 MG SUBQ SOLR $32,749.72 MEPROBAMATE 200 MG PO TABS $15.26 MEPROBAMATE 400 MG PO TABS $19.36 MERCAPTOPURINE 12.5 MG (1/4 X 50 MG) PO TABS $11.65 MERCAPTOPURINE 25 MG (1/2 X 50 MG) PO TABS $21.45 MERCAPTOPURINE 50 MG PO TABS $40.85 MEROPENEM 1 G IV SOLR $157.17 MEROPENEM 500 MG IV SOLR $144.02 MEROPENEM-SODIUM CHLORIDE 1 GM/50ML IV SOLR $303.84 MEROPENEM-SODIUM CHLORIDE 500 MG/50ML IV SOLR $228.62 MESALAMINE 1.2 G PO TBEC $108.78 MESALAMINE 1000 MG PR SUPP $405.55 MESALAMINE 400 MG PO CPDR $42.39 MESALAMINE ER 250 MG PO CPCR $36.59 MESALAMINE ER 500 MG PO CPCR $71.25 MESNA 400 MG PO TABS $898.83 METAXALONE 200 MG (1/4 X 800 MG) PO TABS $16.19 METAXALONE 800 MG PO TABS $58.91 ER 500 MG PO TB24 $8.42 METFORMIN HCL 1000 MG PO TABS $15.00 METFORMIN HCL 125 MG (1/4 X 500 MG) PO TABS $3.62 METFORMIN HCL 250 MG (1/2 X 500 MG) PO TABS $5.29 METFORMIN HCL 425 MG (1/2 X 850 MG) PO TABS $7.66 METFORMIN HCL 500 MG PO TABS $8.62 METFORMIN HCL 850 MG PO TABS $13.36 METFORMIN HCL ER 750 MG PO TB24 $13.33 METHADONE HCL 10 MG PO TABS $5.23 METHADONE HCL 2.5 MG ( 1/2 X 5 MG) PO TABS $3.79 METHADONE HCL 40 MG PO TBSO $5.11 METHADONE HCL 5 MG PO TABS $6.11 METHAZOLAMIDE 25 MG (1/2 X 50 MG) PO TABS $17.40 METHAZOLAMIDE 50 MG PO TABS $74.82 METHIMAZOLE 10 MG PO TABS $9.25 METHIMAZOLE 10 MG PO TABS $9.25 METHIMAZOLE 2.5 MG ( 1/2 X 5 MG) PO TAB $4.06 METHIMAZOLE 5 MG PO TABS $6.17 METHOCARBAMOL 250 MG (1/2 X 500 MG) PO TABS $3.98 METHOHEXITAL 10 MG/ML INJ DIL $768.74 METHOHEXITAL SODIUM 0.5 G IJ SOLR $768.74 METHOHEXITAL SODIUM 2.5 G IJ SOLR $2,885.00 METHOTREXATE 1.25 MG (1/2 X 2.5 MG) PO TABS $31.62 METHOTREXATE 2.5 MG PO TABS $61.26 METHOTREXATE SODIUM 1 G IJ SOLR $760.52 METHOTREXATE SODIUM 1 G IJ SOLR $970.16 METHSUXIMIDE 300 MG PO CAPS $50.60 METHYLDOPA 125 MG (1/2 X 250 MG) PO TABS $3.93 METHYLDOPA 250 MG PO TABS $5.91 METHYLDOPA 500 MG PO TABS $14.32 METHYLERGONOVINE MALEATE 0.2 MG PO TABS $259.67 METHYLPHENIDATE 2.5 MG (1/2 X 5 MG) PO TABS $5.43 METHYLPHENIDATE HCL 10 MG PO TABS $11.86

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MEDICATION CHARGE METHYLPHENIDATE HCL 20 MG PO TABS $16.20 METHYLPHENIDATE HCL 5 MG PO TABS $8.90 METHYLPHENIDATE HCL ER 18 MG PO TBCR $94.49 METHYLPHENIDATE HCL ER 27 MG PO TBCR $96.81 METHYLPHENIDATE HCL ER 36 MG PO TBCR $99.80 1 MG (1/4 X 4 MG) PO TABS $5.35 METHYLPREDNISOLONE 2 MG (1/2 X 4 MG) PO TABS $8.75 METHYLPREDNISOLONE 4 MG PO TABS $15.54 METHYLPREDNISOLONE 500 MG PIGGYBACK IN ACUDOSE $209.36 METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR $490.57 METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR $123.05 METHYLPREDNISOLONE SODIUM SUCC 2000 MG IJ SOLR $960.93 METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR $81.15 METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR $276.31 METOCLOPRAMIDE HCL 1.25 MG (1/4 X 5 MG) PO TABS $2.94 METOCLOPRAMIDE HCL 10 MG PO TABS $11.05 METOCLOPRAMIDE HCL 2.5 MG (1/2 X 5 MG) PO TABS $3.93 METOCLOPRAMIDE HCL 5 MG PO TABS $5.90 METOLAZONE 1.25 MG (1/2 X 2.5 MG) PO TABS $17.77 METOLAZONE 2.5 MG PO TABS $33.58 METOLAZONE 5 MG PO TABS $37.90 METOPROLOL SUCCINATE 12.5 MG ( 1/2 X 25 MG) PO TB24 $7.26 METOPROLOL SUCCINATE 6.25 MG (1/4 X 25 MG) PO TB24 $4.60 METOPROLOL SUCCINATE ER 25 MG PO TB24 $12.55 METOPROLOL TARTRATE 100 MG PO TABS $9.57 METOPROLOL TARTRATE 12.5 MG ( 1/2 X 25 MG) PO TABS $3.28 METOPROLOL TARTRATE 25 MG PO TABS $4.61 METOPROLOL TARTRATE 50 MG PO TABS $5.26 METOPROLOL TARTRATE 6.25 MG (1/4 X 25 MG) PO TABS $2.62 METOPROLOL XL TBCR 100 MG OR $17.88 METOPROLOL XL TBCR 50 MG OR $12.55 METRONIDAZOLE 125 MG (1/2 X 250 MG) PO TABS $4.59 METRONIDAZOLE 250 MG PO TABS $7.23 METRONIDAZOLE 500 MG PO TABS $9.83 METRONIDAZOLE 62.5 MG (1/4 X 250 MG) PO TABS $3.27 MEXILETINE HCL 150 MG PO CAPS $26.07 MEXILETINE HCL 250 MG PO CAPS $35.22 MIAMI J COLLAR ADULT SMALL $1,393.00 MIAMI J COLLAR BARIATRIC $590.00 MIAMI J COLLAR JR P0 $1,393.00 MIAMI J COLLAR JR P1 $1,393.00 MIAMI J COLLAR JR P2 $1,393.00 MIAMI J COLLAR JR P3 $1,393.00 MIAMI J COLLAR MEDIUM $1,393.00 MIAMI J COLLAR PA 100 $1,393.00 MIAMI J COLLAR PICU SMALL $1,393.00 MIAMI J COLLAR STOUT $1,393.00 MIAMI J COLLAR SUPER SHORT $1,393.00 MIAMI J COLLAR TALL $1,393.00 MIAMI J COLLAR XSMALL $1,393.00 MIDODRINE HCL 10 MG PO TABS $49.29 MIDODRINE HCL 2.5 MG PO TABS $13.37 MIDODRINE HCL 5 MG PO TABS $27.72 MIDOSTAURIN 25 MG PO CAPS $1,620.97 MIGLITOL 25 MG PO TABS $33.29 MINOCYCLINE HCL 100 MG PO CAPS $34.26 MINOCYCLINE HCL 50 MG PO CAPS $18.11 MINOXIDIL 0.625 MG (1/4 X 2.5 MG) PO TABS $3.35 MINOXIDIL 1.25 MG (1/2 X 2.5 MG) PO TABS $4.75

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MEDICATION CHARGE MINOXIDIL 10 MG PO TABS $18.00 MINOXIDIL 2.5 MG PO TABS $7.54 15 MG PO TABS $27.77 MIRTAZAPINE 15 MG PO TBDP $26.65 MIRTAZAPINE 3.75 MG (1/2 X 7.5 MG) PO TABS $14.48 MIRTAZAPINE 30 MG PO TBDP $27.40 MIRTAZAPINE 7.5 MG PO TABS $26.99 MISOPROSTOL 100 MCG PO TABS $9.79 MISOPROSTOL 200 MCG PO TABS $20.21 MISOPROSTOL 25 MCG (1/4 X 100 MCG) PO TABS $3.91 MISOPROSTOL 50 MCG (1/2 X 100 MCG) PO TABS $5.87 MITOMYCIN 20 MG IV SOLR $8,794.44 MITOMYCIN 5 MG IV SOLR $3,400.33 MITOTANE 500 MG PO TABS $56.72 MODAFINIL 100 MG PO TABS $252.80 MODAFINIL 200 MG PO TABS $338.47 MODAFINIL 50 MG (1/2 X 100 MG) PO TABS $127.37 MONTELUKAST SODIUM 10 MG PO TABS $55.01 MONTELUKAST SODIUM 2 MG (1/2 X 4 MG) PO CHEW $31.84 MONTELUKAST SODIUM 2.5 MG (1/2 X 5 MG) PO CHEW $28.86 MONTELUKAST SODIUM 2.5 MG(1/4 X 10 MG) PO TABS $13.08 MONTELUKAST SODIUM 2.5 MG(1/4 X 10 MG) PO TABS $18.69 MONTELUKAST SODIUM 4 MG PO CHEW $55.75 MONTELUKAST SODIUM 5 MG (1/2 X 10 MG) PO TABS $28.13 MONTELUKAST SODIUM 5 MG PO CHEW $55.75 MORPHINE SULFATE 10 MG PR SUPP $61.39 MORPHINE SULFATE 15 MG PO TABS $10.59 MORPHINE SULFATE 30 MG PO TABS $10.34 MORPHINE SULFATE 5 MG PR SUPP $49.50 MORPHINE SULFATE 7.5 (1/2 X 15 MG) PO TABS $3.52 MORPHINE SULFATE ER 100 MG PO TBCR $74.57 MORPHINE SULFATE ER 15 MG PO TBCR $19.75 MORPHINE SULFATE ER 30 MG PO TBCR $34.09 MORPHINE SULFATE ER 60 MG PO TBCR $52.58 MOXIFLOXACIN HCL 400 MG PO TABS $349.41 MULTI-VITAMINS PO TABS $2.13 MYCOPHENOLATE MOFETIL 250 MG PO CAPS $39.64 MYCOPHENOLATE MOFETIL 500 MG PO TABS $77.33 MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR $1,244.74 MYCOPHENOLATE SODIUM 180 MG PO TBEC $49.50 MYCOPHENOLATE SODIUM 360 MG PO TBEC $97.05 NABUMETONE 250 MG (1/2 X 500 MG) PO TABS $5.87 NABUMETONE 500 MG PO TABS $9.79 NABUMETONE 750 MG PO TABS $17.40 NADOLOL 10 MG ( 1/2 X 20 MG) PO TABS $18.09 NADOLOL 20 MG PO TABS $60.83 NADOLOL 40 MG PO TABS $70.67 NADOLOL 5 MG (1/4 X 20 MG) PO TABS $10.02 SODIUM 1 G IJ SOLR $208.31 NAFCILLIN SODIUM 10 G IV SOLR $1,874.17 NAFCILLIN SODIUM 2 G IJ SOLR $392.46 NALOXEGOL OXALATE 12.5 MG PO TABS $133.20 NALOXEGOL OXALATE 25 MG PO TABS $133.20 NALOXONE HCL 4 MG/0.1ML NA LIQD $715.20 NALTREXONE 380 MG IM SUSR $14,950.81 NALTREXONE HCL 25MG (1/2 50MG) PO TABS $25.92 NALTREXONE HCL 50 MG PO TABS $25.92 NAPROXEN 125 MG (1/2 X 250 MG) PO TABS $6.12 NAPROXEN 187.5 MG (1/2 X 375 MG) PO TABS $7.01

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MEDICATION CHARGE NAPROXEN 250 MG PO TABS $10.28 NAPROXEN 375 MG PO TABS $11.34 NAPROXEN SODIUM 275 MG PO TABS $10.00 NARATRIPTAN HCL 1 MG PO TABS $282.40 NARATRIPTAN HCL 2.5 MG PO TABS $282.40 NEEDLE-PRO SYR INSULIN 1 ML $14.98 HCL 100 MG PO TABS $47.59 NEFAZODONE HCL 200 MG PO TABS $49.33 NEFAZODONE HCL 50 MG PO TABS $46.51 NELFINAVIR MESYLATE 250 MG PO TABS $48.13 NEOMYCIN SULFATE 250 MG (1/2 X 500 MG) PO TABS $8.44 NEOMYCIN SULFATE 500 MG PO TABS $17.43 NEPHROCAPS 1 MG PO CAPS $8.34 NIACIN 100 MG PO TABS $2.20 NIACIN 50 MG (1/2 X 100 MG) PO TABS $2.07 NIACIN 50 MG (1/2 X 100 MG) PO TABS $2.20 NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR $60.93 NIACIN ER (ANTIHYPERLIPIDEMIC) 750 MG PO TBCR $86.08 HCL 20 MG PO CAPS $23.15 NICARDIPINE HCL 30 MG PO CAPS $32.31 14 MG/24HR TD PT24 $22.24 NICOTINE 21 MG/24HR TD PT24 $22.24 NICOTINE 7 MG/24HR TD PT24 $29.11 NICOTINE POLACRILEX 2 MG MT GUM $5.71 10 MG PO CAPS $12.11 NIFEDIPINE 10 MG/ 0.34 ML CAP PEDIATRICS $12.11 NIFEDIPINE 20 MG PO CAPS $23.85 NIFEDIPINE ER 30 MG PO TB24 $15.21 NIFEDIPINE ER 60 MG PO TB24 $25.56 NIFEDIPINE ER 90 MG PO TB24 $35.60 NIMODIPINE 30 MG PO CAPS $159.31 NINTEDANIB ESYLATE 150 MG PO CAPS $1,743.88 NITAZOXANIDE 500 MG PO TABS $1,192.22 NITRIC OXIDE FOR INHALATION GAS $5,669.91 NITRIC OXIDE FOR INHALATION GAS $5,669.91 NITRIC OXIDE FOR INHALATION GAS CARDIAC CATH ONLY $356.20 NITROFURANTOIN MACROCRYSTAL 100 MG PO CAPS $34.09 NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS $28.24 NITROGLYCERIN 0.1 MG/HR TD PT24 $19.63 NITROGLYCERIN 0.2 MG/HR TD PT24 $20.04 NITROGLYCERIN 0.3 MG/HR TD PT24 $65.40 NITROGLYCERIN 0.4 MG SL SUBL $16.18 NITROGLYCERIN 0.4 MG SL SUBL $16.18 NITROGLYCERIN 0.4 MG/HR TD PT24 $22.62 NITROGLYCERIN 0.6 MG SL SUBL $8.46 NITROGLYCERIN 0.6 MG/HR TD PT24 $31.94 NITROGLYCERIN 0.8 MG/HR TD PT24 $70.76 NITROPRUSSIDE DRIP KIT $3,425.55 DRIP KIT $88.94 NORETHINDRONE ACET-ETHINYL EST 1-20 MG-MCG PO TABS $22.69 HCL 10 MG PO CAPS $6.14 NORTRIPTYLINE HCL 25 MG PO CAPS $10.34 NUTRISOURCE FIBER PO PACK $6.48 O-2 SUSPENSORY MISC $82.98 O-2 SUSPENSORY MISC $82.98 O-2 SUSPENSORY MISC $82.98 O-2 SUSPENSORY MISC $82.98 OCCULT BLOOD VI STRP $7.58 OCTREOTIDE ACETATE 20 MG IM KIT $35,600.06

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MEDICATION CHARGE OCTREOTIDE ACETATE 20 MG IM KIT $46,585.92 OCTREOTIDE ACETATE 30 MG IM KIT $60,429.34 OCTREOTIDE ACETATE 30 MG IM KIT $69,752.85 OLANZAPINE 1.25 MG (1/2 X 2.5 MG) PO TABS $58.92 OLANZAPINE 10 MG IM SOLR $404.79 OLANZAPINE 10 MG PO TABS $212.39 OLANZAPINE 10 MG PO TBDP $201.40 OLANZAPINE 2.5 MG PO TABS $108.43 OLANZAPINE 2.5MG (1/2 X 5MG) TBDP $166.63 OLANZAPINE 5 MG PO TABS $127.63 OLANZAPINE 5 MG PO TBDP $137.70 OLANZAPINE 7.5 MG PO TABS $154.90 OLMESARTAN MEDOXOMIL 10 MG (1/2 X 20 MG) PO TABS $31.83 OLMESARTAN MEDOXOMIL 20 MG PO TABS $61.70 OLMESARTAN MEDOXOMIL 40 MG PO TABS $112.65 OLMESARTAN MEDOXOMIL 5 MG (1/4 X 20 MG) PO TABS $16.89 OMALIZUMAB 150 MG SUBQ SOLR $12,390.62 OMEGA-3 FISH OIL 1000 MG PO CAPS $2.27 OMEGA-3 FISH OIL 1000 MG PO CAPS $2.51 20 MG PO CPDR $32.24 OMNI-STAT GRANULES 3 GRAM POUCH $667.65 ONABOTULINUMTOXINA 100 UNITS IJ SOLR $6,871.11 ONABOTULINUMTOXINA 200 UNITS IJ SOLR $13,729.72 ONDANSETRON 2 MG ODT (1/2 OF 4 MG ODT) $221.76 ONDANSETRON 4 MG PO TBDP $221.76 ONDANSETRON 8 MG PO TBDP $353.72 ONDANSETRON 8 MG PO TBDP $355.08 ONDANSETRON HCL 2 MG (1/2 X 4 MG) PO TABS $114.36 ONDANSETRON HCL 4 MG PO TABS $226.67 ONDANSETRON HCL 8 MG PO TABS $394.33 ONDANSETRON HCL 8 MG PO TABS $394.33 ONDANSETRON HCL 8 MG PO TABS $394.36 ONDANSETRON HCL 8 MG PO TABS $394.45 ONDANSETRON HCL 8 MG PO TABS $394.45 OSELTAMIVIR PHOSPHATE 30 MG PO CAPS $136.80 OSELTAMIVIR PHOSPHATE 75 MG PO CAPS $148.95 OXAZEPAM 10 MG PO CAPS $10.23 OXAZEPAM 15 MG PO CAPS $15.79 OXCARBAZEPINE 150 MG PO TABS $16.46 OXCARBAZEPINE 300 MG PO TABS $28.45 OXCARBAZEPINE 75 MG (1/2 X 150 MG) PO TABS $9.21 OXIDIZED CELLULOSE EX PADS $1,878.60 OXIDIZED CELLULOSE EX PADS 1 X 2 $817.67 OXIDIZED CELLULOSE EX PADS 2 X 4 $1,503.27 OXISENSORS NELLCOR $176.00 OXISENSORS NELLCOR $281.00 OXYBUTYNIN CHLORIDE 1.25 MG (1/4 X 5 MG) PO TABS $3.43 OXYBUTYNIN CHLORIDE 2.5 MG (1/2 X 5 MG) PO TABS $4.90 OXYBUTYNIN CHLORIDE 5 MG PO TABS $6.19 OXYBUTYNIN CHLORIDE 5 MG PO TABS $7.85 OXYBUTYNIN CHLORIDE ER 10 MG PO TB24 $33.22 OXYBUTYNIN CHLORIDE ER 10 MG PO TB24 $33.26 OXYBUTYNIN CHLORIDE ER 15 MG PO TB24 $76.37 OXYBUTYNIN CHLORIDE ER 5 MG PO TB24 $33.18 OXYCODONE HCL 2.5MG (1/2 X 5 MG) TAB $7.22 OXYCODONE HCL 30 MG PO TABS $36.08 OXYCODONE HCL 5 MG PO TABS $6.84 OXYCODONE HCL ER 10 MG PO T12A $43.90 OXYCODONE HCL ER 15 MG PO T12A $65.30

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MEDICATION CHARGE OXYCODONE HCL ER 20 MG PO T12A $82.18 OXYCODONE HCL ER 40 MG PO T12A $135.92 OXYCODONE HCL ER 80 MG PO T12A $235.72 OXYCODONE-ACETAMINOPHEN 2.5-162.5 MG (1/2 X 5-325) PO TABS $8.97 OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS $14.97 OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS $15.99 OXYGEN $197.19 PROTEIN-BOUND PART 100 MG IV SUSR $19,819.93 PAIN-EASE SPRAY FOR IV THERAPY $12.32 PALIFERMIN (KEPIVANCE) 5MG/ML DILUTION $27,779.40 PALIPERIDONE ER 3 MG PO TB24 $292.27 PANCRELIPASE (LIP-PROT-AMYL) 10440 UNITS PO TABS $35.49 PANCRELIPASE (LIP-PROT-AMYL) 10500 UNITS PO CPEP $36.22 PANCRELIPASE (LIP-PROT-AMYL) 12000 UNITS PO CPEP $35.37 PANCRELIPASE (LIP-PROT-AMYL) 16800 UNITS PO CPEP $56.97 PANCRELIPASE (LIP-PROT-AMYL) 21000 UNITS PO CPEP $70.49 PANCRELIPASE (LIP-PROT-AMYL) 24000-76000 UNITS PO CPEP $68.20 PANCRELIPASE (LIP-PROT-AMYL) 3000-9500 UNITS PO CPEP $16.07 PANCRELIPASE (LIP-PROT-AMYL) 4200 UNITS PO CPEP $15.65 PANCRELIPASE (LIP-PROT-AMYL) 6000 UNITS PO CPEP $18.67 PANTOPRAZOLE DRIP KIT 40MG/100ML $144.60 PANTOPRAZOLE SODIUM 40 MG IV SOLR $69.56 PANTOPRAZOLE SODIUM 40 MG PO PACK $165.68 PANTOPRAZOLE SODIUM 40 MG PO TBEC $52.04 PARAGARD INTRAUTERINE COPPER IU IUD $9,228.55 HCL 10 MG PO TABS $28.71 PAROXETINE HCL 20 MG PO TABS $75.30 PAROXETINE HCL 30 MG PO TABS $27.90 PAROXETINE HCL 40 MG PO TABS $24.06 PAROXETINE HCL 5 MG (1/2 X 10 MG) PO TABS $15.33 PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG PO TABS $100.64 PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG PO TABS $110.40 PEGINTERFERON ALFA-2B 150 MCG/0.5ML SUBQ KIT $9,948.93 PEGINTERFERON ALFA-2B 200 MCG SUBQ KIT $22,611.02 PEGINTERFERON ALFA-2B 300 MCG SUBQ KIT $33,910.23 PEGINTERFERON ALFA-2B 600 MCG SUBQ KIT $67,807.96 PEMBROLIZUMAB 50 MG IV SOLR $32,590.92 PEMETREXED DISODIUM 100 MG IV SOLR $10,083.00 PEMETREXED DISODIUM 500 MG IV SOLR $50,317.05 PEMETREXED DISODIUM 500 MG IV SOLR G-CMC $50,317.05 PENICILLAMINE 250 MG PO TABS $693.35 PENICILLIN G 5 MMU PIGGYBACK IN ACUDOSE $396.10 PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR $590.33 PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR $374.18 PENICILLIN V POTASSIUM 125 MG (1/2 X 250 MG) PO TABS $13.27 PENICILLIN V POTASSIUM 250 MG PO TABS $13.27 PENICILLIN V POTASSIUM 500 MG PO TABS $13.05 PENTAMIDINE ISETHIONATE 300 MG IJ SOLR $2,207.44 PENTAMIDINE ISETHIONATE 300 MG IN SOLR $1,917.07 PENTOSTATIN 10 MG IV SOLR $28,273.75 PENTOXIFYLLINE CR 200 MG (1/2 X 400 MG) PO TABS $9.90 PENTOXIFYLLINE ER 400 MG PO TBCR $57.52 PERCUSTAY CATHETER FASTENER $144.60 PERPHENAZINE 1 MG (1/2 X 2 MG) PO TABS $11.30 PERPHENAZINE 2 MG PO TABS $13.02 PERPHENAZINE 4 MG PO TABS $21.96 PH TEST VI TEST $380.26 PHENAZOPYRIDINE HCL 100 MG PO TABS $27.63 PHENAZOPYRIDINE HCL 50 MG (1/2 X 100 MG) PO TABS $4.37

Page 25 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE 16.2 MG PO TABS $6.80 PHENOBARBITAL 24.3 MG (1/4 X 97.2 MG) PO TABS $3.17 PHENOBARBITAL 32.4 MG PO TABS $8.05 PHENOBARBITAL 4.05 MG (1/4 X 16.2 MG) TAB $2.47 PHENOBARBITAL 48.6 MG (1/2 X 97.2 MG) PO TABS $4.39 PHENOBARBITAL 64.8 MG PO TABS $9.58 PHENOBARBITAL 8.1 MG (1/2 X 16.2 MG) PO TABS $2.99 PHENOBARBITAL 97.2 MG PO TABS $13.27 PHENOXYBENZAMINE HCL 10 MG PO CAPS $1,232.97 PHENTERMINE HCL 30 MG PO CAPS $14.24 PHENTOLAMINE MESYLATE 5 MG IJ SOLR $4,862.60 PHENYLEPHRINE DRIP KIT 40 MG/ 250 ML $563.99 25 MG (1/2 X 50 MG) PO CHEW $5.17 PHENYTOIN 50 MG PO CHEW $15.16 PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS $8.06 PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS $14.10 PHOSPHATE ION INJ FOR TPN $10.00 PHYTONADIONE 1.25 MG (1/4 X 5 MG) PO TABS $93.29 PHYTONADIONE 2.5 MG (1/2 X 5 MG) PO TABS $184.64 PHYTONADIONE 5 MG PO TABS $672.52 PILOCARPINE HCL 2.5 MG (1/2 X 5 MG) PO TABS $9.20 PILOCARPINE HCL 5 MG PO TABS $19.20 PIMOZIDE 2 MG PO TABS $28.76 PINDOLOL 2.5 MG (1/2 X 5 MG) PO TABS $7.18 PINDOLOL 5 MG PO TABS $14.50 PIOGLITAZONE HCL 15 MG PO TABS $68.59 PIOGLITAZONE HCL 30 MG PO TABS $84.53 PIOGLITAZONE HCL 45 MG PO TABS $21.54 PIOGLITAZONE HCL 7.5 MG (1/2 X 15 MG) PO TABS $35.24 PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR $147.98 PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR $193.13 POLYETHYLENE GLYCOL 3350 PO PACK $28.42 POLYMYXIN B SULFATE 500000 UNITS IJ SOLR $138.03 POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN $4.96 PORFIMER SODIUM 75 MG IV SOLR $233,125.42 POSACONAZOLE 100 MG PO TBEC $746.81 POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK $6.91 POTASSIUM BICARBONATE 25 MEQ PO TBEF $4.83 POTASSIUM CHLORIDE 25 MEQ PO PACK $138.34 POTASSIUM CHLORIDE CRYS ER 10 MEQ PO TBCR $7.83 POTASSIUM CHLORIDE ER 10 MEQ PO CPCR $11.04 POTASSIUM CHLORIDE ER 10 MEQ PO TB CR $5.66 POTASSIUM CHLORIDE ER 10 MEQ PO TBCR $7.32 POTASSIUM CHLORIDE ER 10 MEQ PO TBCR $7.32 POTASSIUM CHLORIDE ER 10 MEQ PO TBCR $11.04 POTASSIUM ION INJ FOR TPN $10.00 PRALIDOXIME CHLORIDE 1 G IV SOLR $1,001.92 PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS $30.00 PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS $76.14 PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS $30.00 PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG PO TABS $29.97 PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS $29.97 PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS $76.14 PRASUGREL HCL 10 MG PO TABS $74.76 PRASUGREL HCL 5 MG PO TABS $176.55 PRAVASTATIN SODIUM 10 MG PO TABS $29.46 PRAVASTATIN SODIUM 2.5 MG (1/4 X 10 MG) PO TABS $8.83 PRAVASTATIN SODIUM 20 MG PO TABS $25.68 PRAVASTATIN SODIUM 20 MG PO TABS $32.87

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MEDICATION CHARGE PRAVASTATIN SODIUM 40 MG PO TABS $47.32 PRAVASTATIN SODIUM 5 MG (1/2 X 10 MG) PO TABS $15.74 PRAVASTATIN SODIUM 80 MG PO TABS $47.54 PRAZIQUANTEL 600 MG PO TABS $949.59 PRAZOSIN HCL 1 MG PO CAPS $19.18 PRAZOSIN HCL 2 MG PO CAPS $25.95 PRAZOSIN HCL 5 MG PO CAPS $42.92 PREDNISONE 0.25 MG (1/4 X 1 MG) PO TABS $2.55 PREDNISONE 0.5 MG (1/2 X 1 MG) PO TABS $3.16 PREDNISONE 1 MG PO TABS $4.36 PREDNISONE 1.25 MG (1/2 X 2.5 MG) PO TABS $10.56 PREDNISONE 10 MG PO TABS $4.49 PREDNISONE 2.5 MG PO TABS $3.67 PREDNISONE 20 MG PO TABS $4.66 PREDNISONE 5 MG PO TABS $3.92 PREDNISONE 50 MG PO TABS $5.93 PREGABALIN 100 MG PO CAPS $86.76 PREGABALIN 200 MG PO CAPS $86.76 PREGABALIN 25 MG PO CAPS $86.76 PREGABALIN 50 MG PO CAPS $86.76 PREGABALIN 75 MG PO CAPS $86.76 PRENATAL 27-1 MG PO TABS $5.37 PRENATAL FORMULA 27-1 MG PO TABS $5.37 PRENATAL PLUS 27-1 MG PO TABS $5.15 PRIMAQUINE PHOSPHATE 26.3 MG PO TABS $21.17 PRIMIDONE 12.5 MG (1/4 X 50 MG) PO TABS $3.15 PRIMIDONE 125 MG (1/2 X 250 MG) PO TABS $6.69 PRIMIDONE 250 MG PO TABS $11.42 PRIMIDONE 50 MG PO TABS $6.73 PROBENECID 250 MG (1/2 X 500 MG) PO TABS $6.63 PROBENECID 500 MG PO TABS $11.30 PROCARBAZINE HCL 50 MG PO CAPS $1,119.41 PROCHLORPERAZINE 25 MG PR SUPP $118.52 PROCHLORPERAZINE MALEATE 10 MG PO TABS $11.19 PROCHLORPERAZINE MALEATE 5 MG PO TABS $11.91 200 MG VA SUPP $66.11 PROGESTERONE MICRONIZED 100 MG PO CAPS $21.92 PROGESTERONE MICRONIZED 200 MG PO CAPS $40.47 PROMETHAZINE HCL 12.5 MG PO TABS $6.61 PROMETHAZINE HCL 12.5 MG PR SUPP $170.32 PROMETHAZINE HCL 25 MG PO TABS $6.95 PROMETHAZINE HCL 25 MG PR SUPP $44.24 PROMETHAZINE HCL 6.25 MG (1/4 X 25 MG) PO TABS $3.21 PROPAFENONE HCL 150 MG PO TABS $6.11 PROPAFENONE HCL 75 MG (1/2 X 150 MG) PO TABS $4.03 HCL 10 MG PO TABS $4.98 PROPRANOLOL HCL 20 MG PO TABS $4.53 PROPRANOLOL HCL 40 MG PO TABS $5.85 PROPRANOLOL HCL 5 MG (1/2 X 10 MG) PO TABS $3.25 PROPRANOLOL HCL 60 MG PO TABS $18.52 PROPRANOLOL HCL 80 MG PO TABS $10.48 PROPRANOLOL HCL ER 60 MG PO CP24 $22.69 PROPRANOLOL HCL ER 80 MG PO CP24 $24.63 12.5 MG (1/4 X 50 MG) PO TABS $3.73 PROPYLTHIOURACIL 25 MG (1/2 X 50 MG) PO TABS $5.50 PROPYLTHIOURACIL 50 MG PO TABS $10.51 PROSOURCE PO PACK $7.66 PSEUDOEPHEDRINE HCL 30 MG PO TABS $2.25 PSEUDOEPHEDRINE HCL 60 MG PO TABS $2.42

Page 27 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE PYRAZINAMIDE 250 MG (1/2 X 500 MG) PO TABS $15.55 PYRAZINAMIDE 500 MG PO TABS $60.48 PYRIDOSTIGMINE BROMIDE 15 MG (1/4 X 60 MG) PO TABS $23.62 PYRIDOSTIGMINE BROMIDE 30 MG (1/2 X 60 MG) PO TABS $45.30 PYRIDOSTIGMINE BROMIDE 60 MG PO TABS $166.34 PYRIDOSTIGMINE BROMIDE 90 MG (1/2 X 180 MG) PO TBCR $119.91 PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR $237.87 PYRIDOXINE HCL 25 MG PO TABS $2.13 PYRIDOXINE HCL 25 MG PO TABS $2.27 PYRIMETHAMINE 25 MG PO TABS $8,560.95 QUETIAPINE FUMARATE 100 MG PO TABS $7.31 QUETIAPINE FUMARATE 12.5 MG (1/2 X 25 MG) PO TABS $20.95 QUETIAPINE FUMARATE 200 MG PO TABS $124.98 QUETIAPINE FUMARATE 25 MG PO TABS $39.95 QUETIAPINE FUMARATE 300 MG PO TABS $190.14 QUETIAPINE FUMARATE 50 MG PO TABS $64.40 QUETIAPINE FUMARATE 6.25 MG (1/4 X 25 MG) PO TABS $39.95 QUETIAPINE FUMARATE ER 300 MG PO TB24 $244.80 QUETIAPINE FUMARATE ER 50 MG PO TB24 $95.67 QUIKCLOT COMBAT GAUZE 3INX4YD ROLL $409.55 QUIKCLOT CONTROL 12IN X 12IN HEMOSTAT DRESSING $2,728.09 QUIKCLOT CONTROL 8INX8IN HEMOSTAT DRESSING $1,679.13 QUIKCLOT CONTROL ZFOLD 3IN X 2YARDS HEMOSTAT DRESSING $1,511.38 QUIKCLOT GAUZE 4INX4IN HEMOSTAT DRESSING $192.06 QUINAPRIL HCL 10 MG PO TABS $13.58 QUINAPRIL HCL 2.5 MG (1/2 X 5 MG) PO TABS $7.76 QUINAPRIL HCL 20 MG PO TABS $13.57 QUINAPRIL HCL 40 MG PO TABS $13.58 QUINAPRIL HCL 5 MG PO TABS $13.57 QUINIDINE GLUCONATE ER 324 MG PO TBCR $88.14 QUINIDINE SULFATE 100 MG (1/2 X 200 MG) PO TABS $2.91 QUINIDINE SULFATE 200 MG PO TABS $3.86 QUINIDINE SULFATE 300 MG PO TABS $5.63 QUININE SULFATE 324 MG PO CAPS $71.62 QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR $5,348.05 RABIES VACCINE, PCEC IM SUSR $3,847.79 RABIES VIRUS VACCINE, HDC IM INJ $3,885.54 RACEPINEPHRINE HCL 2.25 % IN NEBU $19.07 RADIAL GRAFT MIXTURE 100 ML $74.89 RALOXIFENE HCL 60 MG PO TABS $69.74 RALTEGRAVIR POTASSIUM 400 MG PO TABS $287.25 RAMELTEON 8 MG PO TABS $145.63 RAMIPRIL 1.25 MG PO CAPS $59.61 RAMIPRIL 2.5 MG PO CAPS $20.37 RAMIPRIL 5 MG PO CAPS $19.97 RANOLAZINE ER 500 MG PO TB12 $69.82 RASAGILINE MESYLATE 0.5 MG (1/2 X 1 MG) PO TABS $72.13 RASAGILINE MESYLATE 1 MG PO TABS $142.27 RASBURICASE 1.5 MG IV SOLR $9,459.38 RASBURICASE 7.5 MG IV SOLR $47,248.01 REMIFENTANIL HCL 1 MG IV SOLR $711.95 REMIFENTANIL HCL 2 MG IV SOLR $1,411.39 REMIFENTANIL HCL 5 MG IV SOLR $2,988.92 REPAGLINIDE 0.25 MG (1/2 X 0.5 MG) PO TABS $5.17 REPAGLINIDE 0.5 MG PO TABS $8.37 REPAGLINIDE 1 MG PO TABS $36.76 REPAGLINIDE 2 MG PO TABS $33.62 0.1 MG PO TABS $13.30 RESERPINE 0.25 MG PO TABS $17.61

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MEDICATION CHARGE RESOURCE GLUTASOLVE PO PACK $20.87 RIFABUTIN 150 MG PO CAPS $364.15 RIFAMPIN 150 MG PO CAPS $32.78 RIFAMPIN 300 MG PO CAPS $64.41 RIFAMPIN 600 MG IV SOLR $2,360.90 200 MG PO TABS $220.98 RIFAXIMIN 550 MG PO TABS $419.45 RILUZOLE 50 MG PO TABS $396.81 RISPERIDONE 0.125 MG (1/2 X 0.25 MG) PO TABS $20.50 RISPERIDONE 0.25 MG PO TABS $38.97 RISPERIDONE 0.25 MG PO TBDP $44.55 RISPERIDONE 0.25 MG PO TBDP $44.56 RISPERIDONE 0.5 MG PO TABS $42.58 RISPERIDONE 0.5 MG PO TBDP $48.70 RISPERIDONE 1 MG PO TABS $45.14 RISPERIDONE 1 MG PO TBDP $56.58 RISPERIDONE 2 MG PO TABS $206.22 RISPERIDONE 2 MG PO TBDP $90.76 RISPERIDONE MICROSPHERES 25 MG IM SUSR $5,187.37 RISPERIDONE MICROSPHERES 37.5 MG IM SUSR $7,775.13 RISPERIDONE MICROSPHERES 50 MG IM SUSR $10,362.99 RITONAVIR 100 MG PO TABS $99.78 RIVAROXABAN 10 MG PO TABS $161.37 RIVAROXABAN 10 MG PO TABS (STUDY MED) $1.93 RIVAROXABAN 15 MG PO TABS $161.37 RIVAROXABAN 15 MG PO TABS (STUDY MED) $1.93 RIVAROXABAN 20 MG PO TABS $161.37 RIVAROXABAN 20 MG PO TABS (STUDY MED) $1.93 RIVASTIGMINE 13.3 MG/24HR TD PT24 $248.14 RIVASTIGMINE 4.6 MG/24HR TD PT24 $248.14 RIVASTIGMINE 9.5 MG/24HR TD PT24 $248.14 RIVASTIGMINE TARTRATE 1.5 MG PO CAPS $42.31 RIVASTIGMINE TARTRATE 3 MG PO CAPS $42.31 ROFLUMILAST 250 MCG (1/2 X 500 MCG) PO TABS $55.40 ROFLUMILAST 500 MCG PO TABS $135.34 ROLAPITANT HCL 90 MG PO TABS $3,399.87 ROMIDEPSIN 10 MG IV SOLR $43,546.28 ROMIPLOSTIM 250 MCG SUBQ SOLR $20,604.88 ROPINIROLE HCL 0.125 MG (1/2 X 0.25 MG) PO TABS $21.21 ROPINIROLE HCL 0.25 MG PO TABS $66.08 ROPINIROLE HCL 0.5 MG PO TABS $25.74 ROPINIROLE HCL 1 MG PO TABS $25.77 ROPINIROLE HCL 2 MG PO TABS $25.73 ROSUVASTATIN CALCIUM 10 MG PO TABS $78.43 ROSUVASTATIN CALCIUM 2.5 MG (1/2 X 5 MG) PO TAB $35.92 ROSUVASTATIN CALCIUM 20 MG PO TABS $101.20 ROSUVASTATIN CALCIUM 40 MG PO TABS $101.20 ROSUVASTATIN CALCIUM 5 MG PO TABS $69.89 RUFINAMIDE 100 MG (1/2 X 200 MG) PO TABS $34.14 RUFINAMIDE 200 MG PO TABS $133.57 RUFINAMIDE 50 MG (1/4 X 200 MG) PO TABS $18.05 SACUBITRIL-VALSARTAN 24-26 MG PO TABS $90.06 SACUBITRIL-VALSARTAN 49-51 MG PO TABS $90.06 SACUBITRIL-VALSARTAN 97-103 MG PO TABS $90.06 SALMETEROL XINAFOATE 50 MCG/DOSE IN AEPB $92.48 SAQUINAVIR MESYLATE 200 MG PO CAPS $51.65 SARGRAMOSTIM 250 MCG IV SOLR $2,506.21 SCOPOLAMINE 1 MG/3DAYS TD PT72 $205.46 ACETATE (HUMAN) 16 MCG IV SOLR $6,003.80

Page 29 Geisinger Medical Center Hosptial MEDICATIONS PUBLISHED: January 1, 2019

MEDICATION CHARGE 6 MG/24HR TD PT24 $629.45 SELEGILINE HCL 1.25 MG (1/4 X 5 MG) PO TABS $9.00 SELEGILINE HCL 2.5 MG (1/2 X 5 MG) PO TABS $16.04 SELEGILINE HCL 5 MG PO CAPS $23.84 SELEGILINE HCL 5 MG PO TABS $30.12 50 MCG PO TABS $2.40 SELEXIPAG 200 MCG PO TABS $2,013.32 SENNA-DOCUSATE SODIUM 8.6-50 MG PO TABS $2.43 SENNOSIDES 8.6 MG PO TABS $2.68 SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS $2.43 HCL 100 MG PO TABS $27.74 SERTRALINE HCL 12.5 MG (1/2 X 25 MG) PO TABS $3.86 SERTRALINE HCL 25 MG PO TABS $29.03 SERTRALINE HCL 50 MG PO TABS $27.74 SEVELAMER CARBONATE 800 MG PO TABS $37.92 SEVELAMER HCL 400 MG PO TABS $42.22 SEVELAMER HCL 800 MG PO TABS $82.47 SILDENAFIL CITRATE 10 MG ( 1/2 X 20 MG) PO TAB $135.27 SILDENAFIL CITRATE 20 MG PO TABS $546.25 SILDENAFIL CITRATE 5 MG (1/4 X 20 MG) PO TAB $74.61 SILVER NITRATE-POT NITRATE 75-25 % EX MISC $8.85 SIMETHICONE 20 MG (1/4 X 80 MG) PO CHEW $2.10 SIMETHICONE 40 MG (1/2 X 80 MG) PO CHEW $2.26 SIMETHICONE 80 MG PO CHEW $2.55 10 MG PO TABS $28.47 SIMVASTATIN 2.5 MG (1/2 X 5 MG) PO TABS $3.12 SIMVASTATIN 20 MG PO TABS $48.75 SIMVASTATIN 40 MG PO TABS $48.58 SIMVASTATIN 5 MG PO TABS $4.29 SIMVASTATIN 80 MG PO TABS $48.75 SINCALIDE 5 MCG IJ SOLR $1,167.05 SINUS RINSE KIT NA PACK $8.23 0.5 MG PO TABS $82.54 SIROLIMUS 1 MG PO TABS $164.07 SITAGLIPTIN PHOSPHATE 100 MG PO TABS $165.37 SITAGLIPTIN PHOSPHATE 25 MG PO TABS $165.37 SITAGLIPTIN PHOSPHATE 50 MG PO TABS $165.37 SODIUM BICARBONATE 150 MEQ + D5W 1000 ML $347.14 SODIUM BICARBONATE 162.5 MG (1/2 X 325 MG) PO TABS $2.19 SODIUM BICARBONATE 325 MG PO TABS $2.22 SODIUM BICARBONATE 650 MG PO TABS $2.47 SODIUM CHLORIDE 1 G PO TABS $2.66 SODIUM CHLORIDE 250 MG (1/4 X 1 GM) PO TABS $2.07 SODIUM CHLORIDE 500 MG (1/2 X 1 GM) PO TABS $2.19 SODIUM ION INJ FOR TPN $10.00 SORBSAN WOUND DRESSING EX PADS $171.44 SOTALOL HCL 10 MG (1/8 X 80 MG) PO TABS $7.86 SOTALOL HCL 160 MG PO TABS $42.60 SOTALOL HCL 20 MG (1/4 X 80 MG) PO TABS $13.77 SOTALOL HCL 40 MG (1/2 X 80 MG) PO TABS $25.63 SOTALOL HCL 80 MG PO TABS $26.31 100 MG PO TABS $16.00 SPIRONOLACTONE 12.5 MG (1/2 X 25 MG) PO TABS $3.99 SPIRONOLACTONE 25 MG PO TABS $6.92 SPIRONOLACTONE 50 MG PO TABS $9.71 SPIRONOLACTONE 6.25 MG (1/4 X 25 MG) PO TABS $2.97 SPIRONOLACTONE-HCTZ 25-25 MG PO TABS $22.49 SPY-ELITE KIT 1 EACH $7,562.40 STAVUDINE 20 MG PO CAPS $82.98

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MEDICATION CHARGE STAVUDINE 30 MG PO CAPS $88.03 STAVUDINE 40 MG PO CAPS $89.62 STREPTOMYCIN SULFATE 1 G IM SOLR $1,040.00 STREPTOZOCIN 1 G IV SOLR $939.06 SUB Q BUTTON $83.93 SUCCIMER 100 MG PO CAPS $96.01 1 G PO TABS $5.56 SUCRALFATE 250 MG (1/4 X 1 GM) PO TABS $2.90 SUCRALFATE 500 MG (1/2 X 1 GM) PO TABS $3.76 SULFADIAZINE 500 MG PO TABS $49.95 SULFAMETHOXAZOLE-TRIMETHOPRIM 100-20 MG (1/4 X 400-80 MG) PO TABS $3.53 SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG (1/2 X 400-80 MG) PO TABS $5.12 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS $9.34 SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS $15.65 SULFASALAZINE 125 MG (1/4 X 500 MG) PO TABS $2.56 SULFASALAZINE 250 MG (1/2 X 500 MG) PO TABS $3.17 SULFASALAZINE 500 MG PO TABS $4.26 SULFASALAZINE 500 MG PO TBEC $24.45 SUMATRIPTAN 20 MG/ACT NA SOLN $905.18 SUMATRIPTAN 5 MG/ACT NA SOLN $905.18 SUMATRIPTAN SUCCINATE 12.5 MG (1/2 X 25 MG) PO TABS $136.28 SUMATRIPTAN SUCCINATE 25 MG PO TABS $270.61 SUMATRIPTAN SUCCINATE 50 MG PO TABS $241.03 SUNITINIB MALATE 12.5 MG PO CAPS $1,994.22 SUNITINIB MALATE 25 MG PO CAPS $3,986.50 SUNITINIB MALATE 50 MG PO CAPS $6,938.49 SURGICEL 0.5X2 ABSORB HEMOSTAT $237.68 SURGICEL 1X2 FIBRILLAR $817.67 SURGICEL 2X3 ABSORB HEMOSTAT $481.54 SURGICEL 4X8 ABSORB HEMOSTAT $877.85 SURGICEL 6X9 NU-KNIT $1,825.68 SURGIFOAM ADSORBABLE GELATIN POWDER $552.77 T.E.D. KNEE LENGTH 2X-LARGE $94.48 T.E.D. KNEE LENGTH 3X-LARGE $97.91 T.E.D. KNEE LENGTH/L-LONG MISC $34.92 T.E.D. KNEE LENGTH/L-REGULAR MISC $69.05 T.E.D. KNEE LENGTH/M-REGULAR MISC $34.92 T.E.D. KNEE LENGTH/S-REGULAR MISC $34.92 T.E.D. KNEE LENGTH/XL-REGULAR MISC $69.05 T.E.D. THIGH BELTED/XL-LONG MISC $80.96 T.E.D. THIGH BELTED/XL-REGULAR MISC $80.96 T.E.D. THIGH LENGTH/L-REGULAR MISC $77.19 T.E.D. THIGH LENGTH/M-REGULAR MISC $98.56 T.E.D. THIGH LENGTH/S-REGULAR MISC $98.56 0.5 MG CAPS FOR SUBLINGUAL USE $23.16 TACROLIMUS 0.5 MG PO CAPS $23.16 TACROLIMUS 0.5 MG PO CP24 $28.83 TACROLIMUS 0.75 MG PO TB24 $44.18 TACROLIMUS 1 MG CAPS FOR SUBLINGUAL USE $44.36 TACROLIMUS 1 MG PO CAPS $44.36 TACROLIMUS 1 MG PO CP24 $55.70 TACROLIMUS 1 MG PO TB24 $58.27 TACROLIMUS 5 MG PO CAPS $214.00 TACROLIMUS 5 MG PO CAPS FOR SUBLINGUAL USE $214.00 TACROLIMUS 5 MG PO CP24 $270.68 TALC 2 G PL POWD $1,143.15 TALC 2 G PL POWD $1,143.15 TALC 4 G PLEURAL $1,599.63 TALC 5 G PL SUSR $810.30

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MEDICATION CHARGE TALC 5 G PL SUSR $929.18 TALIGLUCERASE ALFA 200 UNITS IV SOLR $8,907.58 TAMOXIFEN CITRATE 10 MG PO TABS $7.41 TAMOXIFEN CITRATE 2.5 MG (1/4 X 10 MG) PO TABS $3.32 TAMOXIFEN CITRATE 5 MG (1/2 X 10 MG) PO TABS $4.68 TAMSULOSIN HCL 0.4 MG PO CAPS $41.98 20 MG PO TABS $54.45 TELMISARTAN 40 MG PO TABS $54.45 TELMISARTAN 80 MG PO TABS $54.45 TEMAZEPAM 15 MG PO CAPS $8.94 TEMAZEPAM 30 MG PO CAPS $9.87 TEMAZEPAM 7.5 MG PO CAPS $96.48 TEMOZOLOMIDE 20 MG PO CAPS $665.57 TEMOZOLOMIDE 5 MG PO CAPS $116.43 TENECTEPLASE 50 MG IV KIT $66,908.12 TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS $435.69 TERAZOSIN HCL 1 MG PO CAPS $17.21 TERAZOSIN HCL 5 MG PO CAPS $17.22 TERBINAFINE HCL 250 MG PO TABS $125.80 TERBUTALINE SULFATE 2.5 MG PO TABS $53.70 TERBUTALINE SULFATE 5 MG PO TABS $65.15 2 MG/24HR TD PT24 $108.93 TESTOSTERONE 4 MG/24HR TD PT24 $215.92 TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM INJ $5,696.06 HCL 250 MG PO CAPS $76.84 TETRACYCLINE HCL 500 MG PO CAPS $151.73 THEOPHYLLINE 200 MG (1/2 X 400 MG) PO TB24 $8.41 THEOPHYLLINE ER 100 MG PO CP24 $19.12 THEOPHYLLINE ER 150 MG (1/2 X 300 MG) PO TAB TB12 $3.92 THEOPHYLLINE ER 200 MG PO CP24 $27.46 THEOPHYLLINE ER 225 MG (1/2 X 450 MG) PO TAB TB12 $6.46 THEOPHYLLINE ER 300 MG PO TB12 $42.80 THEOPHYLLINE ER 400 MG PO TB24 $14.86 THEOPHYLLINE ER 450 MG PO TB12 $59.44 THERAPEUTIC-M PO TABS $2.97 THIAMINE HCL 100 MG PO TABS $2.84 THIOGUANINE 20 MG (1/2 X 40 MG) PO TABS $73.62 THIOGUANINE 40 MG PO TABS $290.42 THIORIDAZINE HCL 25 MG PO TABS $9.92 THIORIDAZINE HCL 50 MG PO TABS $11.01 THIOTEPA 15 MG IJ SOLR $8,871.01 THIOTHIXENE 1 MG PO CAPS $13.25 THIOTHIXENE 10 MG PO CAPS $50.53 THIOTHIXENE 5 MG PO CAPS $24.60 THROMBIN (RECOMB)SPRAY APPLICATOR DEVICE $59.01 THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR $993.93 THROMBIN 5000 UNITS EX SOLR $831.50 15 MG PO TABS $8.65 THYROID 30 MG PO TABS $9.81 THYROID 60 MG PO TABS $10.68 THYROTROPIN ALFA 1.1 MG IM SOLR $16,981.53 TIAGABINE HCL 12 MG PO TABS $92.79 TIAGABINE HCL 2 MG (1/2 X 4 MG) PO TABS $33.79 TIAGABINE HCL 4 MG PO TABS $65.63 TICAGRELOR 60 MG PO TABS $69.08 TICAGRELOR 90 MG PO TABS $69.07 TIGECYCLINE 50 MG IV SOLR $2,070.81 TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS $181.71 TISSEEL DUPLOCATH DRIP APPLICATOR 921020 $532.99

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MEDICATION CHARGE TISSEEL DUPLOSPRAY APPLICATOR 40CM KIT 0601130MR $9,001.07 TISSEEL TIP SPRAY DUPL 40CM 0601130 $901.86 TISSEEL TIP SPRAY KIT 0600065PR $5,010.30 TISSEEL TIP SPRAY SET 0600065 $502.79 TISSEEL VH 4 ML EX KIT $2,924.94 TIZANIDINE HCL 0.5 MG (1/4 X 2 MG) PO TABS $7.09 TIZANIDINE HCL 1 MG (1/4 X 4 MG) PO TABS $5.43 TIZANIDINE HCL 2 MG (1/2 X 4 MG) PO TABS $8.92 TIZANIDINE HCL 4 MG PO TABS $15.88 TO GO ACETAZOLAMIDE ER 500 MG #2 CAPSULE $159.32 TO GO ALBUTEROL HFA INHALER $579.97 TO GO AMOXICILLIN 250 MG/5ML 150ML $87.54 TO GO AUGMENTIN 875MG #1 TAB $50.00 TO GO CEPHALEXIN #8 250MG CAPS $8.55 TO GO CIPROFLOXACIN 250 MG #2 TABS $89.33 TO GO LEVOFLOXACIN 750 MG #1 TAB $189.65 TO GO OFLOXACIN OPHTH SOLN $215.93 TO GO ONDANSETRON ODT 4MG #2 $213.55 TO GO ONDANSETRON ODT 8MG #2 $708.16 TO GO OXYCODONE 5 MG IMMED RELEASE TAB/CAP $21.26 TO GO OXYCODONE-ACETAMINOPHEN #6 5-325 MG TAB $76.13 TO GO POLYTRIM OPHTHALMIC SOLUTION $129.77 TO GO SULFAMETHOX/TMP #4 800-160 TABS $15.65 TO GO TRAMADOL 50 MG #3 TABS $24.66 TOBRAMYCIN BEADS 6.4 MM STRING $1,190.70 TOBRAMYCIN SULFATE 1.2 G IJ SOLR $2,009.60 TOLMETIN SODIUM 200 MG PO TABS $9.08 TOLTERODINE TARTRATE 0.5 MG (1/2 OF 1 MG) PO TABS $17.85 TOLTERODINE TARTRATE 1 MG PO TABS $33.75 TOLTERODINE TARTRATE 2 MG PO TABS $85.80 TOLTERODINE TARTRATE ER 2 MG PO CP24 $117.02 TOLTERODINE TARTRATE ER 4 MG PO CP24 $117.33 TOLVAPTAN 15 MG PO TABS $4,901.46 TOLVAPTAN 30 MG PO TABS $5,084.63 TOPIRAMATE 100 MG PO TABS $68.04 TOPIRAMATE 12.5 MG (1/2 X 25 MG) PO TABS $14.10 TOPIRAMATE 15 MG PO CPSP $24.95 TOPIRAMATE 200 MG PO TABS $79.56 TOPIRAMATE 25 MG PO TABS $26.25 TOPIRAMATE 25 MG TAB FOR QSYMIA DISCONTINUATION $26.25 TOPOTECAN HCL 4 MG IV SOLR $1,808.71 TOPOTECAN HCL 4 MG IV SOLR $3,518.53 TORSEMIDE 10 MG PO TABS $8.64 TORSEMIDE 100 MG PO TABS $30.86 TORSEMIDE 2.5 MG (1/2 OF 5 MG) PO TABS $4.98 TORSEMIDE 20 MG PO TABS $9.76 TORSEMIDE 5 MG PO TABS $7.99 TRABECTEDIN 1 MG IV SOLR $42,625.21 TRAMADOL 25 MG (1/2 X 50MG) PO TABS $2.36 TRAMADOL HCL 12.5 MG (1/4 X 50 MG) PO TABS $2.16 TRAMADOL HCL 50 MG PO TABS $2.77 TRAMADOL HCL ER 100 MG PO TB24 $36.56 TRAMADOL HCL ER 200 MG PO TB24 $59.17 SULFATE 10 MG PO TABS $65.97 TRASTUZUMAB 150 MG IV SOLR $17,797.15 TRASTUZUMAB 440 MG IV SOLR $47,753.65 HCL 100 MG PO TABS $9.41 TRAZODONE HCL 12.5 MG (1/4 X 50 MG) PO TABS $2.99 TRAZODONE HCL 25 MG (1/2 X 50 MG) PO TABS $4.02

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MEDICATION CHARGE TRAZODONE HCL 50 MG PO TABS $6.09 TRETINOIN 10 MG PO CAPS $357.17 TRIAMTERENE-HCTZ 18.75-12.5 MG (1/4 X 75-50 MG) PO TABS $4.12 TRIAMTERENE-HCTZ 37.5-25 MG PO TABS $5.69 TRIAMTERENE-HCTZ 75-50 MG PO TABS $10.61 TRIAMTERENE-HCTZ 75-50 MG PO TABS $10.64 TRIFLUOPERAZINE HCL 1 MG PO TABS $10.27 TRIFLUOPERAZINE HCL 10 MG PO TABS $20.04 TRIFLUOPERAZINE HCL 2 MG PO TABS $14.21 TRIFLUOPERAZINE HCL 5 MG PO TABS $17.38 TRIHEXYPHENIDYL HCL .5 MG (1/4 X 2 MG) PO TABS $2.39 TRIHEXYPHENIDYL HCL 1 MG (1/2 X 2 MG) PO TABS $2.83 TRIHEXYPHENIDYL HCL 2 MG PO TABS $3.69 TRIHEXYPHENIDYL HCL 2.5 MG (1/2 X 5 MG) PO TABS $3.68 TRIHEXYPHENIDYL HCL 5 MG PO TABS $5.41 TRIMETHOBENZAMIDE HCL 300 MG PO CAPS $53.74 TRIMETHOPRIM 100 MG PO TABS $8.45 TRIPTORELIN PAMOATE 11.25 MG IM SUSR $27,854.55 TRIPTORELIN PAMOATE 3.75 MG IM SUSR $9,293.21 TUCKS 50 % EX PADS $2.84 ULIPRISTAL ACETATE 30 MG PO TABS $409.93 UMECLIDINIUM BROMIDE 62.5 MCG/INH IN AEPB $113.92 UMECLIDINIUM-VILANTEROL 62.5-25 MCG/INH IN AEPB $79.87 UNASYN 1.5 GM PIGGYBACK IN ACUDOSE $177.65 UNASYN 3 GM PIGGYBACK IN ACUDOSE $179.66 UREA 15 G PO PACK $41.89 URSODIOL 300 MG PO CAPS $71.86 VALACYCLOVIR HCL 1 G PO TABS $122.18 VALACYCLOVIR HCL 250 MG (1/2 X 500 MG) PO TABS $36.30 VALACYCLOVIR HCL 500 MG PO TABS $70.65 VALACYCLOVIR HCL 500 MG PO TABS $70.65 VALGANCICLOVIR HCL 450 MG PO TABS $614.37 VALPROIC ACID 250 MG PO CAPS $9.80 VALSARTAN 10 MG (1/4 X 40 MG) PO TABS $11.31 VALSARTAN 160 MG PO TABS $92.88 VALSARTAN 20 MG (1/2 X 40 MG) PO TABS $20.67 VALSARTAN 40 MG PO TABS $72.69 VALSARTAN 80 MG PO TABS $48.05 VALSARTAN-HYDROCHLOROTHIAZIDE 160-12.5 MG PO TABS $42.64 VALSARTAN-HYDROCHLOROTHIAZIDE 40-6.25 MG (1/2 X 80-12.5 MG) PO TABS $39.31 VALSARTAN-HYDROCHLOROTHIAZIDE 80-12.5 MG PO TABS $39.35 VANCOMYCIN 1 GM PIGGYBACK IN ACUDOSE $335.27 VANCOMYCIN HCL 1 G IV SOLR $193.95 VANCOMYCIN HCL 10 G IV SOLR $2,437.55 VANCOMYCIN HCL 125 MG PO CAPS $299.67 VANCOMYCIN HCL 5 G IV SOLR $1,058.08 VANCOMYCIN HCL 500 MG IV SOLR $118.24 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SUBQ INJ $1,393.04 VARICELLA-ZOSTER IMMUNE GLOB 125 UNITS IM SOLR $7,801.19 VECURONIUM BROMIDE 10 MG IV SOLR $69.56 VECURONIUM BROMIDE 20 MG IV SOLR $126.62 VEDOLIZUMAB 300 MG IV SOLR $69,597.93 VENETOCLAX 100 MG PO TABS $1,062.36 HCL 12.5 MG (1/2 X 25 MG) PO TABS $11.19 VENLAFAXINE HCL 18.75 MG (1/4 X 75 MG) PO TABS $7.14 VENLAFAXINE HCL 25 MG PO TABS $20.43 VENLAFAXINE HCL 37.5 MG PO TABS $20.97 VENLAFAXINE HCL 50 MG PO TABS $21.55 VENLAFAXINE HCL 75 MG PO TABS $22.73

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MEDICATION CHARGE VENLAFAXINE HCL ER 150 MG PO CP24 $8.63 VENLAFAXINE HCL ER 37.5 MG PO CP24 $41.55 VENLAFAXINE HCL ER 75 MG PO CP24 $41.86 VERAPAMIL HCL 10 MG (1/4 X 40 MG) PO TABS $2.61 VERAPAMIL HCL 120 MG PO TABS $9.08 VERAPAMIL HCL 20 MG (1/2 X 40 MG) PO TABS $3.26 VERAPAMIL HCL 40 MG PO TABS $4.58 VERAPAMIL HCL 60 MG (1/2 X 120 MG) PO TABS $5.52 VERAPAMIL HCL 80 MG PO TABS $7.37 VERAPAMIL HCL CR 60 MG (1/2 X 120 MG) PO TBCR $6.41 VERAPAMIL HCL CR 90 MG (1/2 X 180 MG) PO TBCR $8.80 VERAPAMIL HCL ER 120 MG PO TBCR $23.98 VERAPAMIL HCL ER 180 MG PO TBCR $15.64 VERAPAMIL HCL ER 240 MG PO TBCR $26.06 VERTEPORFIN 15 MG IV SOLR $18,893.75 V-GO 20 KIT $138.04 VIGABATRIN 500 MG PO PACK $1,519.23 VIGABATRIN 500 MG PO TABS $1,519.23 VINCRISTINE SULFATE LIPOSOME 5 MG/31ML IV SUSP $204,573.42 VITAMIN A 10000 UNITS PO CAPS $2.30 VITAMIN B-1 25 MG (1/2 X 50 MG) PO TABS $2.06 VITAMIN B-1 50 MG PO TABS $2.16 VITAMIN B-12 100 MCG PO TABS $2.17 VITAMIN B-12 25 MCG (1/4 X 100 MCG) PO TAB $2.07 VITAMIN B-12 250 (1/2 X 500 MCG) PO TABS $2.12 VITAMIN B-12 50 MCG (1/2 X 100MCG) PO TABS $2.20 VITAMIN B-12 500 MCG PO TABS $2.29 VITAMIN B-2 100 MG PO TABS $2.54 VITAMIN B-2 100 MG PO TABS $2.79 VITAMIN B-2 25 MG (1/4 X 100 MG) PO TABS $2.14 VITAMIN B-2 50 MG (1/2 X 100 MG) PO TABS $2.37 VITAMIN B-6 100 MG PO TABS $2.26 VITAMIN C 125 MG (1/2 X 250 MG) PO TABS $2.08 VITAMIN C 250 MG PO TABS $2.24 VITAMIN C 500 MG PO TABS $2.40 VITAMIN D2 (ERGOCALCIFEROL)50000 UNIT PO CAPS $20.70 VITAMIN D3 1000 UNITS PO TABS $2.49 VITAMIN E 100 UNITS PO CAPS $2.25 VITAMIN E 400 UNITS PO CAPS $3.00 VIVONEX PEDIATRIC PO PACK $59.11 VIVONEX PLUS PO PACK $91.23 VORICONAZOLE 100 MG (1/2 X 200 MG ) PO TABS $224.99 VORICONAZOLE 200 MG IV SOLR $1,974.67 VORICONAZOLE 200 MG PO TABS $479.78 VORICONAZOLE 50 MG PO TABS $94.35 VORICONAZOLE 50 MG PO TABS $121.41 WARFARIN SODIUM 0.5 MG (1/2 X 1MG) PO TABS $4.84 WARFARIN SODIUM 1 MG PO TABS $7.73 WARFARIN SODIUM 1.25 MG (1/2 X 2.5 MG) PO TABS $5.06 WARFARIN SODIUM 1.5 MG (1/2 X 3 MG) PO TABS $5.08 WARFARIN SODIUM 10 MG PO TABS $11.43 WARFARIN SODIUM 2 MG PO TABS $7.99 WARFARIN SODIUM 2.5 MG PO TABS $8.17 WARFARIN SODIUM 3 MG PO TABS $8.20 WARFARIN SODIUM 3.75 MG (1/2 X 7.5 MG) PO TABS $6.50 WARFARIN SODIUM 4 MG PO TABS $8.22 WARFARIN SODIUM 5 MG PO TABS $8.36 WARFARIN SODIUM 6 MG PO TABS $35.97 WARFARIN SODIUM 7.5 MG PO TABS $10.72

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MEDICATION CHARGE WARFARIN SODIUM 7.5 MG PO TABS $11.03 XEROFORM PETROLATUM DRESSING EX PADS 1X8 $8.74 XEROFORM PETROLATUM DRESSING EX PADS 1X8 $8.74 XEROFORM PETROLATUM DRESSING EX PADS 1X8 $23.97 XEROFORM PETROLATUM DRESSING EX PADS 5X9 $11.93 YELLOW VACCINE IJ SUSR $1,617.69 YELLOW FEVER VACCINE SUBQ INJ $1,607.16 10 MG (1/2 X 20 MG) PO TABS $12.23 ZAFIRLUKAST 20 MG PO TABS $30.39 ZANAMIVIR 5 MG/BLISTER IN AEPB $35.62 ZILEUTON ER 600 MG PO TB12 $359.43 ZINC 50 MG PO TABS $2.36 ZINC GLUCONATE 12.5 MG (1/4 X 50 MG) PO TABS $2.03 ZINC GLUCONATE 25 MG (1/2 X 50 MG) PO TABS $2.11 ZINC GLUCONATE 25 MG (1/2 X 50 MG) PO TABS $2.16 ZINC GLUCONATE 50 MG PO TABS $2.22 ZINC SULFATE 220 (50 ZN) MG PO CAPS $3.06 ZIPRASIDONE HCL 20 MG PO CAPS $82.46 ZIPRASIDONE HCL 40 MG PO CAPS $82.46 ZIPRASIDONE HCL 60 MG PO CAPS $99.65 ZIPRASIDONE HCL 80 MG PO CAPS $99.65 ZIPRASIDONE MESYLATE 20 MG IM SOLR $579.45 ZOLPIDEM TARTRATE 1.25 MG (1/4 X 5 MG) PO TABS $12.98 ZOLPIDEM TARTRATE 2.5 MG (1/2 X 5 MG) PO TABS $23.95 ZOLPIDEM TARTRATE 5 MG PO TABS $45.89 ZONISAMIDE 100 MG PO CAPS $20.73 ZONISAMIDE 25 MG PO CAPS $127.41 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR $1,610.18 ZOSTER VACCINE LIVE 19400 UNT/0.65ML SUBQ SUSR $2,439.44 ZOSYN 4.5 GM PIGGYBACK IN ACUDOSE $348.21

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