{"hospital_name":"Regents of the University of California at Irvine Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Regents of the University of California at Irvine Hospital"],"hospital_address":["101 City Drive South, Orange, CA 92868"],"license_information":{"license_number":"060000148","state":"CA"},"type_2_npi":["1689608150"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Randolph Siwabessy"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Pacific of California","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alpha Care Medical Group","plan_name":"Medicare Managed 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is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Monarch Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"PACE Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caremore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Local Plus Other Commercial 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presented in the standard charge value."},{"payer_name":"MemorialCare Medical Foundation","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orange County Advantage Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health Plan","plan_name":"Circle Network EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Select","plan_name":"Oscar Select EPO EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Premier Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"121197121","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"536012297","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"39328003105","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"57237030416","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"66689005401","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100","type":"CDM"},{"code":"68094065059","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"}]},{"description":"ETOPOSIDE 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10001","type":"CDM"},{"code":"378326694","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":19.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":57.41,"discounted_cash":22.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":78.25,"discounted_cash":31.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"FACTOR IX COMPLEX 1000 U IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10008","type":"CDM"},{"code":"68516320202","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 UNITS"}]},{"description":"FAMOTIDINE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10009","type":"CDM"},{"code":"10019004501","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"65862085901","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"68001024000","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"67877084210","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"68001039700","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"904719361","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"68001039708","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"172572860","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"63739064510","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"46122073771","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"50268029911","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"50268030311","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"50268030315","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"51079096601","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"51079096617","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"51079096620","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"60687059501","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"60687059511","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"61442012101","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"378302001","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"62332000131","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAMOTIDINE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"62332000191","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FAMOTIDINE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10012","type":"CDM"},{"code":"68001039800","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10014","type":"CDM"},{"code":"338051903","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10014","type":"CDM"},{"code":"338051909","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10014","type":"CDM"},{"code":"338051948","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"FELBAMATE 600 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10023","type":"CDM"},{"code":"51525044203","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"},{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"}]},{"description":"FELBAMATE 600 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10023","type":"CDM"},{"code":"70954005110","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"}]},{"description":"FELBAMATE 600 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10023","type":"CDM"},{"code":"51525044208","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"}]},{"description":"FELBAMATE 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10024","type":"CDM"},{"code":"72578005601","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FELBAMATE 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10025","type":"CDM"},{"code":"72578005701","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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NDC EA = 30 EACH"}]},{"description":"LURASIDONE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100549","type":"CDM"},{"code":"63402030230","type":"NDC"}],"standard_charges":[{"gross_charge":42.76,"discounted_cash":17.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":7.54,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LURASIDONE HCL 20 MG PO 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NDC EA = 100 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"904734661","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"50111064801","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SITAGLIP PHOS-METFORMIN HCL ER 50-1000 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100858","type":"CDM"},{"code":"6008061","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SITAGLIP PHOS-METFORMIN HCL ER 100-1000 MG PO 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| NDC EA = 1 EACH"}]},{"description":"OPTICHAMBER DIAMOND-MD MASK MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100963","type":"CDM"},{"code":"8373982600","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.64,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OPTICHAMBER DIAMOND-MD MASK MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100964","type":"CDM"},{"code":"8373982700","type":"NDC"}],"standard_charges":[{"gross_charge":16.94,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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NDC EA = 100 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"24385048447","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"904673080","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"904673061","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"904198861","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"64720033105","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"9001201","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"50268040511","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"54505033105","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"59651041350","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"60687084411","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"64380097025","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10209","type":"CDM"},{"code":"42543014050","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"HYDROCORTISONE 100 MG/60ML RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10210","type":"CDM"},{"code":"62559013807","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"HYDROCORTISONE VALERATE 0.2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10218","type":"CDM"},{"code":"45802045537","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"AKWA TEARS 83-15 % OP 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10226","type":"CDM"},{"code":"406324901","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLORANEX PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102291","type":"CDM"},{"code":"64980012950","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"83980000101","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"378037301","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"904650861","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"57664076188","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"68084026911","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.76,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10235","type":"CDM"},{"code":"69238154401","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYUREA 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10236","type":"CDM"},{"code":"68084028411","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROXYUREA 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10236","type":"CDM"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYUREA 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10236","type":"CDM"},{"code":"904693961","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROXYUREA 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10236","type":"CDM"},{"code":"68084028401","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"IBUPROFEN 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10245","type":"CDM"},{"code":"573176920","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68094060061","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68094060059","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"121091405","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"121183605","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"472127094","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"904530909","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"24385090526","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68094003701","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68001052194","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"60687074340","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"60687074317","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"45802095243","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"63323014210","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":28.9,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":18.19,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"63323014212","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"10019092501","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":30.69,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.99,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"10019092582","type":"NDC"}],"standard_charges":[{"gross_charge":30.69,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.99,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.41,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"338399101","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.99,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":33.18,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10249","type":"CDM"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":50.9,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":89.52,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.52,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10249","type":"CDM"},{"code":"338399301","type":"NDC"}],"standard_charges":[{"gross_charge":24.52,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":50.9,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":94.55,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10249","type":"CDM"},{"code":"10019092616","type":"NDC"}],"standard_charges":[{"gross_charge":89.52,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.52,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":20.75,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10258","type":"CDM"},{"code":"944265908","type":"NDC"}],"standard_charges":[{"gross_charge":1541.53,"discounted_cash":616.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2003.95,"discounted_cash":801.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10258","type":"CDM"},{"code":"944265804","type":"NDC"}],"standard_charges":[{"gross_charge":2003.95,"discounted_cash":801.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1541.53,"discounted_cash":616.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10261","type":"CDM"},{"code":"944265603","type":"NDC"}],"standard_charges":[{"gross_charge":770.76,"discounted_cash":308.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":733.95,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INDAPAMIDE 1.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10264","type":"CDM"},{"code":"378006901","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"INDOMETHACIN SODIUM 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10267","type":"CDM"},{"code":"63323065903","type":"NDC"}],"standard_charges":[{"gross_charge":208.97,"discounted_cash":83.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":478.21,"discounted_cash":191.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":187.94,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INDOMETHACIN SODIUM 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10267","type":"CDM"},{"code":"68382047001","type":"NDC"}],"standard_charges":[{"gross_charge":62.13,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":81.49,"discounted_cash":32.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INDOMETHACIN SODIUM 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10267","type":"CDM"},{"code":"409111301","type":"NDC"}],"standard_charges":[{"gross_charge":237.04,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":180.12,"discounted_cash":72.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1027","type":"CDM"},{"code":"168005546","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1027","type":"CDM"},{"code":"168005515","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLORBETAPIR F 18 500-1900 MBQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102700","type":"CDM"},{"code":"2120001","type":"NDC"}],"standard_charges":[{"gross_charge":301.9,"discounted_cash":120.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1028","type":"CDM"},{"code":"168005760","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"INSULIN ISOPHANE HUMAN 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10284","type":"CDM"},{"code":"169183411","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ISOPHANE HUMAN 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10284","type":"CDM"},{"code":"2831501","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.86,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.15,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ISOPHANE HUMAN 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10284","type":"CDM"},{"code":"2831517","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10286","type":"CDM"},{"code":"169183711","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10286","type":"CDM"},{"code":"2871501","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":10.77,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10286","type":"CDM"},{"code":"2871517","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":10.77,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10289","type":"CDM"},{"code":"2821501","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.24,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10289","type":"CDM"},{"code":"169183311","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.36,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10289","type":"CDM"},{"code":"2021301","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10289","type":"CDM"},{"code":"2821517","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":3.59,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1029","type":"CDM"},{"code":"168005646","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1029","type":"CDM"},{"code":"472038115","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1029","type":"CDM"},{"code":"168005615","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":2.06,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"INTERFERON ALFA-2B 10 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10299","type":"CDM"},{"code":"85057102","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 10 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10299","type":"CDM"},{"code":"85435001","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"713011850","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"713011806","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"45802073200","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 18000000 UNIT IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10300","type":"CDM"},{"code":"85111001","type":"NDC"}],"standard_charges":[{"gross_charge":500.32,"discounted_cash":200.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 50 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10304","type":"CDM"},{"code":"85435201","type":"NDC"}],"standard_charges":[{"gross_charge":299.17,"discounted_cash":119.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":268.27,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 50 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10304","type":"CDM"},{"code":"85053901","type":"NDC"}],"standard_charges":[{"gross_charge":340.28,"discounted_cash":136.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CULTURELLE KIDS PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103062","type":"CDM"},{"code":"49100040008","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.66,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"IOHEXOL 140 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10318","type":"CDM"},{"code":"407140152","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10319","type":"CDM"},{"code":"407141120","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":2.00,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"IOHEXOL 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10319","type":"CDM"},{"code":"407141110","type":"NDC"}],"standard_charges":[{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141490","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141491","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141472","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141489","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141493","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141488","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141498","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141494","type":"NDC"}],"standard_charges":[{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131635","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131652","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131630","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 17.2 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10330","type":"CDM"},{"code":"19086207","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10333","type":"CDM"},{"code":"19095315","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10333","type":"CDM"},{"code":"19095309","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"MITOMYCIN 0.2 MG OP KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103375","type":"CDM"},{"code":"49771000201","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103425","type":"CDM"},{"code":"68455012712","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103425","type":"CDM"},{"code":"40565012164","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103425","type":"CDM"},{"code":"40565012137","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"PERTUZUMAB 420 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103474","type":"CDM"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":270.58,"discounted_cash":108.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":230.84,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":454.70,"discounted_cash":181.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"}]},{"description":"ISOSORBIDE MONONITRATE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10356","type":"CDM"},{"code":"62175010601","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10356","type":"CDM"},{"code":"228263111","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10356","type":"CDM"},{"code":"81665010210","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"143133301","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"81665010310","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"62175010701","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"228262011","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10358","type":"CDM"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":219.55,"discounted_cash":87.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":99.54,"discounted_cash":39.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":82.23,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10358","type":"CDM"},{"code":"67457022000","type":"NDC"}],"standard_charges":[{"gross_charge":82.23,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":99.54,"discounted_cash":39.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":219.55,"discounted_cash":87.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103580","type":"CDM"},{"code":"597002402","type":"NDC"}],"standard_charges":[{"gross_charge":103.67,"discounted_cash":41.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 G"},{"gross_charge":113.92,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 G"},{"gross_charge":36.44,"discounted_cash":14.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 G"}]},{"description":"ISRADIPINE 2.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10362","type":"CDM"},{"code":"16252053901","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ITRACONAZOLE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10364","type":"CDM"},{"code":"10147170003","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.92,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ITRACONAZOLE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10364","type":"CDM"},{"code":"67877045430","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.51,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"K PHOS DI & MONO-SOD PHOS MONO 155-852-130 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10365","type":"CDM"},{"code":"486112501","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"K PHOS DI & MONO-SOD PHOS MONO 155-852-130 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10365","type":"CDM"},{"code":"64980010401","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"K PHOS DI & MONO-SOD PHOS MONO 155-852-130 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10365","type":"CDM"},{"code":"39328010710","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BACLOFEN 20000 MCG/20ML IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103652","type":"CDM"},{"code":"45945015602","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"BACLOFEN 20000 MCG/20ML IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103652","type":"CDM"},{"code":"67457056320","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":16.32,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":11.71,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"168009960","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"168009930","type":"NDC"}],"standard_charges":[{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"21922002505","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"51672129801","type":"NDC"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"168009915","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10368","type":"CDM"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"KETOCONAZOLE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10369","type":"CDM"},{"code":"93090001","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10371","type":"CDM"},{"code":"31722068601","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10371","type":"CDM"},{"code":"378113401","type":"NDC"}],"standard_charges":[{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10371","type":"CDM"},{"code":"35573045002","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10371","type":"CDM"},{"code":"93031401","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"409226754","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 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= 20 ML"},{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"47781058629","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"409226725","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"17478042040","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"24200074048","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"409226720","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV 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20 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"70092155944","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"143962201","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"70092100944","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"51991093598","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV 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40 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"60505071700","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"61553033633","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"68001020500","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"904592861","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"49884012201","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"68001038203","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"904592961","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"68001038200","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"904711061","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.4,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"60687012501","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"60687012511","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"60687045011","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10380","type":"CDM"},{"code":"45802041954","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"}]},{"description":"LEUPROLIDE ACETATE 11.25 MG IM 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":3917.06,"discounted_cash":1566.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":648.66,"discounted_cash":259.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10392","type":"CDM"},{"code":"74364203","type":"NDC"}],"standard_charges":[{"gross_charge":92.83,"discounted_cash":37.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":99.46,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":160.09,"discounted_cash":64.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOBUNOLOL HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10394","type":"CDM"},{"code":"60758006005","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOBUNOLOL HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10394","type":"CDM"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"gross_charge":3.24,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":19.21,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"16729023165","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"43598038957","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":13.73,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"45963079056","type":"NDC"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"ACETAMINOPHEN 325 MG RE 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EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"5167221160","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"713016450","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"713016412","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"69238183301","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"74659490","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"378180777","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"60687048611","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"68180096809","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"378181101","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"42292003901","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"68180097009","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"527134601","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"60687050811","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"60687050801","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 137 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10405","type":"CDM"},{"code":"68180097209","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 137 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10405","type":"CDM"},{"code":"60793085701","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHOTREXATE SODIUM (PF) 100 MG/4ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104054","type":"CDM"},{"code":"55390003210","type":"NDC"}],"standard_charges":[{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":1358.85,"discounted_cash":543.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10426","type":"CDM"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"409317802","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"409317801","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"409318201","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"409014701","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10431","type":"CDM"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10431","type":"CDM"},{"code":"186012201","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX 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= 1 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10434","type":"CDM"},{"code":"168035755","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10434","type":"CDM"},{"code":"574204230","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 1 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BETHANECHOL CHLORIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1044","type":"CDM"},{"code":"832051201","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RANIBIZUMAB 0.3 MG/0.05ML IZ 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NDC EA = 50 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105","type":"CDM"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RE 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NDC EA = 1 EACH"}]},{"description":"MECHLORETHAMINE HCL 10 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10515","type":"CDM"},{"code":"55292091151","type":"NDC"}],"standard_charges":[{"gross_charge":309.71,"discounted_cash":123.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES OR OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10518","type":"CDM"},{"code":"41679036513","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES OR 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NDC EA = 10 ML"}]},{"description":"MEGESTROL ACETATE 40 MG/ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10521","type":"CDM"},{"code":"68094006361","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MEGESTROL ACETATE 40 MG/ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10521","type":"CDM"},{"code":"68094006359","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":184.69,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"70860021461","type":"NDC"}],"standard_charges":[{"gross_charge":143.29,"discounted_cash":57.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":117.08,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":19.44,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":115.73,"discounted_cash":46.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"70860021210","type":"NDC"}],"standard_charges":[{"gross_charge":117.08,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":19.44,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV 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| NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"43598039248","type":"NDC"}],"standard_charges":[{"gross_charge":99.46,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":37.74,"discounted_cash":15.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":104.87,"discounted_cash":41.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"43598039150","type":"NDC"}],"standard_charges":[{"gross_charge":99.46,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":37.74,"discounted_cash":15.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"25021025861","type":"NDC"}],"standard_charges":[{"gross_charge":16.87,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":117.08,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"71288013015","type":"NDC"}],"standard_charges":[{"gross_charge":115.28,"discounted_cash":46.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":64.42,"discounted_cash":25.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LINACLOTIDE 145 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105228","type":"CDM"},{"code":"456120130","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LINACLOTIDE 290 MCG PO 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EA = 0.5 ML"},{"gross_charge":44.72,"discounted_cash":17.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":2.80,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"PHYTONADIONE 1 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105250","type":"CDM"},{"code":"409915725","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":6.71,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"MERCAPTOPURINE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10531","type":"CDM"},{"code":"49884092202","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"MERCAPTOPURINE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10531","type":"CDM"},{"code":"69076091302","type":"NDC"}],"standard_charges":[{"gross_charge":1.80,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":1.81,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"}]},{"description":"MERCAPTOPURINE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10531","type":"CDM"},{"code":"378354752","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":2.87,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"}]},{"description":"MERCAPTOPURINE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10531","type":"CDM"},{"code":"54458111","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"}]},{"description":"MESALAMINE 250 MG OR CPCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10533","type":"CDM"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 EACH"}]},{"description":"MESALAMINE 4 GM RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10535","type":"CDM"},{"code":"45802009846","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"MESALAMINE 4 GM RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10535","type":"CDM"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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NDC EA = 1 EACH"}]},{"description":"METHADONE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10546","type":"CDM"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":9.05,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"METHADONE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10546","type":"CDM"},{"code":"61553014978","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"METHENAMINE HIPPURATE 1 GM OR 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= 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHIMAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10552","type":"CDM"},{"code":"49884064101","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHIMAZOLE 10 MG OR 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= 100 EACH"}]},{"description":"METHIMAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10552","type":"CDM"},{"code":"60687068011","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METHIMAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10552","type":"CDM"},{"code":"60687037011","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10553","type":"CDM"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHIMAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10553","type":"CDM"},{"code":"60687066911","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METHIMAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10553","type":"CDM"},{"code":"832607211","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHIMAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10553","type":"CDM"},{"code":"64380021201","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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NDC EA = 100 EACH"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10571","type":"CDM"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":16.08,"discounted_cash":6.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10571","type":"CDM"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":16.08,"discounted_cash":6.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10571","type":"CDM"},{"code":"17478050101","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":5.38,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10572","type":"CDM"},{"code":"54063905","type":"NDC"}],"standard_charges":[{"gross_charge":48.63,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":6.58,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10588","type":"CDM"},{"code":"51079002401","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.81,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"781707787","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":1.51,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"21922003923","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"45802013970","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"68462018449","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"245086070","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":1.44,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"}]},{"description":"MEXILETINE HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10595","type":"CDM"},{"code":"50742023901","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MEXILETINE HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10595","type":"CDM"},{"code":"60687077811","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.04,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEXILETINE HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10595","type":"CDM"},{"code":"60687077821","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MEXILETINE HCL 150 MG OR 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EA = 100 EACH"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10599","type":"CDM"},{"code":"46122078929","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 71 G"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10599","type":"CDM"},{"code":"316022530","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10599","type":"CDM"},{"code":"11701003816","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"}]},{"description":"MICONAZOLE NITRATE 200 MG VA SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10604","type":"CDM"},{"code":"472173803","type":"NDC"}],"standard_charges":[{"gross_charge":7.24,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":6.25,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":12.80,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"MICROFIBRILLAR COLL HEMOSTAT EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10606","type":"CDM"},{"code":"53276101002","type":"NDC"}],"standard_charges":[{"gross_charge":199.17,"discounted_cash":79.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10608","type":"CDM"},{"code":"641606101","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10608","type":"CDM"},{"code":"409230849","type":"NDC"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"245021111","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"82293000310","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"68084024011","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"68084024001","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"60687038711","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIDODRINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10609","type":"CDM"},{"code":"60687038701","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"60687039801","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"60505132101","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.66,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"51079045320","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"51079045301","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR 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NDC EA = 100 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"185004301","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIDODRINE HCL 5 MG OR 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= 60 EACH"}]},{"description":"MISOPROSTOL 200 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10629","type":"CDM"},{"code":"59762500802","type":"NDC"}],"standard_charges":[{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MISOPROSTOL 200 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10629","type":"CDM"},{"code":"25146131","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MISOPROSTOL 200 MCG OR 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= 1 EACH"},{"gross_charge":169.52,"discounted_cash":67.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10630","type":"CDM"},{"code":"68001039078","type":"NDC"}],"standard_charges":[{"gross_charge":507.38,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":261.4,"discounted_cash":104.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":568.79,"discounted_cash":227.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 20 MG IV 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pharmacy | NDC EA = 30 EACH"}]},{"description":"H-CHLOR 12 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106429","type":"CDM"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"45802025742","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"67405010045","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"713063415","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10648","type":"CDM"},{"code":"713063537","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"APIXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106539","type":"CDM"},{"code":"3089321","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"APIXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106539","type":"CDM"},{"code":"3089331","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OCRIPLASMIN 0.5 MG/0.2ML IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106544","type":"CDM"},{"code":"24856000100","type":"NDC"}],"standard_charges":[{"gross_charge":3037.55,"discounted_cash":1215.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.2 ML"}]},{"description":"APIXABAN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106572","type":"CDM"},{"code":"3089431","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"APIXABAN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106572","type":"CDM"},{"code":"3089421","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LEVONORGESTREL 13.5 MG IU IUD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106628","type":"CDM"},{"code":"50419042201","type":"NDC"}],"standard_charges":[{"gross_charge":910.24,"discounted_cash":364.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":494.12,"discounted_cash":197.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":589.0,"discounted_cash":235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BUDESONIDE 9 MG PO TB24 (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106645","type":"CDM"},{"code":"68012030930","type":"NDC"}],"standard_charges":[{"gross_charge":54.03,"discounted_cash":21.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106665","type":"CDM"},{"code":"40565012164","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"AQUACEL-AG EXTRA HYDROFIBER 4\"X5\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106690","type":"CDM"},{"code":"68455012744","type":"NDC"}],"standard_charges":[{"gross_charge":17.43,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"AQUACEL-AG EXTRA HYDROFIBER 8\"X12\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106692","type":"CDM"},{"code":"68455010951","type":"NDC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"AQUACEL-AG EXTRA HYDROFIBER 8\"X12\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106692","type":"CDM"},{"code":"68455012749","type":"NDC"}],"standard_charges":[{"gross_charge":58.64,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"81033002099","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"51672131201","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"81033003201","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"81033003250","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"93101042","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"50268056811","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"904728454","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.94,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"904728469","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.94,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"NABUMETONE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10676","type":"CDM"},{"code":"93101501","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NABUMETONE 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10677","type":"CDM"},{"code":"185014601","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141365","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141363","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.81,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141368","type":"NDC"}],"standard_charges":[{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141387","type":"NDC"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"99922106793","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141310","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.60,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106793","type":"CDM"},{"code":"407141361","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106794","type":"CDM"},{"code":"407141210","type":"NDC"}],"standard_charges":[{"gross_charge":3.90,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106794","type":"CDM"},{"code":"99922106705","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106794","type":"CDM"},{"code":"407141230","type":"NDC"}],"standard_charges":[{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106794","type":"CDM"},{"code":"407141234","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106794","type":"CDM"},{"code":"407141238","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BION TEARS 0.1-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1068","type":"CDM"},{"code":"65041918","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"NAFCILLIN SODIUM IN DEXTROSE 1 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10681","type":"CDM"},{"code":"338101741","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"68084029111","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.35,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"68084029121","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.44,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"16729008101","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"51224020650","type":"NDC"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"47335032683","type":"NDC"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.96,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"16729008110","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NATAMYCIN 5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10692","type":"CDM"},{"code":"82667001205","type":"NDC"}],"standard_charges":[{"gross_charge":63.13,"discounted_cash":25.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"NATAMYCIN 5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10692","type":"CDM"},{"code":"71776000515","type":"NDC"}],"standard_charges":[{"gross_charge":63.13,"discounted_cash":25.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"NATAMYCIN 5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10692","type":"CDM"},{"code":"65064515","type":"NDC"}],"standard_charges":[{"gross_charge":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":3.95,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"NEOMYCIN SULFATE 25 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10697","type":"CDM"},{"code":"39822033005","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"430075327","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"60687055633","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.70,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"23585318","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"93590786","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"},{"gross_charge":0.81,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"},{"gross_charge":0.97,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"PRENATAL VITAMINS 28-0.8 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107032","type":"CDM"},{"code":"536408501","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10707","type":"CDM"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10707","type":"CDM"},{"code":"78077101","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":53.41,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10707","type":"CDM"},{"code":"65063136","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.39,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"998063006","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":20.37,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.54,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"NICARDIPINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10712","type":"CDM"},{"code":"62559020590","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":7.33,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":1.48,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICARDIPINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10712","type":"CDM"},{"code":"42806050109","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICARDIPINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10712","type":"CDM"},{"code":"378102077","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICARDIPINE HCL 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10713","type":"CDM"},{"code":"42806050209","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.75,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536302925","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536136223","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536136225","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536302923","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107172","type":"CDM"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"gross_charge":3989.63,"discounted_cash":1595.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2848.5,"discounted_cash":1139.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2409.21,"discounted_cash":963.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107173","type":"CDM"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":6383.4,"discounted_cash":2553.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3853.96,"discounted_cash":1541.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4556.79,"discounted_cash":1822.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"50742062001","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"50419070105","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"49884067701","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"591319301","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"93205701","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10719","type":"CDM"},{"code":"378035301","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10720","type":"CDM"},{"code":"50742062101","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"68084091233","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.82,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"69452020907","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.91,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"69452020920","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"23155010811","type":"NDC"}],"standard_charges":[{"gross_charge":7.18,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"23155010830","type":"NDC"}],"standard_charges":[{"gross_charge":6.14,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NITROFURANTOIN 25 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10723","type":"CDM"},{"code":"43386045011","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 230 ML"}]},{"description":"NITROFURANTOIN 25 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10723","type":"CDM"},{"code":"70408023932","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":5.33,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 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NDC EA = 1 EACH"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107314","type":"CDM"},{"code":"63304045101","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MORPHINE SULFATE ER 30 MG PO 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| NDC EA = 10 ML"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107330","type":"CDM"},{"code":"781315295","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV 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| NDC EA = 10 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107330","type":"CDM"},{"code":"70069016101","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV 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EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"68462010530","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"51079052401","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"60687063611","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"57237007530","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"60687063601","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"51079052420","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"51079052520","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"55111015430","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"60687064701","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"57237007650","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"57237007630","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"904655261","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"60687064711","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"50268062211","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"50268062215","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"51079052501","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"65862018830","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"68084022101","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"68084022111","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"REFRESH LACRI-LUBE OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107869","type":"CDM"},{"code":"23031204","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":1.87,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"DOXYLAMINE-PYRIDOXINE 10-10 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107882","type":"CDM"},{"code":"70505010010","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 36000-114000 UNITS PO 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TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1079","type":"CDM"},{"code":"904674860","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BROMFENAC SODIUM 0.07 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107956","type":"CDM"},{"code":"60505100602","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":21.10,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"BROMFENAC SODIUM 0.07 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107956","type":"CDM"},{"code":"24208060203","type":"NDC"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":109.16,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"713010906","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"58980041512","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"46122060851","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"58980041501","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"81421002103","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"904505860","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"904505812","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"536135512","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"574705012","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1080","type":"CDM"},{"code":"713010901","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108022","type":"CDM"},{"code":"143952601","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108022","type":"CDM"},{"code":"338955524","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"338955712","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"143952501","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"70121171201","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"OXANDROLONE 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10803","type":"CDM"},{"code":"68084042411","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.25,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXANDROLONE 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10803","type":"CDM"},{"code":"49884030101","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.89,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXIDIZED CELLULOSE EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10806","type":"CDM"},{"code":"63713005025","type":"NDC"}],"standard_charges":[{"gross_charge":54.62,"discounted_cash":21.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10810","type":"CDM"},{"code":"60432009216","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"42858000110","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRACE MINERALSCRCUFFEIMNMOSEZN IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108223","type":"CDM"},{"code":"63323014397","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"VITAMIN B1 100 MG PO 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EA = 100 EACH"}]},{"description":"OXAPROZIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10825","type":"CDM"},{"code":"60505017600","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PAROMOMYCIN SULFATE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10854","type":"CDM"},{"code":"23155003801","type":"NDC"}],"standard_charges":[{"gross_charge":1.80,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.65,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PAROXETINE HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10855","type":"CDM"},{"code":"68084004511","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PAROXETINE HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10855","type":"CDM"},{"code":"51079077420","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PAROXETINE HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10855","type":"CDM"},{"code":"904567761","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP 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Type: pharmacy | NDC EA = 500 UNITS"}]},{"description":"PEDITRACE IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108592","type":"CDM"},{"code":"63323014710","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM GLYCEROPHOSPHATE 1 MMOLE/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108594","type":"CDM"},{"code":"63323024120","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 40 GM/400ML IV 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pharmacy | NDC EA = 1 EACH"}]},{"description":"LORCASERIN HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108874","type":"CDM"},{"code":"62856052960","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108922","type":"CDM"},{"code":"70121147801","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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| NDC EA = 30 EACH"},{"gross_charge":2.61,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TACROLIMUS 1 MG PO CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"109581","type":"CDM"},{"code":"469067773","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VINCRISTINE SULFATE LIPOSOME 5 MG/31ML IV 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pharmacy | NDC EA = 8.9 G"}]},{"description":"INFLUENZA VAC RECOMB HA (PF) IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110025","type":"CDM"},{"code":"42874001501","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":28.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"INFLUENZA VAC RECOMB HA (PF) IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110025","type":"CDM"},{"code":"42874001510","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":28.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"ROTAVIRUS VAC LIVE PENTAVALENT PO 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NDC EA = 30 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110029","type":"CDM"},{"code":"186103702","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110029","type":"CDM"},{"code":"63323047201","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 10 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110032","type":"CDM"},{"code":"143971001","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE 10 MG/10ML IV 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NDC EA = 20 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110033","type":"CDM"},{"code":"143970901","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110033","type":"CDM"},{"code":"409021211","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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pharmacy | NDC EA = 20 ML"}]},{"description":"MILRINONE LACTATE 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110034","type":"CDM"},{"code":"71288020050","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"MILRINONE LACTATE 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110034","type":"CDM"},{"code":"72485050301","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL ER 20 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110047","type":"CDM"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL ER 20 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110047","type":"CDM"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":9.80,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"OXYCODONE HCL ER 40 MG PO 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= 100 EACH"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11019","type":"CDM"},{"code":"71374066","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD 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75 G"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"832112142","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"45802011602","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"BERACTANT IN NACL 25 MG/ML IN 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EA = 30 EACH"}]},{"description":"PHYTONADIONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11024","type":"CDM"},{"code":"70710101403","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":9.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.16,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"70860060541","type":"NDC"}],"standard_charges":[{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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NDC EA = 1 EACH"}]},{"description":"VORTIOXETINE HBR 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110331","type":"CDM"},{"code":"64764072030","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.87,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":15.50,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VORTIOXETINE HBR 10 MG PO 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NDC EA = 1 EACH"}]},{"description":"PHENYLEPHRINE-MINERAL OIL-PET 0.25-14-74.9 % RE OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110494","type":"CDM"},{"code":"46122067746","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV 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30 EACH"}]},{"description":"PERAMPANEL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110760","type":"CDM"},{"code":"62856027230","type":"NDC"}],"standard_charges":[{"gross_charge":5.87,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":18.63,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":7.64,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PERAMPANEL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110761","type":"CDM"},{"code":"62856027430","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":36.81,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.83,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PERAMPANEL 6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110762","type":"CDM"},{"code":"62856027630","type":"NDC"}],"standard_charges":[{"gross_charge":36.81,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":15.32,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.83,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110774","type":"CDM"},{"code":"63459091015","type":"NDC"}],"standard_charges":[{"gross_charge":364.06,"discounted_cash":145.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":76.8,"discounted_cash":30.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110774","type":"CDM"},{"code":"63459091012","type":"NDC"}],"standard_charges":[{"gross_charge":76.76,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":364.08,"discounted_cash":145.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110774","type":"CDM"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":76.76,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":364.08,"discounted_cash":145.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":30.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":388.7,"discounted_cash":155.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":102.08,"discounted_cash":40.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091215","type":"NDC"}],"standard_charges":[{"gross_charge":76.82,"discounted_cash":30.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":102.07,"discounted_cash":40.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":388.69,"discounted_cash":155.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091212","type":"NDC"}],"standard_charges":[{"gross_charge":388.69,"discounted_cash":155.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":76.82,"discounted_cash":30.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"OBINUTUZUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110777","type":"CDM"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":225.01,"discounted_cash":90.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":131.54,"discounted_cash":52.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":111.30,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11079","type":"CDM"},{"code":"990707726","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11079","type":"CDM"},{"code":"338070348","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 0.15-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11081","type":"CDM"},{"code":"338069104","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CITRATE 1080 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11083","type":"CDM"},{"code":"245007111","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.29,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CITRATE 1080 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11083","type":"CDM"},{"code":"178061001","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POVIDONE-IODINE 5 % EX AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11088","type":"CDM"},{"code":"67618014803","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 88.7 ML"}]},{"description":"POSACONAZOLE 100 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110895","type":"CDM"},{"code":"254204502","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":3.04,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.92,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"POSACONAZOLE 100 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110895","type":"CDM"},{"code":"527213335","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.33,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"POSACONAZOLE 100 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110895","type":"CDM"},{"code":"85432402","type":"NDC"}],"standard_charges":[{"gross_charge":61.68,"discounted_cash":24.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"904589161","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"69097078805","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"60687016911","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"60687088611","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"68462019590","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"60687017801","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"69097078905","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"68462019690","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"68084050111","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"68084050101","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"60687089711","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"60687017811","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"904589261","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRAVASTATIN SODIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11112","type":"CDM"},{"code":"69097079105","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAZIQUANTEL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11113","type":"CDM"},{"code":"49884023183","type":"NDC"}],"standard_charges":[{"gross_charge":60.06,"discounted_cash":24.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":29.34,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":28.39,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"PRAZIQUANTEL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11113","type":"CDM"},{"code":"50419074701","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":75.55,"discounted_cash":30.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"PERAMPANEL 12 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111146","type":"CDM"},{"code":"69616028230","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":36.98,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ PO TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111147","type":"CDM"},{"code":"68382039801","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ PO TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111147","type":"CDM"},{"code":"74302313","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PREDNISOLONE 15 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11117","type":"CDM"},{"code":"58177091007","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111214","type":"CDM"},{"code":"310620530","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111214","type":"CDM"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.41,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.40,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.89,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"310621030","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":16.01,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"310621090","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"310621039","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"527130101","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"53746054401","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"50268068611","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROCARBAZINE HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11136","type":"CDM"},{"code":"54482005301","type":"NDC"}],"standard_charges":[{"gross_charge":81.61,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROCARBAZINE HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11136","type":"CDM"},{"code":"54482005401","type":"NDC"}],"standard_charges":[{"gross_charge":81.61,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"713013512","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":2.47,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"713013506","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"574722612","type":"NDC"}],"standard_charges":[{"gross_charge":1.40,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":7.48,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111399","type":"CDM"},{"code":"63402020230","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":7.84,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111399","type":"CDM"},{"code":"68180029006","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111400","type":"CDM"},{"code":"63402020430","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.71,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111400","type":"CDM"},{"code":"68180029106","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.73,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":12.54,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111401","type":"CDM"},{"code":"63402020660","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111401","type":"CDM"},{"code":"68180029207","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111402","type":"CDM"},{"code":"68180029306","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.75,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111402","type":"CDM"},{"code":"63402020830","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.58,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11143","type":"CDM"},{"code":"713053612","type":"NDC"}],"standard_charges":[{"gross_charge":5.08,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11144","type":"CDM"},{"code":"713052612","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11144","type":"CDM"},{"code":"713052606","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.44,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11145","type":"CDM"},{"code":"70436015542","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11145","type":"CDM"},{"code":"27808005701","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"62559023001","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"68084036111","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"60687070901","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"51079099601","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"51079099620","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"60687053711","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROPAFENONE HCL 225 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11147","type":"CDM"},{"code":"603544921","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 225 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11147","type":"CDM"},{"code":"62559023101","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 225 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11147","type":"CDM"},{"code":"591058301","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPOFOL 10 MG/ML IV 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pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111730","type":"CDM"},{"code":"93598527","type":"NDC"}],"standard_charges":[{"gross_charge":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":103.84,"discounted_cash":41.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":108.14,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111730","type":"CDM"},{"code":"49502050101","type":"NDC"}],"standard_charges":[{"gross_charge":275.12,"discounted_cash":110.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"49502010201","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"49502050002","type":"NDC"}],"standard_charges":[{"gross_charge":275.12,"discounted_cash":110.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"49502010202","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"115169449","type":"NDC"}],"standard_charges":[{"gross_charge":13.72,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":39.59,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"93598627","type":"NDC"}],"standard_charges":[{"gross_charge":104.86,"discounted_cash":41.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":100.46,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"115169430","type":"NDC"}],"standard_charges":[{"gross_charge":39.59,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111731","type":"CDM"},{"code":"93598619","type":"NDC"}],"standard_charges":[{"gross_charge":100.46,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111736","type":"CDM"},{"code":"55150023930","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111736","type":"CDM"},{"code":"63323016530","type":"NDC"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111736","type":"CDM"},{"code":"67457042100","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE HCL 0.1 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111738","type":"CDM"},{"code":"409492134","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE HCL 0.1 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111738","type":"CDM"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.74,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TREPROSTINIL DIOLAMINE ER 1 MG PO TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111745","type":"CDM"},{"code":"66302031010","type":"NDC"}],"standard_charges":[{"gross_charge":56.67,"discounted_cash":22.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"TESTOSTERONE UNDECANOATE 750 MG/3ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111790","type":"CDM"},{"code":"67979051143","type":"NDC"}],"standard_charges":[{"gross_charge":257.71,"discounted_cash":103.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":219.22,"discounted_cash":87.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":724.33,"discounted_cash":289.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"42023019501","type":"NDC"}],"standard_charges":[{"gross_charge":6.34,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"85433101","type":"NDC"}],"standard_charges":[{"gross_charge":21.40,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":28.72,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":18.23,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"68462090401","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":2.25,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"63323068517","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":7.43,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"55150038801","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":6.03,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111882","type":"CDM"},{"code":"63833038702","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.37,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 UNITS"}]},{"description":"APREMILAST 10 & 20 & 30 MG PO TBPK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111916","type":"CDM"},{"code":"59572063255","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 55 EACH"}]},{"description":"ACETAZOLAMIDE 125 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112","type":"CDM"},{"code":"23155028701","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAZOLAMIDE 125 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112","type":"CDM"},{"code":"51672402201","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112119","type":"CDM"},{"code":"63323045200","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.34,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"RAMUCIRUMAB 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112261","type":"CDM"},{"code":"2766901","type":"NDC"}],"standard_charges":[{"gross_charge":85.92,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":102.55,"discounted_cash":41.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":150.08,"discounted_cash":60.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RAMUCIRUMAB 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112262","type":"CDM"},{"code":"2767801","type":"NDC"}],"standard_charges":[{"gross_charge":150.08,"discounted_cash":60.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":85.86,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":102.49,"discounted_cash":41.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"SILTUXIMAB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112295","type":"CDM"},{"code":"57894042001","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 MG"}]},{"description":"SILTUXIMAB 400 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112296","type":"CDM"},{"code":"57894042101","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11237","type":"CDM"},{"code":"781304095","type":"NDC"}],"standard_charges":[{"gross_charge":14.50,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":8.88,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":9.28,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11238","type":"CDM"},{"code":"187301220","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11239","type":"CDM"},{"code":"68084049401","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11239","type":"CDM"},{"code":"68084049411","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11239","type":"CDM"},{"code":"68382065906","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11240","type":"CDM"},{"code":"64980022003","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.86,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.74,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11240","type":"CDM"},{"code":"47781033530","type":"NDC"}],"standard_charges":[{"gross_charge":14.58,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11240","type":"CDM"},{"code":"187301330","type":"NDC"}],"standard_charges":[{"gross_charge":37.08,"discounted_cash":14.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11240","type":"CDM"},{"code":"68682030130","type":"NDC"}],"standard_charges":[{"gross_charge":8.62,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ACTICOAT 4\"X4\" EX SHEE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112406","type":"CDM"},{"code":"223044976","type":"NDC"}],"standard_charges":[{"gross_charge":32.24,"discounted_cash":12.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"ACTICOAT 8\"X16\" EX SHEE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112410","type":"CDM"},{"code":"40565012147","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"PYRIMETHAMINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11246","type":"CDM"},{"code":"72647033001","type":"NDC"}],"standard_charges":[{"gross_charge":289.96,"discounted_cash":115.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":290.89,"discounted_cash":116.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PYRIMETHAMINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11246","type":"CDM"},{"code":"69413033030","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":750.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIMETHAMINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11246","type":"CDM"},{"code":"72647033003","type":"NDC"}],"standard_charges":[{"gross_charge":290.91,"discounted_cash":116.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":289.98,"discounted_cash":115.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"QUINAPRIL HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11252","type":"CDM"},{"code":"31722026990","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"QUINAPRIL HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11252","type":"CDM"},{"code":"59762502101","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"QUINAPRIL HCL 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11253","type":"CDM"},{"code":"59762502201","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"QUINAPRIL HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11254","type":"CDM"},{"code":"68180055609","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"QUINAPRIL HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11254","type":"CDM"},{"code":"31722026790","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"RABIES IMMUNE GLOBULIN 150 UNIT/ML IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11256","type":"CDM"},{"code":"13533061802","type":"NDC"}],"standard_charges":[{"gross_charge":355.06,"discounted_cash":142.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":6.23,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"RABIES IMMUNE GLOBULIN 150 UNIT/ML IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11256","type":"CDM"},{"code":"13533061810","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RABIES VIRUS VACCINE, HDC IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11257","type":"CDM"},{"code":"49281025051","type":"NDC"}],"standard_charges":[{"gross_charge":293.51,"discounted_cash":117.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":293.31,"discounted_cash":117.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":259.53,"discounted_cash":103.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RAMIPRIL 1.25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11258","type":"CDM"},{"code":"16252057030","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"RAMIPRIL 1.25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11258","type":"CDM"},{"code":"68084029421","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"RAMIPRIL 1.25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11258","type":"CDM"},{"code":"61570011001","type":"NDC"}],"standard_charges":[{"gross_charge":4.80,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RAMIPRIL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11259","type":"CDM"},{"code":"61570012001","type":"NDC"}],"standard_charges":[{"gross_charge":7.10,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RAMIPRIL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11261","type":"CDM"},{"code":"61570011201","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RANITIDINE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11265","type":"CDM"},{"code":"51079087901","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VEDOLIZUMAB 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112674","type":"CDM"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":4700.95,"discounted_cash":1880.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9359.91,"discounted_cash":3743.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3947.91,"discounted_cash":1579.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DALBAVANCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112779","type":"CDM"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"gross_charge":904.1,"discounted_cash":361.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":630.84,"discounted_cash":252.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":723.28,"discounted_cash":289.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EFINACONAZOLE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112846","type":"CDM"},{"code":"187540008","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":15.89,"discounted_cash":6.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":174.32,"discounted_cash":69.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"RIBAVIRIN 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11286","type":"CDM"},{"code":"68084017911","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIBAVIRIN 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11286","type":"CDM"},{"code":"68084017965","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"RIBAVIRIN 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11287","type":"CDM"},{"code":"65862020768","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"}]},{"description":"RIBOFLAVIN 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11288","type":"CDM"},{"code":"11845007141","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIBOFLAVIN 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11289","type":"CDM"},{"code":"35046000120","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RALTEGRAVIR POTASSIUM 100 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112892","type":"CDM"},{"code":"6360361","type":"NDC"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":3.22,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112899","type":"CDM"},{"code":"54038225","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112899","type":"CDM"},{"code":"54879002101","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112899","type":"CDM"},{"code":"62332061831","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.54,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFABUTIN 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11290","type":"CDM"},{"code":"68180028501","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFABUTIN 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11290","type":"CDM"},{"code":"70954004110","type":"NDC"}],"standard_charges":[{"gross_charge":8.70,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":4.20,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFABUTIN 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11290","type":"CDM"},{"code":"60687019895","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFABUTIN 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11290","type":"CDM"},{"code":"13530117","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFABUTIN 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11290","type":"CDM"},{"code":"59762135001","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112900","type":"CDM"},{"code":"54879002201","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.49,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.53,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112900","type":"CDM"},{"code":"54038325","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":11.18,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112900","type":"CDM"},{"code":"62332061931","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11291","type":"CDM"},{"code":"68059701","type":"NDC"}],"standard_charges":[{"gross_charge":34.45,"discounted_cash":13.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":33.06,"discounted_cash":13.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":161.44,"discounted_cash":64.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11291","type":"CDM"},{"code":"63323035120","type":"NDC"}],"standard_charges":[{"gross_charge":138.32,"discounted_cash":55.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":70.23,"discounted_cash":28.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":78.74,"discounted_cash":31.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11291","type":"CDM"},{"code":"55390012301","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":32.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11291","type":"CDM"},{"code":"68059901","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11291","type":"CDM"},{"code":"67457044560","type":"NDC"}],"standard_charges":[{"gross_charge":28.72,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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| NDC EA = 500 EACH"}]},{"description":"SERTRALINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11351","type":"CDM"},{"code":"65862001205","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"SERTRALINE HCL 50 MG OR 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NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113534","type":"CDM"},{"code":"9041702","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.33,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM 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NDC EA = 5 ML"},{"gross_charge":11.93,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113537","type":"CDM"},{"code":"66213042205","type":"NDC"}],"standard_charges":[{"gross_charge":329.61,"discounted_cash":131.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113537","type":"CDM"},{"code":"66213042305","type":"NDC"}],"standard_charges":[{"gross_charge":329.61,"discounted_cash":131.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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| NDC EA = 30 EACH"}]},{"description":"ERLOTINIB HCL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113544","type":"CDM"},{"code":"50242006401","type":"NDC"}],"standard_charges":[{"gross_charge":39.95,"discounted_cash":15.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":24.42,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERLOTINIB HCL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113544","type":"CDM"},{"code":"68382091506","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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90 EACH"}]},{"description":"SIMVASTATIN 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11365","type":"CDM"},{"code":"904580161","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIMVASTATIN 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11366","type":"CDM"},{"code":"68180048002","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"SIMVASTATIN 5 MG OR 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EA = 50 EACH"}]},{"description":"SIMVASTATIN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11367","type":"CDM"},{"code":"6072631","type":"NDC"}],"standard_charges":[{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11368","type":"CDM"},{"code":"72266024805","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":63.76,"discounted_cash":25.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SINCALIDE 5 MCG IJ 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EA = 1 EACH"}]},{"description":"PEMBROLIZUMAB 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113711","type":"CDM"},{"code":"6302902","type":"NDC"}],"standard_charges":[{"gross_charge":1659.17,"discounted_cash":663.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SILDENAFIL CITRATE 10 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113740","type":"CDM"},{"code":"69033621","type":"NDC"}],"standard_charges":[{"gross_charge":82.23,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 112 ML"}]},{"description":"SILDENAFIL CITRATE 10 MG/ML PO 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pharmacy | NDC EA = 120 EACH"},{"gross_charge":3.53,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LAN-O-SOOTHE EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113836","type":"CDM"},{"code":"92771059002","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 56 G"}]},{"description":"LAN-O-SOOTHE EX 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| NDC EA = 1 EACH"},{"gross_charge":7.46,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11403","type":"CDM"},{"code":"338004802","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11403","type":"CDM"},{"code":"338004803","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"PROGESTERONE 100 MG PO 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NDC EA = 100 EACH"}]},{"description":"PROGESTERONE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114061","type":"CDM"},{"code":"17478076610","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROGESTERONE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114061","type":"CDM"},{"code":"70700016201","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114071","type":"CDM"},{"code":"70069080201","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114071","type":"CDM"},{"code":"70121157701","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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NDC EA = 30 EACH"},{"gross_charge":9.48,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"COLCHICINE 0.6 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114118","type":"CDM"},{"code":"143301801","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.31,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MENTHOL-ZINC OXIDE 0.44-20.6 % EX 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NDC EA = 100 EACH"}]},{"description":"SOTALOL HCL 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11421","type":"CDM"},{"code":"50268072411","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SOTALOL HCL 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11421","type":"CDM"},{"code":"603576921","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SOTALOL HCL 80 MG OR 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NDC EA = 100 EACH"}]},{"description":"SOTALOL HCL 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11421","type":"CDM"},{"code":"93106101","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 40 GM/400ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114228","type":"CDM"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":7.61,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 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NDC EA = 100 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"68382066201","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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NDC EA = 33.4 G"}]},{"description":"ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114379","type":"CDM"},{"code":"944500101","type":"NDC"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"60687073823","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"60687073842","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"121074710","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"1210974106","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268073211","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268073212","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268074511","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"52817084016","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 420 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"68094017159","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"66689079001","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.76,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"68094004159","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"51079075301","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"59762040105","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"93221001","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"591078001","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":10.13,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"42023016401","type":"NDC"}],"standard_charges":[{"gross_charge":17.99,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.31,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"517102025","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":5.42,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"517102001","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.04,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"548970100","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":4.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":13.56,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"70121164201","type":"NDC"}],"standard_charges":[{"gross_charge":9.43,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":10.70,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"63323093000","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.28,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.28,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"55150037025","type":"NDC"}],"standard_charges":[{"gross_charge":7.66,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":11.21,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"42367057022","type":"NDC"}],"standard_charges":[{"gross_charge":128.15,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":31.95,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"43598008511","type":"NDC"}],"standard_charges":[{"gross_charge":128.15,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"55150037001","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":7.66,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"SUFENTANIL CITRATE 50 MCG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11443","type":"CDM"},{"code":"17478005001","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.34,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"SUFENTANIL CITRATE 50 MCG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11443","type":"CDM"},{"code":"409338211","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3.79,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPINEPHRINE HCL PF 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114435","type":"CDM"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":8.76,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"SULFACETAMIDE-PREDNISOLONE 10-0.2 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11448","type":"CDM"},{"code":"23031304","type":"NDC"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":19.94,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"PERAMIVIR 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114541","type":"CDM"},{"code":"61364018101","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ATAZANAVIR SULFATE 50 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114545","type":"CDM"},{"code":"3363810","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.13,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SUVOREXANT 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114552","type":"CDM"},{"code":"6003330","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SUVOREXANT 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114552","type":"CDM"},{"code":"6003310","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"FLUTICASONE FUROATE 200 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114556","type":"CDM"},{"code":"173087610","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.74,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"HPV 9-VALENT RECOMB VACCINE IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114631","type":"CDM"},{"code":"6412102","type":"NDC"}],"standard_charges":[{"gross_charge":595.21,"discounted_cash":238.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":457.24,"discounted_cash":182.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"HPV 9-VALENT RECOMB VACCINE IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114631","type":"CDM"},{"code":"6412101","type":"NDC"}],"standard_charges":[{"gross_charge":457.24,"discounted_cash":182.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":595.21,"discounted_cash":238.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"HPV 9-VALENT RECOMB VACCINE IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114632","type":"CDM"},{"code":"6411903","type":"NDC"}],"standard_charges":[{"gross_charge":393.29,"discounted_cash":157.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"BLINATUMOMAB 35 MCG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114633","type":"CDM"},{"code":"55513016001","type":"NDC"}],"standard_charges":[{"gross_charge":2640.82,"discounted_cash":1056.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5556.77,"discounted_cash":2222.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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NDC EA = 30 EACH"}]},{"description":"TAMOXIFEN CITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11498","type":"CDM"},{"code":"59651030030","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TAMOXIFEN CITRATE 20 MG OR 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NDC EA = 100 EACH"},{"gross_charge":9.02,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NALOXEGOL OXALATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115068","type":"CDM"},{"code":"57841130103","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":4.74,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":11.88,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NALOXEGOL OXALATE 25 MG PO 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pharmacy | NDC EA = 100 EACH"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11507","type":"CDM"},{"code":"143974601","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3.26,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ 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= 1 ML"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11507","type":"CDM"},{"code":"70860080101","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 80 MCG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115072","type":"CDM"},{"code":"781349395","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"SECUKINUMAB 150 MG/ML SC 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TERBUTALINE SULFATE 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11508","type":"CDM"},{"code":"527131801","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.86,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TERBUTALINE SULFATE 5 MG OR 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20 G"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 G"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11515","type":"CDM"},{"code":"49281029110","type":"NDC"}],"standard_charges":[{"gross_charge":44.47,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TETRACAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11517","type":"CDM"},{"code":"54288012710","type":"NDC"}],"standard_charges":[{"gross_charge":34.58,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"378647016","type":"NDC"}],"standard_charges":[{"gross_charge":13.88,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"378647044","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":5.27,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":16.62,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"378647097","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":13.88,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD 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NDC EA = 10 EACH"},{"gross_charge":0.82,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"10019055388","type":"NDC"}],"standard_charges":[{"gross_charge":19.85,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5.89,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD 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NDC EA = 10 EACH"},{"gross_charge":0.99,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"50742050501","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.92,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":7.28,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD 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Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":48.28,"discounted_cash":19.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115730","type":"CDM"},{"code":"469052002","type":"NDC"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":20.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":104.65,"discounted_cash":41.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG IV 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Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":162.14,"discounted_cash":64.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVONORGESTREL 18.6 MCG/DAY IU IUD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115732","type":"CDM"},{"code":"52544003554","type":"NDC"}],"standard_charges":[{"gross_charge":45.27,"discounted_cash":18.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRETINOIN 0.025 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11576","type":"CDM"},{"code":"574222545","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 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NDC EA = 30 EACH"}]},{"description":"IVABRADINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115910","type":"CDM"},{"code":"50742036260","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"TRIFLURIDINE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11595","type":"CDM"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 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NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN HCL 10 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11627","type":"CDM"},{"code":"25021015899","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":10.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":42.64,"discounted_cash":17.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.68,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN HCL 10 GM IV 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| NDC EA = 1 EACH"}]},{"description":"SACUBITRIL-VALSARTAN 24-26 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"116807","type":"CDM"},{"code":"78065920","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":4.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SACUBITRIL-VALSARTAN 24-26 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"116807","type":"CDM"},{"code":"62332055660","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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pharmacy | NDC EA = 180 EACH"},{"gross_charge":4.21,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"SACUBITRIL-VALSARTAN 97-103 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"116809","type":"CDM"},{"code":"78069620","type":"NDC"}],"standard_charges":[{"gross_charge":5.09,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.63,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":4.21,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SACUBITRIL-VALSARTAN 97-103 MG PO 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pharmacy | NDC EA = 1 EACH"}]},{"description":"OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117738","type":"CDM"},{"code":"99923510835","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117738","type":"CDM"},{"code":"70092107124","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117738","type":"CDM"},{"code":"99918505220","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"INSULIN DEGLUDEC 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117739","type":"CDM"},{"code":"169266015","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":5.06,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":30.64,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117746","type":"CDM"},{"code":"65757040303","type":"NDC"}],"standard_charges":[{"gross_charge":477.31,"discounted_cash":190.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.2 ML"},{"gross_charge":899.01,"discounted_cash":359.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.2 ML"},{"gross_charge":594.88,"discounted_cash":237.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.2 ML"}]},{"description":"FIXODENT ORIGINAL CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117788","type":"CDM"},{"code":"76660000866","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 68 G"}]},{"description":"FIXODENT ORIGINAL CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117788","type":"CDM"},{"code":"76660000864","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 39 G"}]},{"description":"IDARUCIZUMAB 2.5 GM/50ML IV 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pharmacy | NDC EA = 200 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 EACH"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117839","type":"CDM"},{"code":"781208102","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 EACH"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO 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Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117839","type":"CDM"},{"code":"54008813","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ 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pharmacy | NDC EA = 60 EACH"}]},{"description":"TALIMOGENE LAHERPAREPVEC 1000000 UNIT/ML LS SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117964","type":"CDM"},{"code":"55513007801","type":"NDC"}],"standard_charges":[{"gross_charge":69.87,"discounted_cash":27.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":33.36,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":19.03,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"TALIMOGENE LAHERPAREPVEC 100000000 UNIT/ML LS 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":3602.82,"discounted_cash":1441.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118002","type":"CDM"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"gross_charge":73.67,"discounted_cash":29.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":62.63,"discounted_cash":25.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":127.06,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-4 GM/100ML-% IV 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pharmacy | NDC EA = 20 ML"},{"gross_charge":155.12,"discounted_cash":62.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"PATIROMER SORBITEX CALCIUM 8.4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118251","type":"CDM"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"gross_charge":42.89,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":13.41,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":11.73,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"BUPRENORPHINE HCL 75 MCG BU FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118256","type":"CDM"},{"code":"59385002160","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.80,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118270","type":"CDM"},{"code":"45802057800","type":"NDC"}],"standard_charges":[{"gross_charge":16.10,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.2,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118270","type":"CDM"},{"code":"45802057884","type":"NDC"}],"standard_charges":[{"gross_charge":22.00,"discounted_cash":8.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":10.08,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118270","type":"CDM"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":24.74,"discounted_cash":9.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118280","type":"CDM"},{"code":"2771601","type":"NDC"}],"standard_charges":[{"gross_charge":86.60,"discounted_cash":34.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":66.59,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"ELOTUZUMAB 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118314","type":"CDM"},{"code":"3229111","type":"NDC"}],"standard_charges":[{"gross_charge":1471.53,"discounted_cash":588.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2321.17,"discounted_cash":928.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1714.19,"discounted_cash":685.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ELOTUZUMAB 400 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118315","type":"CDM"},{"code":"3452211","type":"NDC"}],"standard_charges":[{"gross_charge":1966.1,"discounted_cash":786.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2286.84,"discounted_cash":914.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3094.86,"discounted_cash":1237.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BENDAMUSTINE HCL 100 MG/4ML IV 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pharmacy | NDC EA = 4 ML"},{"gross_charge":152.57,"discounted_cash":61.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"BENDAMUSTINE HCL 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118376","type":"CDM"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":278.47,"discounted_cash":111.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":192.12,"discounted_cash":76.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":59.66,"discounted_cash":23.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"SEBELIPASE ALFA 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118380","type":"CDM"},{"code":"25682000701","type":"NDC"}],"standard_charges":[{"gross_charge":783.38,"discounted_cash":313.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":783.06,"discounted_cash":313.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1021.0,"discounted_cash":408.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SELEXIPAG 1600 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118428","type":"CDM"},{"code":"66215061606","type":"NDC"}],"standard_charges":[{"gross_charge":406.70,"discounted_cash":162.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118625","type":"CDM"},{"code":"6542302","type":"NDC"}],"standard_charges":[{"gross_charge":34.14,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":61.54,"discounted_cash":24.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":32.83,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118625","type":"CDM"},{"code":"6542312","type":"NDC"}],"standard_charges":[{"gross_charge":34.14,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":61.54,"discounted_cash":24.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":32.83,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"SUGAMMADEX SODIUM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118627","type":"CDM"},{"code":"6542315","type":"NDC"}],"standard_charges":[{"gross_charge":25.76,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CARIPRAZINE HCL 1.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118863","type":"CDM"},{"code":"61874011511","type":"NDC"}],"standard_charges":[{"gross_charge":24.20,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":45.78,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"CARIPRAZINE HCL 6 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118866","type":"CDM"},{"code":"61874016030","type":"NDC"}],"standard_charges":[{"gross_charge":24.18,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 300 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119084","type":"CDM"},{"code":"67457045010","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":10.01,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":13.90,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV 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pharmacy | NDC EA = 20 ML"},{"gross_charge":1.22,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119085","type":"CDM"},{"code":"63323041801","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":7.53,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV 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pharmacy | NDC EA = 20 ML"},{"gross_charge":13.37,"discounted_cash":5.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"63323087550","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":1.60,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"76310002425","type":"NDC"}],"standard_charges":[{"gross_charge":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":1.56,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"76310002415","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"25021018984","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"23155077131","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 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NDC EA = 10 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"67457019700","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV 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NDC EA = 10 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"67457019710","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV 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NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"13111410","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"47781060122","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV 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NDC EA = 10 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119103","type":"CDM"},{"code":"69020910","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119103","type":"CDM"},{"code":"69020901","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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= 50 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119105","type":"CDM"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119105","type":"CDM"},{"code":"25021060851","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119105","type":"CDM"},{"code":"63323026967","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119106","type":"CDM"},{"code":"409909422","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119106","type":"CDM"},{"code":"409909412","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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NDC EA = 2 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119107","type":"CDM"},{"code":"409909345","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ 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NDC EA = 5 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119107","type":"CDM"},{"code":"63323080613","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119108","type":"CDM"},{"code":"409909431","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119109","type":"CDM"},{"code":"409909441","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"TUBERCULIN SYRINGE 25G X 5/8\" 1 ML MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11911","type":"CDM"},{"code":"8222251589","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"GADODIAMIDE 287 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11929","type":"CDM"},{"code":"407069015","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"GADODIAMIDE 287 MG/ML IV 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pharmacy | NDC EA = 1 EACH"}]},{"description":"MILTEFOSINE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119639","type":"CDM"},{"code":"69051030001","type":"NDC"}],"standard_charges":[{"gross_charge":571.43,"discounted_cash":228.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"DEFIBROTIDE SODIUM 200 MG/2.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119654","type":"CDM"},{"code":"68727080002","type":"NDC"}],"standard_charges":[{"gross_charge":382.56,"discounted_cash":153.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"DEFIBROTIDE SODIUM 200 MG/2.5ML IV 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"71266200101","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"5446110801","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"61553035733","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"61553035770","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"69374092005","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.73,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119692","type":"CDM"},{"code":"61958200202","type":"NDC"}],"standard_charges":[{"gross_charge":24.68,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":30.39,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":70.84,"discounted_cash":28.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119692","type":"CDM"},{"code":"61958200201","type":"NDC"}],"standard_charges":[{"gross_charge":24.68,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":30.39,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":71.21,"discounted_cash":28.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV 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7 EACH"},{"gross_charge":31.35,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":65.09,"discounted_cash":26.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"}]},{"description":"VENETOCLAX 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119722","type":"CDM"},{"code":"74057611","type":"NDC"}],"standard_charges":[{"gross_charge":130.15,"discounted_cash":52.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":74.64,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":62.7,"discounted_cash":25.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VENETOCLAX 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119722","type":"CDM"},{"code":"74057634","type":"NDC"}],"standard_charges":[{"gross_charge":128.50,"discounted_cash":51.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"},{"gross_charge":73.85,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"},{"gross_charge":62.70,"discounted_cash":25.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"VENETOCLAX 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119722","type":"CDM"},{"code":"74057622","type":"NDC"}],"standard_charges":[{"gross_charge":62.70,"discounted_cash":25.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":74.64,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":130.17,"discounted_cash":52.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CETAPHIL GENTLE CLEANSER EX LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119904","type":"CDM"},{"code":"299392116","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"BRIVARACETAM 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119911","type":"CDM"},{"code":"50474047066","type":"NDC"}],"standard_charges":[{"gross_charge":22.20,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":12.60,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.66,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"BRIVARACETAM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119912","type":"CDM"},{"code":"50474057066","type":"NDC"}],"standard_charges":[{"gross_charge":22.20,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":12.78,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.62,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"BRIVARACETAM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119914","type":"CDM"},{"code":"50474077009","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":10.74,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":22.20,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BRIVARACETAM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119914","type":"CDM"},{"code":"50474077066","type":"NDC"}],"standard_charges":[{"gross_charge":22.20,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":12.92,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.74,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"BRIVARACETAM 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119916","type":"CDM"},{"code":"50474097075","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":11.42,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"BRIVARACETAM 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119916","type":"CDM"},{"code":"50474097063","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":11.42,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.99,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"RADIUM RA 223 DICHLORIDE 30 MCCI/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119920","type":"CDM"},{"code":"50419020801","type":"NDC"}],"standard_charges":[{"gross_charge":23884.82,"discounted_cash":9553.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ATEZOLIZUMAB 1200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120015","type":"CDM"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":347.38,"discounted_cash":138.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":397.70,"discounted_cash":159.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":579.47,"discounted_cash":231.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"VON WILLEBRAND FACTOR (RECOMB) 650 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120128","type":"CDM"},{"code":"944755102","type":"NDC"}],"standard_charges":[{"gross_charge":831.29,"discounted_cash":332.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1079.1,"discounted_cash":431.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":658.43,"discounted_cash":263.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VON WILLEBRAND FACTOR (RECOMB) 1300 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120129","type":"CDM"},{"code":"944755302","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"}]},{"description":"VON WILLEBRAND FACTOR (RECOMB) 1300 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120129","type":"CDM"},{"code":"9440755201","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"},{"gross_charge":1.19,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1300 UNITS"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"42023021625","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":11.57,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":6.39,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"70121163707","type":"NDC"}],"standard_charges":[{"gross_charge":5.90,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":11.02,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"76014000525","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":10.16,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"781326971","type":"NDC"}],"standard_charges":[{"gross_charge":3.91,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":5.02,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"641623801","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2.39,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"51754420004","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":6.31,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":5.79,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"51754420001","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"536398501","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"904651661","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"50268052211","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"51079008920","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"51079042301","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"60687077501","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12024","type":"CDM"},{"code":"60687077511","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MULTIVITAMIN+ PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120248","type":"CDM"},{"code":"71401091616","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"}]},{"description":"MECLIZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12025","type":"CDM"},{"code":"16571066101","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12025","type":"CDM"},{"code":"70710116201","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MECLIZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12025","type":"CDM"},{"code":"46122053551","type":"NDC"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CARFILZOMIB 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120269","type":"CDM"},{"code":"76075010201","type":"NDC"}],"standard_charges":[{"gross_charge":868.64,"discounted_cash":347.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1768.6,"discounted_cash":707.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":764.24,"discounted_cash":305.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LANOLIN-PETROLATUM 15.5-53.4 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120316","type":"CDM"},{"code":"65197040010","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 42.5 G"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 42.5 G"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120326","type":"CDM"},{"code":"61553034024","type":"NDC"}],"standard_charges":[{"gross_charge":12.77,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120326","type":"CDM"},{"code":"5446074001","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV 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= 30 EACH"}]},{"description":"COLESTIPOL HCL 5 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12218","type":"CDM"},{"code":"115521218","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1222","type":"CDM"},{"code":"409116018","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1222","type":"CDM"},{"code":"409116001","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1222","type":"CDM"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1223","type":"CDM"},{"code":"409161050","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1223","type":"CDM"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122450","type":"CDM"},{"code":"61958230101","type":"NDC"}],"standard_charges":[{"gross_charge":24.33,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":26.62,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":49.36,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FLAVOR SWEET-SF PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122505","type":"CDM"},{"code":"395009416","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"FLAVOR SWEET-SF PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122505","type":"CDM"},{"code":"574030216","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"BEZLOTOXUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122628","type":"CDM"},{"code":"6302500","type":"NDC"}],"standard_charges":[{"gross_charge":73.03,"discounted_cash":29.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"BEZLOTOXUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122628","type":"CDM"},{"code":"6302501","type":"NDC"}],"standard_charges":[{"gross_charge":73.03,"discounted_cash":29.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"UREA 15 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122694","type":"CDM"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"PRENATABS FA 29-1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122740","type":"CDM"},{"code":"60258019001","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NUSINERSEN 12 MG/5ML IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122749","type":"CDM"},{"code":"64406005801","type":"NDC"}],"standard_charges":[{"gross_charge":28407.57,"discounted_cash":11363.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":21721.50,"discounted_cash":8688.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"BOTULINUM TOXIN TYPE A 100 UNIT IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12295","type":"CDM"},{"code":"23114501","type":"NDC"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":417.94,"discounted_cash":167.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":468.94,"discounted_cash":187.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RANIBIZUMAB 0.5 MG/0.05ML IZ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122982","type":"CDM"},{"code":"50242008003","type":"NDC"}],"standard_charges":[{"gross_charge":8074.0,"discounted_cash":3229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.05 ML"},{"gross_charge":39000.0,"discounted_cash":15600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.05 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":2.60,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"409330803","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"63323069422","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":2.60,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"99918000123","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"54302802","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"517760401","type":"NDC"}],"standard_charges":[{"gross_charge":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":1.22,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"517760425","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ROPIVACAINE HCL-NACL (PF) 0.2-0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123434","type":"CDM"},{"code":"61553049003","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123434","type":"CDM"},{"code":"99918123434","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"NOREPINEPHRINE-SODIUM CHLORIDE 16-0.9 MG/250ML-% IV 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Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ADENOSINE 90 MG/30ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123466","type":"CDM"},{"code":"61553023174","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"66689005501","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"60687075156","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"121131411","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"60687075142","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123519","type":"CDM"},{"code":"60687074037","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123519","type":"CDM"},{"code":"66689005601","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123519","type":"CDM"},{"code":"60687074024","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"}]},{"description":"LINACLOTIDE 72 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123536","type":"CDM"},{"code":"456120330","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":17.12,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ACCU-CHEK GUIDE W/DEVICE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123555","type":"CDM"},{"code":"65702072910","type":"NDC"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.66,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.59,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PSYLLIUM 51.7 % PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123662","type":"CDM"},{"code":"37000002410","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.44,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"517073501","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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| NDC EA = 2 ML"},{"gross_charge":510.10,"discounted_cash":204.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"OCRELIZUMAB 300 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"124245","type":"CDM"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":1271.31,"discounted_cash":508.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1316.71,"discounted_cash":526.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2064.10,"discounted_cash":825.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV 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NDC EA = 2.5 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12580","type":"CDM"},{"code":"76204010030","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 36-4.5 GM IV 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NDC EA = 30 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TERBINAFINE HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12724","type":"CDM"},{"code":"69097085907","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TERBINAFINE HCL 250 MG OR 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100 EACH"}]},{"description":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"31722013801","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"50268010511","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"50268010515","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127318","type":"CDM"},{"code":"63323045100","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127321","type":"CDM"},{"code":"67157010151","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127321","type":"CDM"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"SARILUMAB 150 MG/1.14ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127350","type":"CDM"},{"code":"24592001","type":"NDC"}],"standard_charges":[{"gross_charge":826.66,"discounted_cash":330.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"gross_charge":693.91,"discounted_cash":277.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"gross_charge":1958.60,"discounted_cash":783.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"}]},{"description":"SARILUMAB 200 MG/1.14ML SC 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Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127434","type":"CDM"},{"code":"69130501","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":20.97,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":8.02,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 3000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127435","type":"CDM"},{"code":"69130601","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":31.46,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.34,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127436","type":"CDM"},{"code":"69130701","type":"NDC"}],"standard_charges":[{"gross_charge":41.94,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":12.46,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":20.72,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127437","type":"CDM"},{"code":"69131810","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":31.14,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":104.86,"discounted_cash":41.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127437","type":"CDM"},{"code":"69130801","type":"NDC"}],"standard_charges":[{"gross_charge":31.14,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":16.75,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":104.85,"discounted_cash":41.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127437","type":"CDM"},{"code":"69131801","type":"NDC"}],"standard_charges":[{"gross_charge":104.86,"discounted_cash":41.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":16.75,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":31.14,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127438","type":"CDM"},{"code":"69130901","type":"NDC"}],"standard_charges":[{"gross_charge":186.44,"discounted_cash":74.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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ML"},{"gross_charge":419.40,"discounted_cash":167.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127471","type":"CDM"},{"code":"71288018204","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":14.69,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127471","type":"CDM"},{"code":"703523311","type":"NDC"}],"standard_charges":[{"gross_charge":30.21,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":12.01,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":10.43,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127471","type":"CDM"},{"code":"42658002102","type":"NDC"}],"standard_charges":[{"gross_charge":19.09,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":24.47,"discounted_cash":9.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":6.99,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127471","type":"CDM"},{"code":"42658002101","type":"NDC"}],"standard_charges":[{"gross_charge":21.05,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":24.44,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":6.98,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129380","type":"CDM"},{"code":"54811616","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129382","type":"CDM"},{"code":"23040350","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129382","type":"CDM"},{"code":"23040370","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 EACH"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129382","type":"CDM"},{"code":"23040330","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129384","type":"CDM"},{"code":"58790000330","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE ER 300 MG IM PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129385","type":"CDM"},{"code":"59148004580","type":"NDC"}],"standard_charges":[{"gross_charge":838.93,"discounted_cash":335.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1969.43,"discounted_cash":787.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":997.68,"discounted_cash":399.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ARIPIPRAZOLE ER 400 MG IM PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129386","type":"CDM"},{"code":"59148007280","type":"NDC"}],"standard_charges":[{"gross_charge":2625.91,"discounted_cash":1050.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129393","type":"CDM"},{"code":"409492120","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE HCL 0.1 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129393","type":"CDM"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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EACH"},{"gross_charge":362.88,"discounted_cash":145.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"COPANLISIB HCL 60 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129466","type":"CDM"},{"code":"50419038501","type":"NDC"}],"standard_charges":[{"gross_charge":5150.4,"discounted_cash":2060.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3939.13,"discounted_cash":1575.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3410.17,"discounted_cash":1364.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIBOFLAV5 & RIBOFLAV5-DEXTRAN 0.146 &0.146-20 % OP 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Type: pharmacy | NDC EA = 118 ML"}]},{"description":"ACETAMINOPHEN CHILDRENS 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129819","type":"CDM"},{"code":"904744520","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"SPIRONOLACTONE 25 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129881","type":"CDM"},{"code":"46287002004","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 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= 5 ML"},{"gross_charge":4.31,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.78,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SPIRONOLACTONE 25 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129881","type":"CDM"},{"code":"69238202708","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":2.97,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"FLUTICASONE PROPIONATE 93 MCG/ACT NA 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| NDC EA = 500 ML"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1299","type":"CDM"},{"code":"121476605","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ABEMACICLIB 50 MG PO 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| NDC EA = 14 EACH"},{"gross_charge":165.71,"discounted_cash":66.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":141.02,"discounted_cash":56.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129935","type":"CDM"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129985","type":"CDM"},{"code":"58160082803","type":"NDC"}],"standard_charges":[{"gross_charge":194.84,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":194.65,"discounted_cash":77.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CALCIUM CARBONATE 1250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1300","type":"CDM"},{"code":"999170001300","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CALCIUM CARBONATE 1250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1300","type":"CDM"},{"code":"54812025","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130008","type":"CDM"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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pharmacy | NDC EA = 1 EACH"}]},{"description":"BORTEZOMIB 3.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130025","type":"CDM"},{"code":"63323072110","type":"NDC"}],"standard_charges":[{"gross_charge":402.22,"discounted_cash":160.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":225.15,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BENRALIZUMAB 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130047","type":"CDM"},{"code":"310173030","type":"NDC"}],"standard_charges":[{"gross_charge":3655.19,"discounted_cash":1462.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13031","type":"CDM"},{"code":"32909075003","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 176 G"}]},{"description":"BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130315","type":"CDM"},{"code":"59310030240","type":"NDC"}],"standard_charges":[{"gross_charge":18.68,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.6 G"},{"gross_charge":5.26,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.6 G"}]},{"description":"BECLOMETHASONE DIPROP HFA 80 MCG/ACT IN 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= 1 EACH"},{"gross_charge":274.39,"discounted_cash":109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LETERMOVIR 480 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130319","type":"CDM"},{"code":"6307602","type":"NDC"}],"standard_charges":[{"gross_charge":184.08,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":274.39,"discounted_cash":109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":156.32,"discounted_cash":62.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"}]},{"description":"LETERMOVIR 480 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130319","type":"CDM"},{"code":"6307601","type":"NDC"}],"standard_charges":[{"gross_charge":274.39,"discounted_cash":109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":156.32,"discounted_cash":62.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":184.08,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"}]},{"description":"LETERMOVIR 480 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130319","type":"CDM"},{"code":"6307603","type":"NDC"}],"standard_charges":[{"gross_charge":156.32,"discounted_cash":62.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":274.39,"discounted_cash":109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":184.08,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LETERMOVIR 480 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130321","type":"CDM"},{"code":"6500401","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":15.81,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":9.08,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"}]},{"description":"APREPITANT 130 MG/18ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130322","type":"CDM"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 ML"},{"gross_charge":13.21,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 ML"},{"gross_charge":6.76,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 ML"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 40000-126000 UNITS PO 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pharmacy | NDC EA = 6 ML"},{"gross_charge":110.05,"discounted_cash":44.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"},{"gross_charge":103.71,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"517271025","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"64253090030","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"70121230901","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"70121230907","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130608","type":"CDM"},{"code":"68547050102","type":"NDC"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":706.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"NIVOLUMAB 240 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130626","type":"CDM"},{"code":"3373413","type":"NDC"}],"standard_charges":[{"gross_charge":207.77,"discounted_cash":83.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":330.96,"discounted_cash":132.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":239.22,"discounted_cash":95.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130631","type":"CDM"},{"code":"13533070511","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 MG"}]},{"description":"GEMCITABINE HCL 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130654","type":"CDM"},{"code":"68001034234","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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pharmacy | NDC EA = 10 ML"}]},{"description":"GEMCITABINE HCL 1 GM/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130655","type":"CDM"},{"code":"68001034836","type":"NDC"}],"standard_charges":[{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.01,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"VERAPAMIL HCL SR (BID) 240 MG OR 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VERAPAMIL HCL SR (BID) 240 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13073","type":"CDM"},{"code":"51079086901","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN CHILDRENS 80 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13089","type":"CDM"},{"code":"68001033200","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LISINOPRIL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13089","type":"CDM"},{"code":"68180051202","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP 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Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130987","type":"CDM"},{"code":"61958250103","type":"NDC"}],"standard_charges":[{"gross_charge":70.27,"discounted_cash":28.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":136.32,"discounted_cash":54.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":82.8,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO 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10 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1312","type":"CDM"},{"code":"63323036005","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV 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50 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1312","type":"CDM"},{"code":"80830167202","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1312","type":"CDM"},{"code":"80830167201","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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NDC EA = 90 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"VALACYCLOVIR HCL 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13133","type":"CDM"},{"code":"378427593","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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NDC EA = 30 EACH"}]},{"description":"VALACYCLOVIR HCL 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13133","type":"CDM"},{"code":"51079009301","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.75,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VALACYCLOVIR HCL 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13133","type":"CDM"},{"code":"51079009303","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132834","type":"CDM"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":1695.41,"discounted_cash":678.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":721.11,"discounted_cash":288.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE 0.4 MG OP INST","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132837","type":"CDM"},{"code":"70382020410","type":"NDC"}],"standard_charges":[{"gross_charge":249.88,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132843","type":"CDM"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132844","type":"CDM"},{"code":"63323051902","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132844","type":"CDM"},{"code":"409762013","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132844","type":"CDM"},{"code":"409762003","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132878","type":"CDM"},{"code":"68682030705","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132878","type":"CDM"},{"code":"69238173102","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"ACCU-CHEK GUIDE W/DEVICE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132879","type":"CDM"},{"code":"65702072910","type":"NDC"}],"standard_charges":[{"gross_charge":21.66,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":26.35,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.59,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ATEZOLIZUMAB 840 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132897","type":"CDM"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":324.18,"discounted_cash":129.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":540.84,"discounted_cash":216.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":375.12,"discounted_cash":150.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"}]},{"description":"DILUENT FOR TREPROSTINIL IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132980","type":"CDM"},{"code":"781602194","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133459","type":"CDM"},{"code":"63323088510","type":"NDC"}],"standard_charges":[{"gross_charge":13.11,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":5.68,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":6.28,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TAFAMIDIS MEGLUMINE (CARDIAC) 20 MG PO 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EA = 30 EACH"}]},{"description":"FAMCICLOVIR 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13358","type":"CDM"},{"code":"54019813","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FAMCICLOVIR 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13358","type":"CDM"},{"code":"60505324703","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SUMATRIPTAN SUCCINATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13369","type":"CDM"},{"code":"173073701","type":"NDC"}],"standard_charges":[{"gross_charge":68.46,"discounted_cash":27.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"},{"gross_charge":4.35,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"}]},{"description":"SM IODINE TINCTURE EX TINC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13381","type":"CDM"},{"code":"395121316","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"MEPOLIZUMAB 100 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133837","type":"CDM"},{"code":"173089242","type":"NDC"}],"standard_charges":[{"gross_charge":2489.75,"discounted_cash":995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3837.48,"discounted_cash":1534.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MEPOLIZUMAB 100 MG/ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133838","type":"CDM"},{"code":"173089201","type":"NDC"}],"standard_charges":[{"gross_charge":2489.75,"discounted_cash":995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3837.48,"discounted_cash":1534.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133845","type":"CDM"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":18611.41,"discounted_cash":7444.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13871.63,"discounted_cash":5548.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TESTOSTERONE 1.62 % TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133947","type":"CDM"},{"code":"69238101302","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"},{"gross_charge":0.76,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"ACETAMINOPHEN 650 MG OR 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pharmacy | NDC EA = 4 ML"},{"gross_charge":29.32,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134298","type":"CDM"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":49.53,"discounted_cash":19.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"},{"gross_charge":180.48,"discounted_cash":72.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"},{"gross_charge":80.48,"discounted_cash":32.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"}]},{"description":"TRASTUZUMAB-ANNS 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134309","type":"CDM"},{"code":"55513013201","type":"NDC"}],"standard_charges":[{"gross_charge":3693.94,"discounted_cash":1477.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1513.55,"discounted_cash":605.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":826.28,"discounted_cash":330.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134368","type":"CDM"},{"code":"44567062101","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134368","type":"CDM"},{"code":"80830236309","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134368","type":"CDM"},{"code":"80830236301","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"AMLODIPINE BENZOATE 1 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134371","type":"CDM"},{"code":"52652500101","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488801","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"63323018601","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488802","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488803","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488806","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488810","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135134","type":"CDM"},{"code":"409488850","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"ALIROCUMAB 75 MG/ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135135","type":"CDM"},{"code":"61755002002","type":"NDC"}],"standard_charges":[{"gross_charge":208.86,"discounted_cash":83.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":107.96,"discounted_cash":43.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":235.78,"discounted_cash":94.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VITAMIN D 12.5 MCG/0.25ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135170","type":"CDM"},{"code":"68176000018","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"SEMAGLUTIDE 7 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135283","type":"CDM"},{"code":"169430730","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":30.06,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERGOCALCIFEROL 200 MCG/ML (8000 UNIT/ML) PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135300","type":"CDM"},{"code":"69367028302","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"ERGOCALCIFEROL 200 MCG/ML (8000 UNIT/ML) PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135300","type":"CDM"},{"code":"43199001560","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"ERGOCALCIFEROL 200 MCG/ML (8000 UNIT/ML) PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135300","type":"CDM"},{"code":"69543023460","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"ERGOCALCIFEROL 200 MCG/ML (8000 UNIT/ML) PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135300","type":"CDM"},{"code":"75834001060","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135326","type":"CDM"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"}]},{"description":"VITAMIN D 25 MCG (1000 UNIT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135396","type":"CDM"},{"code":"536333401","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CHOLECALCIFEROL 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135402","type":"CDM"},{"code":"54838000650","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135402","type":"CDM"},{"code":"71399740105","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"VITAMIN D 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135406","type":"CDM"},{"code":"50383091750","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL 10 MCG /0.028ML (400 UNITS/0.028ML) PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135425","type":"CDM"},{"code":"51228000006","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"INDIUM IN-111 PENTETREOTIDE IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13545","type":"CDM"},{"code":"19905040","type":"NDC"}],"standard_charges":[{"gross_charge":783.33,"discounted_cash":313.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 100 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1355","type":"CDM"},{"code":"13668027101","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 100 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1355","type":"CDM"},{"code":"51672404101","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"68094021459","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"70954024010","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"60432012916","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"121189410","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"121189494","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"62135080253","type":"NDC"}],"standard_charges":[{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"68094000759","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"68094000859","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1356","type":"CDM"},{"code":"51672404709","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135687","type":"CDM"},{"code":"57237030416","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135689","type":"CDM"},{"code":"67457084744","type":"NDC"}],"standard_charges":[{"gross_charge":1018.81,"discounted_cash":407.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":766.68,"discounted_cash":306.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2342.55,"discounted_cash":937.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135689","type":"CDM"},{"code":"67457084550","type":"NDC"}],"standard_charges":[{"gross_charge":2342.55,"discounted_cash":937.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":766.68,"discounted_cash":306.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135691","type":"CDM"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":82.02,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":22.62,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB-ABBS 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135692","type":"CDM"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":20.83,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":82.02,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":22.58,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"TRASTUZUMAB-DKST 150 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135696","type":"CDM"},{"code":"67457099115","type":"NDC"}],"standard_charges":[{"gross_charge":837.11,"discounted_cash":334.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":363.86,"discounted_cash":145.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":258.58,"discounted_cash":103.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"904617261","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.76,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"60505018300","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"68084044411","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"68084044401","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ROMIPLOSTIM 125 MCG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135708","type":"CDM"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":1376.53,"discounted_cash":550.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":737.65,"discounted_cash":295.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":862.64,"discounted_cash":345.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRETOMANID 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135709","type":"CDM"},{"code":"49502047626","type":"NDC"}],"standard_charges":[{"gross_charge":18.64,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 26 EACH"},{"gross_charge":24.48,"discounted_cash":9.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 26 EACH"}]},{"description":"FLUCONAZOLE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13577","type":"CDM"},{"code":"68001025344","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.14,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13577","type":"CDM"},{"code":"68462010340","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":1.89,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"FLUCONAZOLE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13577","type":"CDM"},{"code":"68462011944","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":1.90,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"FLUCONAZOLE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13577","type":"CDM"},{"code":"68001025321","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13577","type":"CDM"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"SULFADIAZINE POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13579","type":"CDM"},{"code":"38779055005","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"BROLUCIZUMAB-DBLL 6 MG/0.05ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135793","type":"CDM"},{"code":"78082761","type":"NDC"}],"standard_charges":[{"gross_charge":106378.4,"discounted_cash":42551.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.05 ML"}]},{"description":"BARICITINIB 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135806","type":"CDM"},{"code":"2473230","type":"NDC"}],"standard_charges":[{"gross_charge":58.50,"discounted_cash":23.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":53.00,"discounted_cash":21.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":83.4,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAKINS (FULL STRENGTH) 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135831","type":"CDM"},{"code":"39328006250","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"DAKINS (FULL STRENGTH) 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135831","type":"CDM"},{"code":"436094616","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"TRASTUZUMAB-ANNS 150 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135870","type":"CDM"},{"code":"55513014101","type":"NDC"}],"standard_charges":[{"gross_charge":1319.27,"discounted_cash":527.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":347.12,"discounted_cash":138.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1225.7,"discounted_cash":490.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PEGFILGRASTIM-BMEZ 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135887","type":"CDM"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":6313.57,"discounted_cash":2525.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":1591.58,"discounted_cash":636.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"536300094","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"904322035","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"904662735","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"904747835","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"37205045705","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"42037010478","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"42037010479","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"78112073623","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"536101294","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"LUSPATERCEPT-AAMT 25 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135903","type":"CDM"},{"code":"59572071101","type":"NDC"}],"standard_charges":[{"gross_charge":3047.3,"discounted_cash":1218.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3545.19,"discounted_cash":1418.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4113.14,"discounted_cash":1645.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LUSPATERCEPT-AAMT 75 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135904","type":"CDM"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"gross_charge":10635.56,"discounted_cash":4254.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12339.37,"discounted_cash":4935.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9134.59,"discounted_cash":3653.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METHOTREXATE SODIUM 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13594","type":"CDM"},{"code":"555057235","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 36 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 36 EACH"}]},{"description":"METHOTREXATE SODIUM 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13594","type":"CDM"},{"code":"62332073031","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METHOTREXATE SODIUM 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13594","type":"CDM"},{"code":"69238142301","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135948","type":"CDM"},{"code":"78088361","type":"NDC"}],"standard_charges":[{"gross_charge":179.69,"discounted_cash":71.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":188.63,"discounted_cash":75.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":245.29,"discounted_cash":98.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"OMRON 3 SERIES BP MONITOR DEVI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136190","type":"CDM"},{"code":"73796027150","type":"NDC"}],"standard_charges":[{"gross_charge":26.32,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":32.03,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSINOH LANOLIN EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136234","type":"CDM"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 G"}]},{"description":"INSULIN ASPART 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136239","type":"CDM"},{"code":"73070010315","type":"NDC"}],"standard_charges":[{"gross_charge":8.42,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136284","type":"CDM"},{"code":"51144002001","type":"NDC"}],"standard_charges":[{"gross_charge":2809.0,"discounted_cash":1123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1952.62,"discounted_cash":781.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1648.9,"discounted_cash":659.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136285","type":"CDM"},{"code":"51144003001","type":"NDC"}],"standard_charges":[{"gross_charge":2929.17,"discounted_cash":1171.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138053","type":"CDM"},{"code":"44206045896","type":"NDC"}],"standard_charges":[{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":13.59,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 4 GM/20ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138053","type":"CDM"},{"code":"44206045824","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":13.59,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ZINC 220 (50 ZN) MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138066","type":"CDM"},{"code":"80681013500","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV 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Type: pharmacy | NDC EA = 200 ML"}]},{"description":"NIMODIPINE 6 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138098","type":"CDM"},{"code":"24338023015","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":10.68,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"NIMODIPINE 6 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138098","type":"CDM"},{"code":"24338023030","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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= 120 EACH"},{"gross_charge":119.05,"discounted_cash":47.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":219.98,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138147","type":"CDM"},{"code":"14789025007","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV 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Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1549.03,"discounted_cash":619.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"54162001709","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX 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NDC EA = 1 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"68001053145","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"603044150","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"168001104","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 113.4 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"168001116","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 453.6 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"472110556","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138416","type":"CDM"},{"code":"61958290201","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":19.99,"discounted_cash":8.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138418","type":"CDM"},{"code":"68094002959","type":"NDC"}],"standard_charges":[{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"46122075929","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"182616737","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"37205016526","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"904734920","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"904252820","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138633","type":"CDM"},{"code":"68803072205","type":"NDC"}],"standard_charges":[{"gross_charge":151.4,"discounted_cash":60.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"INEBILIZUMAB-CDON 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138758","type":"CDM"},{"code":"72677055103","type":"NDC"}],"standard_charges":[{"gross_charge":4366.67,"discounted_cash":1746.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3295.24,"discounted_cash":1318.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3355.99,"discounted_cash":1342.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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| NDC EA = 1 EACH"}]},{"description":"ENLITE GLUCOSE SENSOR MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138790","type":"CDM"},{"code":"8627007701","type":"NDC"}],"standard_charges":[{"gross_charge":138.09,"discounted_cash":55.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":113.5,"discounted_cash":45.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DUPILUMAB 300 MG/2ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138818","type":"CDM"},{"code":"24591502","type":"NDC"}],"standard_charges":[{"gross_charge":570.19,"discounted_cash":228.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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NDC EA = 30 EACH"},{"gross_charge":13.21,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":26.60,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TACROLIMUS ER 4 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139106","type":"CDM"},{"code":"68992304001","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":26.60,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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pharmacy | NDC EA = 2.5 ML"},{"gross_charge":41.59,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG/2.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139294","type":"CDM"},{"code":"70860021803","type":"NDC"}],"standard_charges":[{"gross_charge":41.08,"discounted_cash":16.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":49.52,"discounted_cash":19.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":5.43,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV 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NDC EA = 5 ML"}]},{"description":"TAFASITAMAB-CXIX 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139298","type":"CDM"},{"code":"73535020801","type":"NDC"}],"standard_charges":[{"gross_charge":1395.87,"discounted_cash":558.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1023.8,"discounted_cash":409.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":915.62,"discounted_cash":366.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TAFASITAMAB-CXIX 200 MG IV 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30 EACH"},{"gross_charge":13.29,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FERRIC DERISOMALTOSE(ONE DOSE) 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139535","type":"CDM"},{"code":"73594931001","type":"NDC"}],"standard_charges":[{"gross_charge":120.69,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":222.08,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":365.22,"discounted_cash":146.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"APIXABAN STARTER PACK 5 MG PO 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NDC EA = 1 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LAMOTRIGINE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13982","type":"CDM"},{"code":"65862022801","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LAMOTRIGINE 100 MG OR 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100 EACH"}]},{"description":"LAMOTRIGINE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13982","type":"CDM"},{"code":"93046301","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"60687070411","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"62332004060","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"69097015203","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"51079086620","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"29300011416","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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Type: pharmacy | NDC EA = 2 ML"}]},{"description":"RAVULIZUMAB-CWVZ 300 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140031","type":"CDM"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":1628.85,"discounted_cash":651.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":870.94,"discounted_cash":348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1627.27,"discounted_cash":650.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"RAVULIZUMAB-CWVZ 1100 MG/11ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140032","type":"CDM"},{"code":"25682002801","type":"NDC"}],"standard_charges":[{"gross_charge":1629.71,"discounted_cash":651.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"},{"gross_charge":1633.51,"discounted_cash":653.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"},{"gross_charge":870.94,"discounted_cash":348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"}]},{"description":"CALCIUM CARBONATE ANTACID 1000 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14005","type":"CDM"},{"code":"24385059523","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"69097052444","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"46122075252","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"536129497","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"67815203","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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| NDC EA = 10 ML"},{"gross_charge":69.53,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB-ARRX 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140845","type":"CDM"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":16.91,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":69.53,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":25.84,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"RELUGOLIX 120 MG PO 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"51079016101","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ASPIRIN EC 81 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14113","type":"CDM"},{"code":"63739052201","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 750 EACH"}]},{"description":"ASPIRIN EC 81 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14113","type":"CDM"},{"code":"63739052210","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ASPIRIN EC 81 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14113","type":"CDM"},{"code":"77333003120","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"ASPIRIN EC 81 MG OR TBEC 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SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14132","type":"CDM"},{"code":"10147075004","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"SEMAGLUTIDE (1 MG/DOSE) 4 MG/3ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141440","type":"CDM"},{"code":"169413013","type":"NDC"}],"standard_charges":[{"gross_charge":120.24,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":100.72,"discounted_cash":40.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":300.64,"discounted_cash":120.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"TRASTUZUMAB-QYYP 150 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141442","type":"CDM"},{"code":"69030801","type":"NDC"}],"standard_charges":[{"gross_charge":125.02,"discounted_cash":50.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":385.29,"discounted_cash":154.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":916.69,"discounted_cash":366.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV 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Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1191.18,"discounted_cash":476.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141828","type":"CDM"},{"code":"74527002202","type":"NDC"}],"standard_charges":[{"gross_charge":227.26,"discounted_cash":90.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":267.37,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":159.42,"discounted_cash":63.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141828","type":"CDM"},{"code":"74527002201","type":"NDC"}],"standard_charges":[{"gross_charge":267.37,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":227.26,"discounted_cash":90.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":159.42,"discounted_cash":63.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14196","type":"CDM"},{"code":"46110711","type":"NDC"}],"standard_charges":[{"gross_charge":8.00,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"CONJ ESTROG-MEDROXYPROGEST ACE 0.625-5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14197","type":"CDM"},{"code":"46110811","type":"NDC"}],"standard_charges":[{"gross_charge":8.00,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"VINORELBINE TARTRATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14203","type":"CDM"},{"code":"64370053201","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VINORELBINE TARTRATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14203","type":"CDM"},{"code":"64370053202","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"VITAMIN E 180 MG (400 UNIT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142056","type":"CDM"},{"code":"77333095125","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VITAMIN E 180 MG (400 UNIT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142056","type":"CDM"},{"code":"87701040754","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUORESCEIN SODIUM/BENOXINATE 0.3-0.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142087","type":"CDM"},{"code":"82260073405","type":"NDC"}],"standard_charges":[{"gross_charge":5.33,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.45,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN SODIUM/BENOXINATE 0.3-0.4 % OP 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| NDC EA = 35 ML"}]},{"description":"FLUCONAZOLE 40 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14233","type":"CDM"},{"code":"57237015035","type":"NDC"}],"standard_charges":[{"gross_charge":0.3,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"}]},{"description":"FLUCONAZOLE 40 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14233","type":"CDM"},{"code":"59762503001","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"}]},{"description":"FLUCONAZOLE 40 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14233","type":"CDM"},{"code":"70436022748","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"}]},{"description":"ARTESUNATE 110 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142374","type":"CDM"},{"code":"73607001111","type":"NDC"}],"standard_charges":[{"gross_charge":3739.42,"discounted_cash":1495.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5378.5,"discounted_cash":2151.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ARTESUNATE 110 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142374","type":"CDM"},{"code":"73607000201","type":"NDC"}],"standard_charges":[{"gross_charge":5378.5,"discounted_cash":2151.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3739.42,"discounted_cash":1495.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DOSTARLIMAB-GXLY 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142547","type":"CDM"},{"code":"173089803","type":"NDC"}],"standard_charges":[{"gross_charge":885.68,"discounted_cash":354.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1203.03,"discounted_cash":481.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1036.94,"discounted_cash":414.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"LONCASTUXIMAB TESIRINE-LPYL 10 MG IV 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pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMOTRIGINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14266","type":"CDM"},{"code":"51079086520","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"AMIVANTAMAB-VMJW 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142802","type":"CDM"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":369.39,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142948","type":"CDM"},{"code":"407141369","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 125 ML"}]},{"description":"IOHEXOL 350 MG/ML CO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142949","type":"CDM"},{"code":"99220010323","type":"NDC"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG/ML CO 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pharmacy | NDC EA = 4 EACH"}]},{"description":"SEMAGLUTIDE-WEIGHT MANAGEMENT 0.25 MG/0.5ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"143019","type":"CDM"},{"code":"169452514","type":"NDC"}],"standard_charges":[{"gross_charge":654.28,"discounted_cash":261.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":352.56,"discounted_cash":141.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":262.22,"discounted_cash":104.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"SEMAGLUTIDE-WEIGHT MANAGEMENT 0.5 MG/0.5ML SC 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pharmacy | NDC EA = 60 EACH"}]},{"description":"TRIAMCINOLONE (SUPRACHOROIDAL) 40 MG/ML IO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144737","type":"CDM"},{"code":"71565004001","type":"NDC"}],"standard_charges":[{"gross_charge":1409.83,"discounted_cash":563.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.9 ML"},{"gross_charge":1833.33,"discounted_cash":733.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.9 ML"}]},{"description":"TOPIRAMATE 25 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144750","type":"CDM"},{"code":"67877083361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1448","type":"CDM"},{"code":"25021010010","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.69,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ 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NDC EA = 10 ML"}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145230","type":"CDM"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":1459.08,"discounted_cash":583.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"},{"gross_charge":2287.18,"discounted_cash":914.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"}]},{"description":"TEBENTAFUSP-TEBN 100 MCG/0.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145442","type":"CDM"},{"code":"80446040101","type":"NDC"}],"standard_charges":[{"gross_charge":41980.0,"discounted_cash":16792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUTIMLIMAB-JOME 1100 MG/22ML IV 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pharmacy | NDC EA = 30 EACH"},{"gross_charge":20.40,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DARUNAVIR 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145696","type":"CDM"},{"code":"60687081921","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.08,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14793","type":"CDM"},{"code":"60505025203","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"TIZANIDINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14793","type":"CDM"},{"code":"904641861","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TIZANIDINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14793","type":"CDM"},{"code":"51079099820","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TIZANIDINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14793","type":"CDM"},{"code":"55111018015","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"CALCIUM CARB-CHOLECALCIFEROL 600-800 MG-UNIT PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147936","type":"CDM"},{"code":"5550919","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SALMETEROL XINAFOATE 50 MCG/ACT IN 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pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147973","type":"CDM"},{"code":"173088710","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.21,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":2.77,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CENTRUM OR 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| NDC EA = 90 EACH"}]},{"description":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"68084034611","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"65862020190","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 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pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14824","type":"CDM"},{"code":"65862020299","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR 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| NDC EA = 1 EACH"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"69097057967","type":"NDC"}],"standard_charges":[{"gross_charge":51.54,"discounted_cash":20.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.78,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"60219395503","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":6.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":49.45,"discounted_cash":19.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"456430008","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"discounted_cash":22.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":13.44,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148343","type":"CDM"},{"code":"310453530","type":"NDC"}],"standard_charges":[{"gross_charge":2050.79,"discounted_cash":820.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":2759.14,"discounted_cash":1103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"POSACONAZOLE 300 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148370","type":"CDM"},{"code":"85222401","type":"NDC"}],"standard_charges":[{"gross_charge":163.18,"discounted_cash":65.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14845","type":"CDM"},{"code":"409780922","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14845","type":"CDM"},{"code":"409780911","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14846","type":"CDM"},{"code":"338100902","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14847","type":"CDM"},{"code":"24385044164","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 32 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 32 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 32 EACH"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14847","type":"CDM"},{"code":"41167000623","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 48 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 48 EACH"}]},{"description":"TERLIPRESSIN ACETATE 0.85 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148520","type":"CDM"},{"code":"43825020001","type":"NDC"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TECLISTAMAB-CQYV 30 MG/3ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148592","type":"CDM"},{"code":"57894044901","type":"NDC"}],"standard_charges":[{"gross_charge":682.84,"discounted_cash":273.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":472.19,"discounted_cash":188.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"TECLISTAMAB-CQYV 153 MG/1.7ML SC 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Type: pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14923","type":"CDM"},{"code":"409196601","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14923","type":"CDM"},{"code":"409196607","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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EA = 1 EACH"}]},{"description":"FREESTYLE LIBRE 2 READER SYSTM DEVI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149263","type":"CDM"},{"code":"8627007801","type":"NDC"}],"standard_charges":[{"gross_charge":328.9,"discounted_cash":131.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":270.33,"discounted_cash":108.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IRON (FERROUS SULFATE) 75 (15 FE) MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149278","type":"CDM"},{"code":"39328055750","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVIT/MULTIMINERAL ADULT PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149289","type":"CDM"},{"code":"81033050115","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVIT/MULTIMINERAL ADULT PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149289","type":"CDM"},{"code":"81033050150","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149292","type":"CDM"},{"code":"17478051500","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.04,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149303","type":"CDM"},{"code":"50242015901","type":"NDC"}],"standard_charges":[{"gross_charge":476.81,"discounted_cash":190.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":624.25,"discounted_cash":249.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MOSUNETUZUMAB-AXGB 30 MG/30ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149304","type":"CDM"},{"code":"50242014201","type":"NDC"}],"standard_charges":[{"gross_charge":473.81,"discounted_cash":189.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149440","type":"CDM"},{"code":"11994000602","type":"NDC"}],"standard_charges":[{"gross_charge":53.21,"discounted_cash":21.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LECANEMAB-IRMB 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149521","type":"CDM"},{"code":"62856021201","type":"NDC"}],"standard_charges":[{"gross_charge":130.62,"discounted_cash":52.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":96.19,"discounted_cash":38.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"LECANEMAB-IRMB 500 MG/5ML IV 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