{"hospital_name":"UCI Health - Lakewood","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["UCI Health - Lakewood"],"hospital_address":["101 City Drive South, Orange, CA 92868"],"license_information":{"license_number":"060000148","state":"CA"},"type_2_npi":["1184655581"],"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":"Administered intravenously","code":"JA","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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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 Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Riverside Medical Clinic","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]},{"description":"Administered subcutaneously","code":"JB","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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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 Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Riverside Medical Clinic","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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 Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Riverside Medical Clinic","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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 Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Riverside Medical Clinic","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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 Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PrimeCare Medical Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Redlands Community Hospital","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Riverside Medical Clinic","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]},{"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 Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AltaMed Health Services","plan_name":"Senior Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AMVI/Prospect Medical Group","plan_name":"OneCare Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beaver Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"UC SHIP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Vivity Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bright Health Physicians of PIH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price 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 Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coast Healthcare Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Family Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Greater Newport Physicians Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthCare Partners","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hemet Community Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"DualChoice Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Key Medical Group","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Medi-Cal Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Behavioral Health Plan","description":"The modified price is 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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Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Seaside Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Joseph","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"St. Mary Choice Medical Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select, Select Plus, Navigate and Doctors Plan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"UCI University Physicians and Surgeons HMO","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"SEMI-PRIVATE ROOM","code_information":[{"code":"001990002","type":"CDM"},{"code":"0120","type":"RC"}],"standard_charges":[{"gross_charge":5216.0,"discounted_cash":2086.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: UCI - Lakewood Regional 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10011","type":"CDM"},{"code":"46122073771","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 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"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":"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":0.11,"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":"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":0.05,"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":"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":"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":"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":"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":"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":"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":"172572860","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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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":"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":"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":"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 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":0.02,"discounted_cash":0.006,"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"},{"gross_charge":0.01,"discounted_cash":0.0052,"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":0.01,"discounted_cash":0.004,"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 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":0.09,"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":0.04,"discounted_cash":0.02,"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":"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":"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":"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":"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 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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":0.23,"discounted_cash":0.09,"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"}]},{"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":"51525043101","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":3.93,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"FELBAMATE 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10025","type":"CDM"},{"code":"51525043111","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":3.98,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 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":"65162073509","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 = 90 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":2.52,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"FILGRASTIM 300 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10036","type":"CDM"},{"code":"55513053001","type":"NDC"}],"standard_charges":[{"gross_charge":43.90,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":79.16,"discounted_cash":31.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":305.08,"discounted_cash":122.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"FILGRASTIM 300 MCG/ML IJ 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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":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"16729009001","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":0.02,"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":"FINASTERIDE 5 MG OR 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EA = 1 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 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"HYDROCORTISONE VALERATE 0.2 % EX 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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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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":0.08,"discounted_cash":0.03,"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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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":"68382009601","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":0.07,"discounted_cash":0.03,"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":"HYDROXYCHLOROQUINE SULFATE 200 MG OR 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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":"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68001052194","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 = 240 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"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":"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":"68094049459","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 = 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":0.12,"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 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"60687074317","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 = 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":"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":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"121091400","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":"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 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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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":0.02,"discounted_cash":0.006,"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":"24385037226","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 = 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":"24385090526","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 = 120 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"338399101","type":"NDC"}],"standard_charges":[{"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"},{"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 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":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"},{"gross_charge":24.8,"discounted_cash":9.92,"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":30.69,"discounted_cash":12.28,"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"},{"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 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":89.52,"discounted_cash":35.81,"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":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":"10019092616","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":89.52,"discounted_cash":35.81,"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":"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":"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":733.95,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":770.76,"discounted_cash":308.30,"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":"68382047001","type":"NDC"}],"standard_charges":[{"gross_charge":81.49,"discounted_cash":32.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":62.13,"discounted_cash":24.85,"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":180.12,"discounted_cash":72.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":237.04,"discounted_cash":94.82,"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":"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":187.94,"discounted_cash":75.18,"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"}]},{"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":1.05,"discounted_cash":0.42,"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":0.26,"discounted_cash":0.10,"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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"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":0.07,"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":"2831501","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 = 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"},{"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 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":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 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":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"},{"gross_charge":3.86,"discounted_cash":1.54,"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":"2871517","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 = 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"},{"gross_charge":11.65,"discounted_cash":4.66,"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":"2871501","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":3.32,"discounted_cash":1.33,"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":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 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":"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":2.24,"discounted_cash":0.90,"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"},{"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":"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":"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":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"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"}]},{"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":"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":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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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":0.08,"discounted_cash":0.03,"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":"INTERFERON ALFA-2B 18000000 UNIT IJ 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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":"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":0.54,"discounted_cash":0.22,"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":0.50,"discounted_cash":0.20,"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":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 180 MG/ML IJ 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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 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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":"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":0.05,"discounted_cash":0.02,"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":"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":"62175010701","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":0.16,"discounted_cash":0.06,"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":"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":"ISOSORBIDE MONONITRATE 20 MG OR 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EA = 5 ML"}]},{"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":"IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT IN 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100 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":0.24,"discounted_cash":0.09,"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":0.26,"discounted_cash":0.10,"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":"10147170003","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.39,"discounted_cash":0.16,"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":0.73,"discounted_cash":0.29,"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"}]},{"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":0.22,"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":"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":11.71,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"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"}]},{"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":"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":"168009960","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 = 60 G"},{"gross_charge":0.53,"discounted_cash":0.21,"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":"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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"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":0.10,"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":"51672129802","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 = 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":0.12,"discounted_cash":0.05,"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":"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 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 EACH"}]},{"description":"KETOCONAZOLE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10369","type":"CDM"},{"code":"378026101","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":"KETOCONAZOLE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10369","type":"CDM"},{"code":"51672402601","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.34,"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":0.19,"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":"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":"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":0.30,"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"},{"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":"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":0.95,"discounted_cash":0.38,"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":"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":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":0.02,"discounted_cash":0.0072,"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":"72266010301","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 = 40 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":0.04,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"17478042020","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 = 20 ML"},{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.02,"discounted_cash":0.0072,"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":"36000032202","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 = 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"}]},{"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":0.50,"discounted_cash":0.20,"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":0.09,"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":"47781058656","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 = 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"},{"gross_charge":0.08,"discounted_cash":0.03,"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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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":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"99918504675","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 = 4 ML"},{"gross_charge":1.06,"discounted_cash":0.42,"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":"72266010201","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":0.09,"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":"60505071700","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 = 4 ML"},{"gross_charge":2.01,"discounted_cash":0.80,"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":"51991093498","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 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= 100 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 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":"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 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= 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":"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":"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":"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 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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"}]},{"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":1.29,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.24,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOBUNOLOL HCL 0.5 % OP 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"69238183301","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":0.02,"discounted_cash":0.008,"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"}]},{"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":"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":0.41,"discounted_cash":0.16,"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":0.28,"discounted_cash":0.11,"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":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":0.08,"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":"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":"378181101","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"},{"gross_charge":0.50,"discounted_cash":0.20,"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":"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":"LEVOTHYROXINE SODIUM 137 MCG OR 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pharmacy | NDC EA = 40 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104057","type":"CDM"},{"code":"703367801","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 = 40 ML"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104057","type":"CDM"},{"code":"16729027735","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 = 40 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":1536.72,"discounted_cash":614.69,"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":"409317701","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":0.07,"discounted_cash":0.03,"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":0.05,"discounted_cash":0.02,"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":0.25,"discounted_cash":0.1,"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":"99917010427","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"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":0.32,"discounted_cash":0.13,"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 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":"409318202","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"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"63323048303","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 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":"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 %-1:200000 IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10431","type":"CDM"},{"code":"409318301","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 = 20 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10431","type":"CDM"},{"code":"63323048921","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 = 20 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"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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30 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10434","type":"CDM"},{"code":"62332058204","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 = 5 G"},{"gross_charge":1.49,"discounted_cash":0.60,"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":"62332058231","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 = 30 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NDC EA = 1 EACH"},{"gross_charge":0.83,"discounted_cash":0.33,"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":"60687070011","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 = 1 EACH"},{"gross_charge":0.7,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BETHANECHOL CHLORIDE 25 MG OR 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NDC EA = 100 EACH"}]},{"description":"LISINOPRIL 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10450","type":"CDM"},{"code":"68001048600","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":0.03,"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":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO 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NDC EA = 120 EACH"}]},{"description":"MAGNESIUM OXIDE 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10491","type":"CDM"},{"code":"603020922","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 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"MAGNESIUM OXIDE 400 MG OR 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= 50 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"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 650 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105","type":"CDM"},{"code":"45802073000","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 = 1 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MALATHION 0.5 % EX 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INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10512","type":"CDM"},{"code":"6468100","type":"NDC"}],"standard_charges":[{"gross_charge":78.91,"discounted_cash":31.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":88.81,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"41679036503","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"}]},{"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 946 ML"}]},{"description":"MEFLOQUINE HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10520","type":"CDM"},{"code":"54002511","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 = 25 EACH"}]},{"description":"MEGESTROL ACETATE 40 MG/ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10521","type":"CDM"},{"code":"68094025059","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 = 10 ML"},{"gross_charge":0.21,"discounted_cash":0.09,"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":"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 ML"},{"gross_charge":0.43,"discounted_cash":0.17,"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":"64380016002","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 = 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":"MELPHALAN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"63323076020","type":"NDC"}],"standard_charges":[{"gross_charge":252.34,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"54288010601","type":"NDC"}],"standard_charges":[{"gross_charge":104.14,"discounted_cash":41.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":136.03,"discounted_cash":54.41,"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":"59572030101","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":"MELPHALAN HCL 50 MG IV 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| 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":"71288011110","type":"NDC"}],"standard_charges":[{"gross_charge":105.63,"discounted_cash":42.25,"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":"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":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"},{"gross_charge":99.46,"discounted_cash":39.78,"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":19.44,"discounted_cash":7.78,"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":"43598039150","type":"NDC"}],"standard_charges":[{"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":99.46,"discounted_cash":39.78,"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":"71288013290","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 CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105229","type":"CDM"},{"code":"456120230","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":"MENINGOCOCCAL VAC A,C,Y,W-135 SC INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10524","type":"CDM"},{"code":"49281048901","type":"NDC"}],"standard_charges":[{"gross_charge":108.26,"discounted_cash":43.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PHYTONADIONE 1 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105250","type":"CDM"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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":"PHYTONADIONE 1 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105250","type":"CDM"},{"code":"409915701","type":"NDC"}],"standard_charges":[{"gross_charge":7.57,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":5.73,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":5.88,"discounted_cash":2.35,"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":"54458111","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 = 25 EACH"},{"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":0.39,"discounted_cash":0.16,"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":"69076091302","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":1.80,"discounted_cash":0.72,"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":"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":"378354752","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 = 25 EACH"},{"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":2.87,"discounted_cash":1.15,"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":"62559042007","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":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.04,"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":0.05,"discounted_cash":0.02,"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"},{"gross_charge":0.14,"discounted_cash":0.06,"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":"45802009846","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 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10537","type":"CDM"},{"code":"25021020110","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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10537","type":"CDM"},{"code":"25021020111","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 = 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":"MESNA 100 MG/ML IV 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= 1 EACH"}]},{"description":"METOLAZONE 5 MG OR 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":"21922003923","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 = 70 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10592","type":"CDM"},{"code":"68462018449","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 70 G"},{"gross_charge":0.07,"discounted_cash":0.03,"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":"781707787","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 = 70 G"},{"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":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":"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":"527410737","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":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"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":"93873901","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 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10595","type":"CDM"},{"code":"60687077821","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 = 30 EACH"},{"gross_charge":1.04,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"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":0.40,"discounted_cash":0.16,"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":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MEXILETINE HCL 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10596","type":"CDM"},{"code":"527410837","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MEXILETINE HCL 200 MG OR 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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"},{"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":"MEXILETINE HCL 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10597","type":"CDM"},{"code":"50742024101","type":"NDC"}],"standard_charges":[{"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":0.74,"discounted_cash":0.30,"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":"MEXILETINE HCL 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10597","type":"CDM"},{"code":"527410937","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.40,"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":"MEXILETINE HCL 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10597","type":"CDM"},{"code":"93874101","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":1.62,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"},{"gross_charge":0.06,"discounted_cash":0.02,"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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"},{"gross_charge":0.06,"discounted_cash":0.02,"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":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ 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":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10608","type":"CDM"},{"code":"409230801","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.96,"discounted_cash":0.38,"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":"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":"68084024001","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 = 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":"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":"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":"245021111","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":0.02,"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"}]},{"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":0.48,"discounted_cash":0.19,"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"}]},{"description":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"82293000410","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":0.02,"discounted_cash":0.01,"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 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":0.56,"discounted_cash":0.22,"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":"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":0.71,"discounted_cash":0.28,"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":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"49884084901","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":1.11,"discounted_cash":0.44,"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":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"245021211","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":0.02,"discounted_cash":0.0076,"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":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"60687039811","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":0.56,"discounted_cash":0.22,"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":"MIDODRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10610","type":"CDM"},{"code":"72888011301","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":0.03,"discounted_cash":0.01,"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":"68084024111","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"}]},{"description":"MIDODRINE HCL 5 MG OR 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":146.79,"discounted_cash":58.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MINOCYCLINE HCL 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10612","type":"CDM"},{"code":"70842016010","type":"NDC"}],"standard_charges":[{"gross_charge":100.45,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":258.5,"discounted_cash":103.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":115.20,"discounted_cash":46.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MINOCYCLINE HCL 100 MG IV 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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"}]},{"description":"MISOPROSTOL 100 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10628","type":"CDM"},{"code":"59762500702","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 = 120 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"MISOPROSTOL 100 MCG OR 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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":"MITOMYCIN 5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10632","type":"CDM"},{"code":"67457051805","type":"NDC"}],"standard_charges":[{"gross_charge":219.02,"discounted_cash":87.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":87.86,"discounted_cash":35.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":66.2,"discounted_cash":26.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 5 MG IV 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EA = 1 EACH"}]},{"description":"MITOMYCIN 5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10632","type":"CDM"},{"code":"16729011505","type":"NDC"}],"standard_charges":[{"gross_charge":51.13,"discounted_cash":20.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":44.42,"discounted_cash":17.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":219.9,"discounted_cash":87.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOTANE 500 MG OR 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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":"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 CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"45802025742","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 = 45 G"},{"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":0.60,"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 OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10648","type":"CDM"},{"code":"713063537","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 = 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"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"APIXABAN 2.5 MG PO 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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"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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":"3089421","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":3.65,"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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"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":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.44,"discounted_cash":0.18,"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":"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":494.12,"discounted_cash":197.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":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":"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":"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":"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":0.34,"discounted_cash":0.14,"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":0.08,"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":"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":0.14,"discounted_cash":0.06,"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"}]},{"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":0.08,"discounted_cash":0.03,"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":0.36,"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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.63,"discounted_cash":0.65,"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":"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":"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":"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":"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":"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":"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":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"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":0.37,"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":"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":"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":"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":"407141365","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 = 150 ML"},{"gross_charge":0.79,"discounted_cash":0.32,"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":0.81,"discounted_cash":0.33,"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":"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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":"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":"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 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":"407141230","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":0.70,"discounted_cash":0.28,"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.90,"discounted_cash":1.56,"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":"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":"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":"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":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"},{"gross_charge":1.44,"discounted_cash":0.58,"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":"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":0.46,"discounted_cash":0.18,"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":"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":"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":"16729008110","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 = 30 EACH"},{"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"}]},{"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":"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":"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 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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":"93590786","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 = 180 EACH"},{"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"}]},{"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":"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":0.04,"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":"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":1.32,"discounted_cash":0.53,"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"}]},{"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":53.41,"discounted_cash":21.37,"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 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":0.93,"discounted_cash":0.37,"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":0.84,"discounted_cash":0.34,"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":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"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":0.54,"discounted_cash":0.21,"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":20.37,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"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":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":1.51,"discounted_cash":0.60,"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":"536136225","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 = 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":0.08,"discounted_cash":0.03,"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":"536302923","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 = 110 EACH"},{"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"}]},{"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":0.15,"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"}]},{"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":2409.21,"discounted_cash":963.68,"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":3989.63,"discounted_cash":1595.85,"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":0.04,"discounted_cash":0.01,"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":"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":"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 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 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":0.05,"discounted_cash":0.02,"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":0.08,"discounted_cash":0.03,"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":"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":1.82,"discounted_cash":0.73,"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"}]},{"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":"NITROFURANTOIN 25 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10723","type":"CDM"},{"code":"59651020623","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 230 ML"},{"gross_charge":5.38,"discounted_cash":2.15,"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":8.64,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 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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"},{"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":"MORPHINE SULFATE ER 30 MG PO TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107314","type":"CDM"},{"code":"68084015811","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 = 1 EACH"},{"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":"MORPHINE SULFATE (PF) 2 MG/ML IV 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EA = 1 ML"},{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107329","type":"CDM"},{"code":"74437805","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 = 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"}]},{"description":"CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV 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pharmacy | NDC EA = 10 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.08,"discounted_cash":0.43,"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":"703205603","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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 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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":"68084022011","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 = 1 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"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":"68462010530","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 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EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"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":"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 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":0.02,"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"},{"gross_charge":0.11,"discounted_cash":0.05,"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":"51079052520","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":0.35,"discounted_cash":0.14,"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":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":0.0092,"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":"50268062211","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":0.35,"discounted_cash":0.14,"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":"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":"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":"904655261","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 = 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":0.57,"discounted_cash":0.23,"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":"68084022101","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 = 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":"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":"57237007630","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 = 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"},{"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":"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":"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":"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":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"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"}]},{"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":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 36000-114000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107888","type":"CDM"},{"code":"32301613","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.49,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BISACODYL 5 MG OR 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":"BISACODYL 5 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1079","type":"CDM"},{"code":"46122052963","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 = 25 EACH"}]},{"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":109.16,"discounted_cash":43.67,"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":11.57,"discounted_cash":4.63,"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":"60505100602","type":"NDC"}],"standard_charges":[{"gross_charge":21.10,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":15.38,"discounted_cash":6.15,"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":"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":"713010906","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 = 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":"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":"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":"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":"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":"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":"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":"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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"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":"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":"143952501","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 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":"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":"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":"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":"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":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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"}]},{"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":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10810","type":"CDM"},{"code":"54838051080","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":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10813","type":"CDM"},{"code":"406855605","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 = 500 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10813","type":"CDM"},{"code":"66689040101","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":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10813","type":"CDM"},{"code":"406855689","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"10702001801","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":0.05,"discounted_cash":0.02,"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":"10702001850","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 = 500 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"description":"OXYCODONE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"42858000110","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 = 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":0.04,"discounted_cash":0.02,"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":"406055262","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":0.39,"discounted_cash":0.16,"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":"OXYCODONE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"406055223","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 = 1 EACH"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXYCODONE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"406055201","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 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":0.04,"discounted_cash":0.02,"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":"228287611","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 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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"},{"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":"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":0.23,"discounted_cash":0.09,"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":"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":"ARTIFICIAL TEARS 83-15 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108572","type":"CDM"},{"code":"536108691","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 = 3.5 G"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108590","type":"CDM"},{"code":"63833038602","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 = 500 UNITS"},{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108617","type":"CDM"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"},{"gross_charge":6.80,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"},{"gross_charge":11.64,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"}]},{"description":"INFLUENZA VIRUS VAC LIVE QUAD NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108873","type":"CDM"},{"code":"66019030501","type":"NDC"}],"standard_charges":[{"gross_charge":19.51,"discounted_cash":7.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108923","type":"CDM"},{"code":"548960200","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 = 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":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108923","type":"CDM"},{"code":"641614901","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":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108923","type":"CDM"},{"code":"71288050110","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 = 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":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV 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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":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108923","type":"CDM"},{"code":"76014000333","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.42,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INFLUENZA VAC SPLIT QUAD 0.25 ML IM 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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":"143933510","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"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ 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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":0.05,"discounted_cash":0.02,"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 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ 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Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 40-5 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110031","type":"CDM"},{"code":"409277602","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 = 200 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 40-5 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110031","type":"CDM"},{"code":"143971801","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 = 200 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NDC EA = 10 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"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":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV 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NDC EA = 50 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"MILRINONE LACTATE 50 MG/50ML IV 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25 ML"},{"gross_charge":1.07,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110036","type":"CDM"},{"code":"63323010425","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 = 25 ML"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV 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1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11023","type":"CDM"},{"code":"68462075801","type":"NDC"}],"standard_charges":[{"gross_charge":13.52,"discounted_cash":5.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":12.72,"discounted_cash":5.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"PHYTONADIONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11024","type":"CDM"},{"code":"69238105103","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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":0.08,"discounted_cash":0.03,"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":0.04,"discounted_cash":0.01,"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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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"}]},{"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":11.83,"discounted_cash":4.73,"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":36.81,"discounted_cash":14.72,"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":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":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":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":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":76.76,"discounted_cash":30.70,"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":"63459091215","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"},{"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"}]},{"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":"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":"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":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"},{"gross_charge":225.01,"discounted_cash":90.00,"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":0.04,"discounted_cash":0.02,"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":0.06,"discounted_cash":0.03,"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":"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":"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":"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":0.28,"discounted_cash":0.11,"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":0.24,"discounted_cash":0.10,"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":"904589161","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 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"},{"gross_charge":0.12,"discounted_cash":0.05,"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":"60687088611","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 = 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":"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":0.06,"discounted_cash":0.02,"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 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":0.04,"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":"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":"68462019690","type":"NDC"}],"standard_charges":[{"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":0.05,"discounted_cash":0.02,"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":"69097078905","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 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 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":0.46,"discounted_cash":0.18,"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":0.41,"discounted_cash":0.16,"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":"60687017811","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 = 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":0.41,"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":"60687089711","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":0.39,"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":"68084050111","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 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 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"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":75.55,"discounted_cash":30.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"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":"74302313","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":0.04,"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"}]},{"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":0.21,"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"},{"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":"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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"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":"66993045630","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.74,"discounted_cash":2.70,"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":"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 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":6.89,"discounted_cash":2.76,"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"},{"gross_charge":11.40,"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":"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":"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":"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":"53746054401","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 = 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":0.14,"discounted_cash":0.05,"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":"527130101","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":0.04,"discounted_cash":0.02,"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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"}]},{"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"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":"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":"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":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"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"}]},{"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":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.69,"discounted_cash":1.08,"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":"68180029006","type":"NDC"}],"standard_charges":[{"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":1.69,"discounted_cash":0.67,"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":"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 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":12.54,"discounted_cash":5.01,"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":2.03,"discounted_cash":0.81,"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":13.71,"discounted_cash":5.48,"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":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":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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"}]},{"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":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.29,"discounted_cash":0.52,"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":1.75,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.03,"discounted_cash":0.81,"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":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.58,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":12.42,"discounted_cash":4.97,"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":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"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"}]},{"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":6.44,"discounted_cash":2.57,"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":"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":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":6.44,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 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":"27808005701","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 = 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":"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0044,"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":0.04,"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":0.14,"discounted_cash":0.06,"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":"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":"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":"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 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":0.04,"discounted_cash":0.02,"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"}]},{"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 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":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.11,"discounted_cash":0.05,"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":"603544921","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":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPOFOL 10 MG/ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11150","type":"CDM"},{"code":"63323027027","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 = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11150","type":"CDM"},{"code":"310030061","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 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111685","type":"CDM"},{"code":"16729011431","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 = 5 ML"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.76,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111685","type":"CDM"},{"code":"143951001","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"},{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.40,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111685","type":"CDM"},{"code":"703565301","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 = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111685","type":"CDM"},{"code":"68001026525","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 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| NDC EA = 120 ML"}]},{"description":"CETIRIZINE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111689","type":"CDM"},{"code":"51991083716","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 = 480 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 480 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111707","type":"CDM"},{"code":"169320415","type":"NDC"}],"standard_charges":[{"gross_charge":33.68,"discounted_cash":13.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 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NDC EA = 2 ML"}]},{"description":"FAMOTIDINE 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111724","type":"CDM"},{"code":"67457044843","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 = 4 ML"},{"gross_charge":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FAMOTIDINE 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111724","type":"CDM"},{"code":"69012502","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 = 4 ML"}]},{"description":"FAMOTIDINE 40 MG/4ML IV 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SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111730","type":"CDM"},{"code":"49502010102","type":"NDC"}],"standard_charges":[{"gross_charge":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":12.73,"discounted_cash":5.09,"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 0.15 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111730","type":"CDM"},{"code":"49502050102","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":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":13.31,"discounted_cash":5.32,"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":100.46,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"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"}]},{"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":"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":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"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"}]},{"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":135.61,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":39.59,"discounted_cash":15.84,"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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":275.12,"discounted_cash":110.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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":0.07,"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"}]},{"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":"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":"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":0.74,"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 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":"409492134","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 = 10 ML"},{"gross_charge":0.47,"discounted_cash":0.19,"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":724.33,"discounted_cash":289.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"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"}]},{"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":"68462090401","type":"NDC"}],"standard_charges":[{"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"},{"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"}]},{"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":"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":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":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":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":"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":"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":1.37,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":2.12,"discounted_cash":0.85,"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":"51672402201","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":0.19,"discounted_cash":0.08,"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":"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":0.09,"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":"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":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"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"}]},{"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":150.08,"discounted_cash":60.03,"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"}]},{"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":85.86,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"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":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":9.28,"discounted_cash":3.71,"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"}]},{"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":0.08,"discounted_cash":0.03,"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":"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":1.52,"discounted_cash":0.61,"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":14.58,"discounted_cash":5.83,"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":"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":1.74,"discounted_cash":0.69,"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"}]},{"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":"72647033003","type":"NDC"}],"standard_charges":[{"gross_charge":289.98,"discounted_cash":115.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":290.91,"discounted_cash":116.36,"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":"72647033001","type":"NDC"}],"standard_charges":[{"gross_charge":290.89,"discounted_cash":116.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":289.96,"discounted_cash":115.98,"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":750.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":20.0,"discounted_cash":8.0,"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":"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 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 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":"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":"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":"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":6.23,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":355.06,"discounted_cash":142.02,"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":259.53,"discounted_cash":103.81,"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":293.51,"discounted_cash":117.40,"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":"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 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 10 MG OR 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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":3947.91,"discounted_cash":1579.16,"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"}]},{"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":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"},{"gross_charge":904.1,"discounted_cash":361.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EFINACONAZOLE 10 % EX 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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"},{"gross_charge":0.25,"discounted_cash":0.10,"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":3.22,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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"}]},{"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":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG PO 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NDC EA = 100 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":"70954004110","type":"NDC"}],"standard_charges":[{"gross_charge":4.20,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":8.70,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIFABUTIN 150 MG OR 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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":"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":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.65,"discounted_cash":1.06,"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":1.53,"discounted_cash":0.61,"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":3.15,"discounted_cash":1.26,"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":"67457044560","type":"NDC"}],"standard_charges":[{"gross_charge":21.29,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":117.25,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":28.72,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG IV 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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":"68059701","type":"NDC"}],"standard_charges":[{"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 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| NDC EA = 100 EACH"}]},{"description":"SERTRALINE HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11350","type":"CDM"},{"code":"60687025301","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":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SERTRALINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11351","type":"CDM"},{"code":"65862001201","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 = 100 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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":"SERTRALINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11351","type":"CDM"},{"code":"68084018111","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"}]},{"description":"SERTRALINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11351","type":"CDM"},{"code":"60687024211","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 = 1 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| NDC EA = 1 ML"},{"gross_charge":6.75,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"409656201","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.91,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM 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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 PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113539","type":"CDM"},{"code":"66213042510","type":"NDC"}],"standard_charges":[{"gross_charge":7.30,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LITHIUM 8 MEQ/5ML PO 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113540","type":"CDM"},{"code":"72888017205","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 = 5 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ERLOTINIB HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113542","type":"CDM"},{"code":"378713193","type":"NDC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":74.48,"discounted_cash":29.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERLOTINIB HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113543","type":"CDM"},{"code":"50242006301","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":34.89,"discounted_cash":13.96,"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":"50242006401","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"discounted_cash":9.77,"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":"113555","type":"CDM"},{"code":"66658023401","type":"NDC"}],"standard_charges":[{"gross_charge":314.45,"discounted_cash":125.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.67 ML"},{"gross_charge":14.40,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.67 ML"}]},{"description":"BUPRENORPHINE 7.5 MCG/HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113577","type":"CDM"},{"code":"59011075704","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":65.01,"discounted_cash":26.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"SILVER NITRATE-POT NITRATE 75-25 % EX MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11359","type":"CDM"},{"code":"12165010003","type":"NDC"}],"standard_charges":[{"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":"SILVER NITRATE-POT NITRATE 75-25 % EX MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11359","type":"CDM"},{"code":"12870000101","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 = 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"}]},{"description":"SILVER NITRATE-POT NITRATE 75-25 % EX MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11359","type":"CDM"},{"code":"12870000102","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"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIMETHICONE 125 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11361","type":"CDM"},{"code":"67013410","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 = 10 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"SIMVASTATIN 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11364","type":"CDM"},{"code":"68180047802","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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 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":"SIMVASTATIN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11367","type":"CDM"},{"code":"63739057010","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 = 100 EACH"},{"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":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIMVASTATIN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11367","type":"CDM"},{"code":"50268071215","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"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11368","type":"CDM"},{"code":"63323057901","type":"NDC"}],"standard_charges":[{"gross_charge":54.10,"discounted_cash":21.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":62.52,"discounted_cash":25.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11368","type":"CDM"},{"code":"270055615","type":"NDC"}],"standard_charges":[{"gross_charge":103.54,"discounted_cash":41.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":120.31,"discounted_cash":48.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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 SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113740","type":"CDM"},{"code":"27241017529","type":"NDC"}],"standard_charges":[{"gross_charge":1.90,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 112 ML"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 112 ML"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 112 ML"}]},{"description":"NALTREXONE-BUPROPION HCL ER 8-90 MG PO TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113777","type":"CDM"},{"code":"51267089099","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"92771059007","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 G"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 G"}]},{"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":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML OR 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pharmacy | NDC EA = 473 ML"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11394","type":"CDM"},{"code":"57237031903","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 ML"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11394","type":"CDM"},{"code":"60687083445","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 = 30 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EACH"},{"gross_charge":19.84,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":35.77,"discounted_cash":14.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114","type":"CDM"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"ACETAZOLAMIDE SODIUM 500 MG IJ 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NDC EA = 1 EACH"},{"gross_charge":36.16,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.86,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114","type":"CDM"},{"code":"39822019007","type":"NDC"}],"standard_charges":[{"gross_charge":14.04,"discounted_cash":5.62,"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":"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":"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":"PROGESTERONE 100 MG PO 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114061","type":"CDM"},{"code":"59651015201","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 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":0.05,"discounted_cash":0.02,"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":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROGESTERONE 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114064","type":"CDM"},{"code":"17478076710","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":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BENDAMUSTINE HCL 45 MG/0.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114068","type":"CDM"},{"code":"63459039502","type":"NDC"}],"standard_charges":[{"gross_charge":1492.76,"discounted_cash":597.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"BENDAMUSTINE HCL 180 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114069","type":"CDM"},{"code":"63459039602","type":"NDC"}],"standard_charges":[{"gross_charge":1492.75,"discounted_cash":597.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV 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pharmacy | NDC EA = 5 ML"},{"gross_charge":0.74,"discounted_cash":0.30,"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":"71288080875","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV 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NDC EA = 100 EACH"}]},{"description":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"53489032905","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 = 500 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"SPIRONOLACTONE 100 MG OR 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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":5.13,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.68,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SUVOREXANT 10 MG PO 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| NDC EA = 30 EACH"},{"gross_charge":3.51,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALOXEGOL OXALATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115067","type":"CDM"},{"code":"82625880101","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.22,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALOXEGOL OXALATE 25 MG PO 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.32,"discounted_cash":1.33,"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":"82625880201","type":"NDC"}],"standard_charges":[{"gross_charge":4.22,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.15,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALOXEGOL OXALATE 25 MG PO 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NDC EA = 100 EACH"},{"gross_charge":3.51,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"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":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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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":0.48,"discounted_cash":0.19,"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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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":"378647099","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":13.88,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 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":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":"67434509","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 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"},{"gross_charge":3.41,"discounted_cash":1.36,"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 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| NDC EA = 5 ML"},{"gross_charge":2.03,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115353","type":"CDM"},{"code":"65219005209","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 = 5 ML"},{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATES 45 MMOLE/15ML IV SOLN 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NDC EA = 1 EACH"}]},{"description":"ADALIMUMAB 40 MG/0.8ML SC PNKT (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115358","type":"CDM"},{"code":"74433902","type":"NDC"}],"standard_charges":[{"gross_charge":3129.38,"discounted_cash":1251.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115360","type":"CDM"},{"code":"641610301","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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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":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":16.27,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":10.88,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP 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NDC EA = 1 EACH"},{"gross_charge":19.51,"discounted_cash":7.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"70594004801","type":"NDC"}],"standard_charges":[{"gross_charge":16.28,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.33,"discounted_cash":4.93,"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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pharmacy | NDC EA = 1 EACH"},{"gross_charge":228.44,"discounted_cash":91.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"116313","type":"CDM"},{"code":"63323059403","type":"NDC"}],"standard_charges":[{"gross_charge":146.66,"discounted_cash":58.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN HCL IN DEXTROSE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11632","type":"CDM"},{"code":"338355148","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 ML"}]},{"description":"VECURONIUM BROMIDE 10 MG IV 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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":594.88,"discounted_cash":237.95,"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"}]},{"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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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"}]},{"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":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO 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Type: pharmacy | NDC EA = 200 EACH"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"68084047911","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 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117844","type":"CDM"},{"code":"69171039801","type":"NDC"}],"standard_charges":[{"gross_charge":125.64,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ELUXADOLINE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117959","type":"CDM"},{"code":"61874010060","type":"NDC"}],"standard_charges":[{"gross_charge":9.56,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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pharmacy | NDC EA = 63 EACH"},{"gross_charge":129.43,"discounted_cash":51.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 63 EACH"}]},{"description":"DEKAS PLUS PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118051","type":"CDM"},{"code":"68176000010","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 = 60 ML"}]},{"description":"DARATUMUMAB 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118054","type":"CDM"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":89.66,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118055","type":"CDM"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":89.66,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":73.88,"discounted_cash":29.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":147.06,"discounted_cash":58.83,"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":11.73,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"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"}]},{"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 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| 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":"45802057884","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":22.00,"discounted_cash":8.80,"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":"45802057800","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":16.10,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NECITUMUMAB 800 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118280","type":"CDM"},{"code":"2771601","type":"NDC"}],"standard_charges":[{"gross_charge":66.59,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":86.60,"discounted_cash":34.64,"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":1714.19,"discounted_cash":685.68,"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"}]},{"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":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"},{"gross_charge":1966.1,"discounted_cash":786.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"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":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"},{"gross_charge":278.47,"discounted_cash":111.39,"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":"10019007901","type":"NDC"}],"standard_charges":[{"gross_charge":59.66,"discounted_cash":23.87,"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":278.47,"discounted_cash":111.39,"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":"60505622800","type":"NDC"}],"standard_charges":[{"gross_charge":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"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":783.06,"discounted_cash":313.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":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":61.54,"discounted_cash":24.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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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 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.78,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LINEZOLID 200 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119081","type":"CDM"},{"code":"9513701","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 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV 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NDC EA = 300 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119082","type":"CDM"},{"code":"55150024251","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 = 300 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"LINEZOLID 600 MG/300ML IV 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NDC EA = 300 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119082","type":"CDM"},{"code":"67457084300","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":13.90,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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pharmacy | NDC EA = 10 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119084","type":"CDM"},{"code":"42658001001","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":6.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":23.99,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":6.50,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV 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pharmacy | NDC EA = 20 ML"},{"gross_charge":2.27,"discounted_cash":0.91,"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":2.86,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":2.92,"discounted_cash":1.17,"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":"74438220","type":"NDC"}],"standard_charges":[{"gross_charge":13.37,"discounted_cash":5.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":3.93,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":4.49,"discounted_cash":1.80,"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":"703204501","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":2.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":2.92,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV 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pharmacy | NDC EA = 250 ML"},{"gross_charge":0.97,"discounted_cash":0.39,"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":1.70,"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 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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":"67850004100","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":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.44,"discounted_cash":0.17,"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":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.22,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"42192060501","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 = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV 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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"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"55150018810","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":0.48,"discounted_cash":0.19,"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":"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":"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"47781060191","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"},{"gross_charge":0.93,"discounted_cash":0.37,"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":"13111421","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 = 10 ML"},{"gross_charge":1.08,"discounted_cash":0.43,"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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= 20 ML"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119104","type":"CDM"},{"code":"63323026950","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119104","type":"CDM"},{"code":"25021060850","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 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"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":"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":"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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119106","type":"CDM"},{"code":"409909332","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 = 2 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"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":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"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":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119106","type":"CDM"},{"code":"641602725","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.34,"discounted_cash":0.14,"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":"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 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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":0.21,"discounted_cash":0.08,"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":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119107","type":"CDM"},{"code":"409909418","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":0.62,"discounted_cash":0.25,"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"}]},{"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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.47,"discounted_cash":0.19,"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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.56,"discounted_cash":0.23,"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":"407069020","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":4.61,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"GADODIAMIDE 287 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11929","type":"CDM"},{"code":"407069010","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.09,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"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":"HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11931","type":"CDM"},{"code":"49281054758","type":"NDC"}],"standard_charges":[{"gross_charge":12.19,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.97,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11931","type":"CDM"},{"code":"49281054503","type":"NDC"}],"standard_charges":[{"gross_charge":12.19,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":10.31,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.97,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11931","type":"CDM"},{"code":"49281054505","type":"NDC"}],"standard_charges":[{"gross_charge":25.55,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.36,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MILTEFOSINE 50 MG PO 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119654","type":"CDM"},{"code":"68727080001","type":"NDC"}],"standard_charges":[{"gross_charge":325.08,"discounted_cash":130.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":455.2,"discounted_cash":182.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119659","type":"CDM"},{"code":"70092141836","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 ML"}]},{"description":"MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119659","type":"CDM"},{"code":"70092103036","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 ML"}]},{"description":"MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119659","type":"CDM"},{"code":"61553019648","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 ML"}]},{"description":"MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV 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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":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119661","type":"CDM"},{"code":"70092108644","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":1.43,"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":"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":"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":"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":30.39,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":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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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119720","type":"CDM"},{"code":"74056114","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":7.46,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":6.27,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"VENETOCLAX 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119721","type":"CDM"},{"code":"74056607","type":"NDC"}],"standard_charges":[{"gross_charge":37.32,"discounted_cash":14.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":"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":130.17,"discounted_cash":52.07,"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":62.70,"discounted_cash":25.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 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":62.7,"discounted_cash":25.08,"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"}]},{"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":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"},{"gross_charge":22.20,"discounted_cash":8.88,"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":10.62,"discounted_cash":4.25,"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":22.20,"discounted_cash":8.88,"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":22.20,"discounted_cash":8.88,"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"}]},{"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":"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":"BRIVARACETAM 50 MG/5ML IV 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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":579.47,"discounted_cash":231.79,"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":347.38,"discounted_cash":138.95,"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":658.43,"discounted_cash":263.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"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":1.12,"discounted_cash":0.45,"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"}]},{"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":1.12,"discounted_cash":0.45,"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"}]},{"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":5.79,"discounted_cash":2.31,"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"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV 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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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120146","type":"CDM"},{"code":"76014000525","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":10.15,"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":"70121163707","type":"NDC"}],"standard_charges":[{"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":5.90,"discounted_cash":2.36,"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":"641623801","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3.62,"discounted_cash":1.45,"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":5.02,"discounted_cash":2.01,"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"}]},{"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":"60687077501","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":0.27,"discounted_cash":0.11,"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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"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":"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":"51079042301","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":0.01,"discounted_cash":0.004,"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":0.30,"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"}]},{"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":"MECLIZINE HCL 12.5 MG OR 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":"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":"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":"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":"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":0.006,"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":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARFILZOMIB 30 MG IV 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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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NDC EA = 20 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120963","type":"CDM"},{"code":"59762453802","type":"NDC"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":15.36,"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"},{"gross_charge":64.87,"discounted_cash":25.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM 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pharmacy | NDC EA = 100 ML"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120966","type":"CDM"},{"code":"14789010205","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 = 250 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV 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Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.9,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120966","type":"CDM"},{"code":"25021041784","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 = 250 ML"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"NALOXONE HCL 4 MG/10ML IJ 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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":0.06,"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":"409116001","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":"55150024950","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 = 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"},{"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":0.07,"discounted_cash":0.03,"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":"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":"6302501","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":73.03,"discounted_cash":29.21,"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":"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":"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":0.32,"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"}]},{"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":21721.50,"discounted_cash":8688.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":28407.57,"discounted_cash":11363.03,"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":468.94,"discounted_cash":187.58,"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":651.0,"discounted_cash":260.4,"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":"409330803","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 = 30 ML"},{"gross_charge":0.24,"discounted_cash":0.09,"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":"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":"517760425","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":"63323069404","type":"NDC"}],"standard_charges":[{"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":0.92,"discounted_cash":0.37,"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":"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 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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":"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":"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123447","type":"CDM"},{"code":"81298965801","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 = 250 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE-SODIUM CHLORIDE 16-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123447","type":"CDM"},{"code":"81298965803","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 = 250 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.06,"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":"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 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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.03,"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"}]},{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20.3 ML"},{"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"}]},{"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":"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":0.07,"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":17.12,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.88,"discounted_cash":1.15,"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":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"},{"gross_charge":26.35,"discounted_cash":10.54,"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":0.38,"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":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"143968910","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 = 10 ML"},{"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":1.12,"discounted_cash":0.45,"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":"143968901","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 = 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| NDC EA = 15 ML"}]},{"description":"PORACTANT ALFA 120 MG/1.5ML INTRATRACHEA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123982","type":"CDM"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"gross_charge":361.01,"discounted_cash":144.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":217.14,"discounted_cash":86.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":138.62,"discounted_cash":55.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"PORACTANT ALFA 240 MG/3ML INTRATRACHEA 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12491","type":"CDM"},{"code":"50268029015","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 = 50 EACH"}]},{"description":"ESTRADIOL 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12491","type":"CDM"},{"code":"42806008701","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 12 GM IV 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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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"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"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12580","type":"CDM"},{"code":"487980101","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 = 2.5 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NDC EA = 30 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"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":0.03,"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":0.23,"discounted_cash":0.09,"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":"70710160901","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":0.13,"discounted_cash":0.05,"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":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"60687080411","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 = 1 EACH"},{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"50268010515","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 = 50 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"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 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EA = 4 ML"},{"gross_charge":31.51,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127330","type":"CDM"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":81.14,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":40.59,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FAMOTIDINE IN NACL 20 MG/50ML IV 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= 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 SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127351","type":"CDM"},{"code":"24592201","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":1825.54,"discounted_cash":730.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 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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":20.72,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"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"}]},{"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":31.14,"discounted_cash":12.45,"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"}]},{"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":104.86,"discounted_cash":41.94,"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":16.75,"discounted_cash":6.70,"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 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127438","type":"CDM"},{"code":"69130904","type":"NDC"}],"standard_charges":[{"gross_charge":186.44,"discounted_cash":74.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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"},{"gross_charge":124.56,"discounted_cash":49.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":124.56,"discounted_cash":49.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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"},{"gross_charge":186.44,"discounted_cash":74.57,"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":"42658002101","type":"NDC"}],"standard_charges":[{"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 Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":21.05,"discounted_cash":8.42,"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":"703523313","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":4.17,"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"}]},{"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":12.01,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"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":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":"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":"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":6.99,"discounted_cash":2.80,"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"}]},{"description":"BARIUM SULFATE 60 % OR 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NDC EA = 1 ML"},{"gross_charge":694.06,"discounted_cash":277.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"AVATROMBOPAG MALEATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127497","type":"CDM"},{"code":"71369002015","type":"NDC"}],"standard_charges":[{"gross_charge":421.9,"discounted_cash":168.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 EACH"},{"gross_charge":255.24,"discounted_cash":102.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 EACH"}]},{"description":"BARIUM SULFATE 98 % OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12750","type":"CDM"},{"code":"32909076401","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BARICITINIB 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127708","type":"CDM"},{"code":"2418230","type":"NDC"}],"standard_charges":[{"gross_charge":83.4,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":48.29,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":58.22,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ALCOHOL 98 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127836","type":"CDM"},{"code":"17478050305","type":"NDC"}],"standard_charges":[{"gross_charge":6.30,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":17.43,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":7.40,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6ML SC 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Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":1764.85,"discounted_cash":705.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"}]},{"description":"PILOCARPINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12803","type":"CDM"},{"code":"62856070510","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":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PILOCARPINE HCL 5 MG OR 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128263","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 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128263","type":"CDM"},{"code":"69374092510","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 = 10 ML"}]},{"description":"TILDRAKIZUMAB-ASMN 100 MG/ML SC 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EACH"},{"gross_charge":14.27,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128271","type":"CDM"},{"code":"310111001","type":"NDC"}],"standard_charges":[{"gross_charge":25.96,"discounted_cash":10.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.28,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO 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Type: pharmacy | NDC EA = 11 EACH"},{"gross_charge":10.64,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 EACH"},{"gross_charge":25.96,"discounted_cash":10.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 EACH"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 25 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128277","type":"CDM"},{"code":"641623601","type":"NDC"}],"standard_charges":[{"gross_charge":1.90,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE HCL 50 MG/5ML IJ 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128287","type":"CDM"},{"code":"71266908004","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE HCL 50 MG/5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128287","type":"CDM"},{"code":"71449006811","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 = 5 ML"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 5000-0.9 UNIT/L-% IV 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Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6258.77,"discounted_cash":2503.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ADALIMUMAB 80 MG/0.8ML SC PNKT (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128298","type":"CDM"},{"code":"74012402","type":"NDC"}],"standard_charges":[{"gross_charge":6258.76,"discounted_cash":2503.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2441.68,"discounted_cash":976.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1126.58,"discounted_cash":450.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PHENYLEPHRINE HCL 1 MG/10ML IV 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NDC EA = 60 ML"},{"gross_charge":17.10,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"CANNABIDIOL 100 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"128952","type":"CDM"},{"code":"70127010010","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":9.33,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":17.1,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"FISH OIL TRIGLYCERIDES 5 GM/50ML IV 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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":"CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129001","type":"CDM"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":1063.11,"discounted_cash":425.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 ML"},{"gross_charge":1619.24,"discounted_cash":647.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 ML"}]},{"description":"TESTOSTERONE ENANTHATE 100 MG/0.5ML SC 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100 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.04,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TACROLIMUS 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12933","type":"CDM"},{"code":"55111052601","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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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= 100 EACH"},{"gross_charge":6.82,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":5.67,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TACROLIMUS 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12934","type":"CDM"},{"code":"16729004301","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.05,"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"},{"gross_charge":0.74,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TACROLIMUS 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12934","type":"CDM"},{"code":"69452015520","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":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TACROLIMUS 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12934","type":"CDM"},{"code":"64380072206","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":"TACROLIMUS 5 MG OR 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129349","type":"CDM"},{"code":"50242021401","type":"NDC"}],"standard_charges":[{"gross_charge":1472.76,"discounted_cash":589.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":891.62,"discounted_cash":356.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":367.12,"discounted_cash":146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TACROLIMUS 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12935","type":"CDM"},{"code":"469301601","type":"NDC"}],"standard_charges":[{"gross_charge":92.23,"discounted_cash":36.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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NDC EA = 20 ML"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML PO 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":"CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129380","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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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":0.18,"discounted_cash":0.07,"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":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE ER 300 MG IM 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10 ML"}]},{"description":"EPINEPHRINE HCL PF 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129394","type":"CDM"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":6.92,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129394","type":"CDM"},{"code":"54288010301","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"}]},{"description":"MEROPENEM-VABORBACTAM 2 (1-1) G IV 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Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":119.35,"discounted_cash":47.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":158.32,"discounted_cash":63.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129425","type":"CDM"},{"code":"8451001","type":"NDC"}],"standard_charges":[{"gross_charge":591.08,"discounted_cash":236.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":10195.68,"discounted_cash":4078.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.02,"discounted_cash":0.0068,"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":"574113304","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 = 118 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= 5 ML"},{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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"}]},{"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":2.97,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":2.20,"discounted_cash":0.88,"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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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"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CALCIUM CARBONATE 1250 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1299","type":"CDM"},{"code":"54311763","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 = 500 ML"}]},{"description":"ABEMACICLIB 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129904","type":"CDM"},{"code":"2448354","type":"NDC"}],"standard_charges":[{"gross_charge":165.90,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":282.86,"discounted_cash":113.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":141.11,"discounted_cash":56.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"ABEMACICLIB 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129906","type":"CDM"},{"code":"2533754","type":"NDC"}],"standard_charges":[{"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":282.86,"discounted_cash":113.14,"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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"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 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 32 MG IX SRER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129938","type":"CDM"},{"code":"65250000301","type":"NDC"}],"standard_charges":[{"gross_charge":423.67,"discounted_cash":169.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":577.49,"discounted_cash":231.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129985","type":"CDM"},{"code":"58160082803","type":"NDC"}],"standard_charges":[{"gross_charge":194.65,"discounted_cash":77.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":194.84,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129985","type":"CDM"},{"code":"58160082311","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"},{"gross_charge":145.86,"discounted_cash":58.34,"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":"54812025","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":"999170001300","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":3.38,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":3.56,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":3.13,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"BORTEZOMIB 3.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130025","type":"CDM"},{"code":"43598086560","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":438.55,"discounted_cash":175.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":405.54,"discounted_cash":162.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":225.15,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":402.22,"discounted_cash":160.89,"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 ML"},{"gross_charge":5847.05,"discounted_cash":2338.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EMICIZUMAB-KXWH 60 MG/0.4ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130065","type":"CDM"},{"code":"50242092101","type":"NDC"}],"standard_charges":[{"gross_charge":13518.48,"discounted_cash":5407.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.4 ML"},{"gross_charge":11206.82,"discounted_cash":4482.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.4 ML"},{"gross_charge":18135.65,"discounted_cash":7254.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.4 ML"}]},{"description":"BARIUM SULFATE 96 % OR 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 AERB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130316","type":"CDM"},{"code":"59310030480","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.6 G"},{"gross_charge":7.02,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.6 G"},{"gross_charge":25.02,"discounted_cash":10.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.6 G"}]},{"description":"LETERMOVIR 240 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130318","type":"CDM"},{"code":"6307503","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 = 1 EACH"},{"gross_charge":185.22,"discounted_cash":74.09,"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":"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":184.08,"discounted_cash":73.63,"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"}]},{"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":156.32,"discounted_cash":62.53,"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":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":"6307602","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/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":9.08,"discounted_cash":3.63,"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"}]},{"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":6.76,"discounted_cash":2.70,"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"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 40000-126000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130378","type":"CDM"},{"code":"73562011401","type":"NDC"}],"standard_charges":[{"gross_charge":7.48,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.74,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":14.73,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARSENIC TRIOXIDE 12 MG/6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130390","type":"CDM"},{"code":"63459060111","type":"NDC"}],"standard_charges":[{"gross_charge":103.71,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"},{"gross_charge":40.84,"discounted_cash":16.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"70069077301","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 = 10 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"517671010","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":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.83,"discounted_cash":0.73,"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":"409163110","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 = 10 ML"},{"gross_charge":1.14,"discounted_cash":0.46,"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":"64253090030","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 = 10 ML"},{"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":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"517671001","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.78,"discounted_cash":0.31,"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":0.62,"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":"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":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":0.95,"discounted_cash":0.38,"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":"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":"ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130608","type":"CDM"},{"code":"68547050102","type":"NDC"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1765.0,"discounted_cash":706.0,"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":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"},{"gross_charge":207.77,"discounted_cash":83.11,"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":11.88,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":2.35,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GEMCITABINE HCL 1 GM/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130655","type":"CDM"},{"code":"16729041903","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.71,"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"},{"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":"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":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"},{"gross_charge":1.50,"discounted_cash":0.60,"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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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":2.75,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.58,"discounted_cash":0.63,"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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pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VERAPAMIL HCL SR (BID) 120 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13184","type":"CDM"},{"code":"25190131","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"}]},{"description":"VERAPAMIL HCL SR (BID) 120 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13184","type":"CDM"},{"code":"51079089401","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":"LEVOTHYROXINE SODIUM 200 MCG PO 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pharmacy | NDC EA = 5 ML"}]},{"description":"DENOSUMAB 60 MG/ML SC 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":"DENOSUMAB 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"132834","type":"CDM"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":643.48,"discounted_cash":257.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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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":"409100501","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":"409100520","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":"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 ML"},{"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":"PYRIDOSTIGMINE BROMIDE 60 MG/5ML 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":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"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":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":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"},{"gross_charge":21.66,"discounted_cash":8.66,"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":540.84,"discounted_cash":216.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"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":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":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"STAVUDINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13310","type":"CDM"},{"code":"31722051760","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 = 60 EACH"}]},{"description":"TRASTUZUMAB-HYALURONIDASE-OYSK 600-10000 MG-UNT/5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133182","type":"CDM"},{"code":"50242007701","type":"NDC"}],"standard_charges":[{"gross_charge":331.47,"discounted_cash":132.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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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":"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":6.28,"discounted_cash":2.51,"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"}]},{"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":"60505324703","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 = 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"},{"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":"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":"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":3837.48,"discounted_cash":1534.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2489.75,"discounted_cash":995.9,"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":169.2,"discounted_cash":67.68,"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":"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":"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":"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":"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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pharmacy | NDC EA = 1 EACH"},{"gross_charge":301.49,"discounted_cash":120.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MENINGOCOCCAL VAC A,C,Y,W-135 SC INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135129","type":"CDM"},{"code":"49281048901","type":"NDC"}],"standard_charges":[{"gross_charge":108.26,"discounted_cash":43.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ 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 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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":"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":0.04,"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"}]},{"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":"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":"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":"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":30.06,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":8.69,"discounted_cash":3.48,"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":"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":"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":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.46,"discounted_cash":0.18,"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":"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":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"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":0.11,"discounted_cash":0.04,"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":"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":0.06,"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":"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":"51672404101","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":0.11,"discounted_cash":0.04,"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":"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":0.04,"discounted_cash":0.01,"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":"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"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":0.10,"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":"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":"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":"51672404709","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 = 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":0.12,"discounted_cash":0.05,"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":0.28,"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":"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":0.32,"discounted_cash":0.13,"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"}]},{"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":"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":"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":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"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":"67457084550","type":"NDC"}],"standard_charges":[{"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":"67457084744","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":1018.81,"discounted_cash":407.52,"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":82.02,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"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":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":363.86,"discounted_cash":145.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":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":0.05,"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"},{"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":"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":"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":"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":"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":"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":"68462010340","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 = 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":0.21,"discounted_cash":0.08,"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":"57237000511","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 = 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":1.02,"discounted_cash":0.41,"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":"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":"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":0.07,"discounted_cash":0.03,"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"}]},{"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":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"},{"gross_charge":58.50,"discounted_cash":23.40,"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":"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":"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":"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":347.12,"discounted_cash":138.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":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":"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":"904322035","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 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":"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":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"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":"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":"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":"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":"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":"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":"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":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"},{"gross_charge":3047.3,"discounted_cash":1218.92,"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":"69238142301","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":0.04,"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":"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":"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":188.63,"discounted_cash":75.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":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":32.03,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":26.32,"discounted_cash":10.53,"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 ML"},{"gross_charge":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC 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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 Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2473.36,"discounted_cash":989.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4213.5,"discounted_cash":1685.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"GLUCAGON HCL 1 MG IJ 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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"}]},{"description":"BISACODYL 5 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13632","type":"CDM"},{"code":"46122052963","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 = 25 EACH"}]},{"description":"BISACODYL EC 5 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13632","type":"CDM"},{"code":"904640761","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 = 100 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NDC EA = 1 EACH"}]},{"description":"DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137438","type":"CDM"},{"code":"55566840301","type":"NDC"}],"standard_charges":[{"gross_charge":260.14,"discounted_cash":104.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":689.01,"discounted_cash":275.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":321.08,"discounted_cash":128.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM HYPOCHLORITE 0.125 % EX 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EA = 30 EACH"}]},{"description":"CENOBAMATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137452","type":"CDM"},{"code":"71699010030","type":"NDC"}],"standard_charges":[{"gross_charge":23.92,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":36.63,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":22.28,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CENOBAMATE 200 MG PO 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pharmacy | NDC EA = 8 EACH"},{"gross_charge":50.15,"discounted_cash":20.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":32.68,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"ISATUXIMAB-IRFC 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137496","type":"CDM"},{"code":"24065601","type":"NDC"}],"standard_charges":[{"gross_charge":98.38,"discounted_cash":39.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"},{"gross_charge":173.98,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"},{"gross_charge":118.82,"discounted_cash":47.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"GLUCAGON 0.5 MG/0.1ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138010","type":"CDM"},{"code":"72065012011","type":"NDC"}],"standard_charges":[{"gross_charge":2943.05,"discounted_cash":1177.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.1 ML"},{"gross_charge":1745.5,"discounted_cash":698.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.1 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 1 GM/5ML SC 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pharmacy | NDC EA = 5 ML"},{"gross_charge":11.53,"discounted_cash":4.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 2 GM/10ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138035","type":"CDM"},{"code":"44206045795","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 = 10 ML"},{"gross_charge":13.57,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 2 GM/10ML SC 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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":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"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":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":0.0092,"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"},{"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":"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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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":"904880467","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":0.08,"discounted_cash":0.03,"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":"BACITRACIN ZINC 500 UNIT/GM EX 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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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"},{"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"}]},{"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 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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":"472110556","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 = 28 G"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 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":"INFLIXIMAB-AXXQ 100 MG IV 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SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138385","type":"CDM"},{"code":"49281012088","type":"NDC"}],"standard_charges":[{"gross_charge":51.27,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLUENZA VAC HIGH-DOSE QUAD 0.7 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138385","type":"CDM"},{"code":"49281012188","type":"NDC"}],"standard_charges":[{"gross_charge":81.96,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLUENZA VAC HIGH-DOSE QUAD 0.7 ML IM 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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":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":0.30,"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":0.02,"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":"37205016526","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 = 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":"182616737","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 = 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":"904734920","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 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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":"75987015001","type":"NDC"}],"standard_charges":[{"gross_charge":3585.87,"discounted_cash":1434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4674.95,"discounted_cash":1869.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INEBILIZUMAB-CDON 100 MG/10ML IV 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DEVI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138788","type":"CDM"},{"code":"8627007801","type":"NDC"}],"standard_charges":[{"gross_charge":270.33,"discounted_cash":108.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":328.9,"discounted_cash":131.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":113.5,"discounted_cash":45.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":138.09,"discounted_cash":55.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ENLITE GLUCOSE SENSOR MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138790","type":"CDM"},{"code":"57599084400","type":"NDC"}],"standard_charges":[{"gross_charge":69.9,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":85.05,"discounted_cash":34.02,"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":902.6,"discounted_cash":361.04,"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":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.65,"discounted_cash":2.66,"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":"139104","type":"CDM"},{"code":"469067773","type":"NDC"}],"standard_charges":[{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.22,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TACROLIMUS ER 0.75 MG PO 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NDC EA = 100 EACH"},{"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":15.83,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TACROLIMUS ER 4 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139106","type":"CDM"},{"code":"68992304003","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 = 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 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NDC EA = 5 ML"},{"gross_charge":17.18,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139295","type":"CDM"},{"code":"75907019007","type":"NDC"}],"standard_charges":[{"gross_charge":38.88,"discounted_cash":15.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":14.27,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139295","type":"CDM"},{"code":"50742052005","type":"NDC"}],"standard_charges":[{"gross_charge":33.19,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":30.68,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":40.50,"discounted_cash":16.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139295","type":"CDM"},{"code":"55150027199","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":40.50,"discounted_cash":16.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":915.62,"discounted_cash":366.25,"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":1395.87,"discounted_cash":558.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TAFASITAMAB-CXIX 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139298","type":"CDM"},{"code":"50881001303","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"}]},{"description":"CARISOPRODOL 350 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1395","type":"CDM"},{"code":"63739004910","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":"TRIPLE ANTIBIOTIC EX 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30 EACH"},{"gross_charge":20.20,"discounted_cash":8.08,"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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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139653","type":"CDM"},{"code":"69945006401","type":"NDC"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139664","type":"CDM"},{"code":"143952601","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"},{"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":"DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV 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Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERAVACYCLINE DIHYDROCHLORIDE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139731","type":"CDM"},{"code":"71773010005","type":"NDC"}],"standard_charges":[{"gross_charge":87.60,"discounted_cash":35.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":116.67,"discounted_cash":46.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACITRETIN 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13979","type":"CDM"},{"code":"115175308","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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pharmacy | NDC EA = 30 EACH"}]},{"description":"ACITRETIN 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13979","type":"CDM"},{"code":"145009125","type":"NDC"}],"standard_charges":[{"gross_charge":48.80,"discounted_cash":19.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ACITRETIN 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13979","type":"CDM"},{"code":"93113656","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.60,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ACITRETIN 25 MG OR 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= 1 EACH"}]},{"description":"LAMOTRIGINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13981","type":"CDM"},{"code":"68084031811","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":0.14,"discounted_cash":0.06,"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":"LAMOTRIGINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13981","type":"CDM"},{"code":"51672413001","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":"LAMOTRIGINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13981","type":"CDM"},{"code":"62332003731","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 = 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"}]},{"description":"LAMOTRIGINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13981","type":"CDM"},{"code":"51079049820","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":"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":0.06,"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":0.0064,"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":"51079049901","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":0.12,"discounted_cash":0.05,"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":"29300011201","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":0.02,"discounted_cash":0.008,"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":"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":"59746024860","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 = 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 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= 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"}]},{"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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"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":"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":"60687070401","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":0.27,"discounted_cash":0.11,"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 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":"SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139998","type":"CDM"},{"code":"70436002880","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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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":870.94,"discounted_cash":348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"},{"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"}]},{"description":"CALCIUM CARBONATE ANTACID 1000 MG OR 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"68001062145","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 G"},{"gross_charge":0.07,"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":"21922000909","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 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.02,"discounted_cash":0.006,"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":"43598097710","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 G"},{"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":0.04,"discounted_cash":0.01,"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":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.07,"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":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"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":0.006,"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":"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 G"},{"gross_charge":0.04,"discounted_cash":0.02,"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":"58602060407","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 G"},{"gross_charge":0.09,"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":"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":"MAGNESIUM CHLORIDE 70 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14025","type":"CDM"},{"code":"904791152","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 = 60 EACH"}]},{"description":"MAGNESIUM CHLORIDE 64 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14025","type":"CDM"},{"code":"68585000575","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 = 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 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Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.08,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PEGFILGRASTIM-APGF 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140681","type":"CDM"},{"code":"69032401","type":"NDC"}],"standard_charges":[{"gross_charge":1676.93,"discounted_cash":670.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":6218.52,"discounted_cash":2487.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":2042.73,"discounted_cash":817.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"}]},{"description":"POTASSIUM CHLORIDE 10 % PO 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EA = 15 ML"}]},{"description":"RITUXIMAB-ARRX 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140844","type":"CDM"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":69.53,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":25.84,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":13.93,"discounted_cash":5.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB-ARRX 500 MG/50ML IV 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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":"ACETAMINOPHEN-CODEINE #3 300-30 MG OR TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"63739000410","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAMINOPHEN-CODEINE #3 300-30 MG OR TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"68084037201","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":"ACETAMINOPHEN-CODEINE #3 300-30 MG OR TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"68084037211","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":"ASPIRIN EC 81 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14113","type":"CDM"},{"code":"77333003125","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 = 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":"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 (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":"CABOTEGRAVIR & RILPIVIRINE ER 600 & 900 MG/3ML IM 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pharmacy | NDC EA = 30 EACH"},{"gross_charge":626.97,"discounted_cash":250.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141192","type":"CDM"},{"code":"70069063101","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141192","type":"CDM"},{"code":"517100425","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141201","type":"CDM"},{"code":"409493311","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":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141201","type":"CDM"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"KETOCONAZOLE 2 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14132","type":"CDM"},{"code":"713059204","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 = 120 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"KETOCONAZOLE 2 % EX 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 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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":300.64,"discounted_cash":120.26,"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"}]},{"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":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"},{"gross_charge":125.02,"discounted_cash":50.01,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141560","type":"CDM"},{"code":"65219065002","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":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"TRILACICLIB DIHYDROCHLORIDE 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141575","type":"CDM"},{"code":"73462010101","type":"NDC"}],"standard_charges":[{"gross_charge":1083.44,"discounted_cash":433.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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"},{"gross_charge":1613.03,"discounted_cash":645.21,"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":"74527002201","type":"NDC"}],"standard_charges":[{"gross_charge":267.37,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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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"}]},{"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 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pharmacy | NDC EA = 5 ML"},{"gross_charge":4.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUCONAZOLE 10 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14232","type":"CDM"},{"code":"59762502901","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 = 35 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"}]},{"description":"FLUCONAZOLE 10 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14232","type":"CDM"},{"code":"57237014935","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 = 35 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.21,"discounted_cash":0.08,"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":"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":"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":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":"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 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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":"LAMOTRIGINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14266","type":"CDM"},{"code":"65862022960","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":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"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":543.81,"discounted_cash":217.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 ML"},{"gross_charge":369.39,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 ML"}]},{"description":"AMIVANTAMAB-VMJW 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142802","type":"CDM"},{"code":"57894050100","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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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 SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"143020","type":"CDM"},{"code":"169450514","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 1 MG/0.5ML SC 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14471","type":"CDM"},{"code":"72266019701","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 = 10 ML"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14471","type":"CDM"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RANIBIZUMAB (IMPLANT 1ST FILL) 10 MG/0.1ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144711","type":"CDM"},{"code":"50242007855","type":"NDC"}],"standard_charges":[{"gross_charge":61520.0,"discounted_cash":24608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.1 ML"},{"gross_charge":80000.0,"discounted_cash":32000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.1 ML"}]},{"description":"RANIBIZUMAB (IMPLANT REFILL) 10 MG/0.1ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144713","type":"CDM"},{"code":"50242007812","type":"NDC"}],"standard_charges":[{"gross_charge":80000.0,"discounted_cash":32000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.1 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pharmacy | NDC EA = 120 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 ML"},{"gross_charge":2.04,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"SIROLIMUS PROTEIN-BOUND PART 100 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144796","type":"CDM"},{"code":"80803015350","type":"NDC"}],"standard_charges":[{"gross_charge":5603.94,"discounted_cash":2241.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8217.89,"discounted_cash":3287.16,"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":"63323023610","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 = 1 EACH"},{"gross_charge":2.33,"discounted_cash":0.93,"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"}]},{"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":0.69,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":"CEFAZOLIN SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1448","type":"CDM"},{"code":"781345070","type":"NDC"}],"standard_charges":[{"gross_charge":5.14,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.90,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"MEDPURA VITAMIN A & D EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144811","type":"CDM"},{"code":"71399012204","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 = 113 G"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 113 G"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 113 G"}]},{"description":"INCLISIRAN SODIUM 284 MG/1.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145007","type":"CDM"},{"code":"78100060","type":"NDC"}],"standard_charges":[{"gross_charge":2391.82,"discounted_cash":956.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":1576.44,"discounted_cash":630.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145038","type":"CDM"},{"code":"70860021810","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":49.52,"discounted_cash":19.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145038","type":"CDM"},{"code":"50742052110","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":16.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":25.59,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145038","type":"CDM"},{"code":"75907018935","type":"NDC"}],"standard_charges":[{"gross_charge":14.10,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145109","type":"CDM"},{"code":"60687087856","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":2287.18,"discounted_cash":914.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"},{"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"}]},{"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145475","type":"CDM"},{"code":"80203034701","type":"NDC"}],"standard_charges":[{"gross_charge":89.78,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 ML"},{"gross_charge":67.03,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 ML"}]},{"description":"TERAZOSIN HCL 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14550","type":"CDM"},{"code":"51079093601","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 = 1 EACH"}]},{"description":"TERAZOSIN HCL 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14550","type":"CDM"},{"code":"50268076411","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"},{"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":"TERAZOSIN HCL 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14550","type":"CDM"},{"code":"59746038306","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TERAZOSIN HCL 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14550","type":"CDM"},{"code":"51079093620","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 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"}]},{"description":"GALLIUM GA 68 GOZETOTIDE 25 MCG IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145526","type":"CDM"},{"code":"74725010064","type":"NDC"}],"standard_charges":[{"gross_charge":4700.0,"discounted_cash":1880.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TERAZOSIN HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14553","type":"CDM"},{"code":"51079093820","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 = 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"}]},{"description":"TERAZOSIN HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14553","type":"CDM"},{"code":"50268076611","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":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TERAZOSIN HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14553","type":"CDM"},{"code":"51079093801","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TERAZOSIN HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14553","type":"CDM"},{"code":"59746038506","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":0.02,"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"}]},{"description":"DARUNAVIR 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145695","type":"CDM"},{"code":"59676056201","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":34.89,"discounted_cash":13.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":8.46,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DARUNAVIR 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145695","type":"CDM"},{"code":"480773606","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":10.33,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DARUNAVIR 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145695","type":"CDM"},{"code":"60687080811","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.10,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":4.08,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.51,"discounted_cash":1.41,"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":"68180034606","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147795","type":"CDM"},{"code":"73070040315","type":"NDC"}],"standard_charges":[{"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":10.73,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147828","type":"CDM"},{"code":"81284031500","type":"NDC"}],"standard_charges":[{"gross_charge":63.65,"discounted_cash":25.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":53.90,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147909","type":"CDM"},{"code":"54288014701","type":"NDC"}],"standard_charges":[{"gross_charge":18.99,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":14.60,"discounted_cash":5.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE 1 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"147909","type":"CDM"},{"code":"17478050410","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14792","type":"CDM"},{"code":"57664050289","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 = 150 EACH"}]},{"description":"TIZANIDINE HCL 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14792","type":"CDM"},{"code":"60505025103","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 = 150 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"TIZANIDINE HCL 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14792","type":"CDM"},{"code":"29300016815","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"TIZANIDINE HCL 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14792","type":"CDM"},{"code":"68084077595","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.19,"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":"TIZANIDINE HCL 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14792","type":"CDM"},{"code":"55111017915","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 = 150 EACH"}]},{"description":"TIZANIDINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14793","type":"CDM"},{"code":"60505025203","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 = 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"},{"gross_charge":0.04,"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":"55111018015","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":0.01,"discounted_cash":0.0048,"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":"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":"CALCIUM CARB-CHOLECALCIFEROL 600-800 MG-UNIT PO 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Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CENTRUM OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1481","type":"CDM"},{"code":"68094012059","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 = 15 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CENTRUM OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1481","type":"CDM"},{"code":"68094012061","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 = 15 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| NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"43547036009","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"}]},{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"65862020199","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 = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"68084034601","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 = 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":"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":0.26,"discounted_cash":0.10,"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":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"68180037609","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"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR 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| 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":"68180037703","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 = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14824","type":"CDM"},{"code":"68084034701","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":0.44,"discounted_cash":0.17,"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":"LOSARTAN POTASSIUM 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14824","type":"CDM"},{"code":"93736598","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 = 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14824","type":"CDM"},{"code":"68084034711","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 = 1 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.44,"discounted_cash":0.17,"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":"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 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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":"456430001","type":"NDC"}],"standard_charges":[{"gross_charge":63.34,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.36,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.47,"discounted_cash":5.39,"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":"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":"70700026899","type":"NDC"}],"standard_charges":[{"gross_charge":25.49,"discounted_cash":10.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":60.8,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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pharmacy | NDC EA = 48 EACH"}]},{"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":0.08,"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"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 32 EACH"}]},{"description":"TERLIPRESSIN ACETATE 0.85 MG IV 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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":"409196602","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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 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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":270.33,"discounted_cash":108.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":328.9,"discounted_cash":131.56,"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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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NDC EA = 30 EACH"}]},{"description":"MIRIKIZUMAB-MRKZ 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153050","type":"CDM"},{"code":"2757501","type":"NDC"}],"standard_charges":[{"gross_charge":485.11,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":639.55,"discounted_cash":255.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"TORIPALIMAB-TPZI 240 MG/6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153083","type":"CDM"},{"code":"70114034001","type":"NDC"}],"standard_charges":[{"gross_charge":1151.15,"discounted_cash":460.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 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NDC EA = 9 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"}]},{"description":"SUMATRIPTAN SUCCINATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15328","type":"CDM"},{"code":"63304009819","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 = 9 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"}]},{"description":"SUMATRIPTAN SUCCINATE 50 MG OR 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pharmacy | NDC EA = 36 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 36 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 36 EACH"}]},{"description":"SUMATRIPTAN SUCCINATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15328","type":"CDM"},{"code":"55111029209","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 = 9 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 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NDC EA = 100 EACH"}]},{"description":"SALINE NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15371","type":"CDM"},{"code":"225052547","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 = 14.1 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.1 G"}]},{"description":"PEGFILGRASTIM-CBQV (INF DEV) 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153770","type":"CDM"},{"code":"70114013001","type":"NDC"}],"standard_charges":[{"gross_charge":6749.58,"discounted_cash":2699.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 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EA = 1 EACH"},{"gross_charge":8.39,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15426","type":"CDM"},{"code":"25021081530","type":"NDC"}],"standard_charges":[{"gross_charge":5.39,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":15.37,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ 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| NDC EA = 1 EACH"},{"gross_charge":11.3,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HALOPERIDOL LACTATE 10 MG/5ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"154316","type":"CDM"},{"code":"60687079940","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 = 5 ML"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CENOBAMATE 25 MG PO 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pharmacy | NDC EA = 1 EACH"}]},{"description":"SOTALOL HCL 120 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15723","type":"CDM"},{"code":"60505015900","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":0.02,"discounted_cash":0.008,"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":"SOTALOL HCL 120 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15723","type":"CDM"},{"code":"93106001","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15738","type":"CDM"},{"code":"245000835","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15738","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":9.77,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"},{"gross_charge":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"},{"gross_charge":1.29,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15738","type":"CDM"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":18.30,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"},{"gross_charge":4.13,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.7 ML"}]},{"description":"BICALUTAMIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15746","type":"CDM"},{"code":"47335048588","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":0.09,"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":"BICALUTAMIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15746","type":"CDM"},{"code":"68084061221","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"BICALUTAMIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15746","type":"CDM"},{"code":"904601946","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 = 30 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"BICALUTAMIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15746","type":"CDM"},{"code":"16729002310","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.69,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CARVEDILOL 6.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15747","type":"CDM"},{"code":"68001015403","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 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"CARVEDILOL 6.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15747","type":"CDM"},{"code":"65862014301","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":"CARVEDILOL 6.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15747","type":"CDM"},{"code":"68001015400","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15748","type":"CDM"},{"code":"51079093220","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARVEDILOL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15748","type":"CDM"},{"code":"51079093201","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"68382009405","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 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"68001015100","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 = 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":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"68001015103","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 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"51079093120","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"43547025610","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 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"51079093101","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"68084086501","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"68084086511","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":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"904730761","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARVEDILOL 12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15749","type":"CDM"},{"code":"904630261","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":"USTEKINUMAB-KFCE 90 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157515","type":"CDM"},{"code":"83257002541","type":"NDC"}],"standard_charges":[{"gross_charge":238.34,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2909.99,"discounted_cash":1164.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"ZENOCUTUZUMAB-ZBCO(750MG DOSE) 375 MG/18.75ML IV SOPK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157522","type":"CDM"},{"code":"71837100001","type":"NDC"}],"standard_charges":[{"gross_charge":633.33,"discounted_cash":253.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18.75 ML"},{"gross_charge":487.03,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18.75 ML"}]},{"description":"NIVOLUMAB-HYALURONIDASE-NVHY 600-10000 MG-UT/5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157539","type":"CDM"},{"code":"3612001","type":"NDC"}],"standard_charges":[{"gross_charge":1125.3,"discounted_cash":450.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1588.62,"discounted_cash":635.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"DATOPOTAMAB DERUXTECAN-DLNK 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157679","type":"CDM"},{"code":"65597080101","type":"NDC"}],"standard_charges":[{"gross_charge":3752.18,"discounted_cash":1500.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4891.07,"discounted_cash":1956.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AXATILIMAB-CSFR 9 MG/0.18ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157870","type":"CDM"},{"code":"50881003412","type":"NDC"}],"standard_charges":[{"gross_charge":20186.28,"discounted_cash":8074.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.18 ML"},{"gross_charge":26250.0,"discounted_cash":10500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.18 ML"}]},{"description":"AXATILIMAB-CSFR 22 MG/0.44ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"157871","type":"CDM"},{"code":"50881002311","type":"NDC"}],"standard_charges":[{"gross_charge":26250.0,"discounted_cash":10500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.44 ML"},{"gross_charge":20186.25,"discounted_cash":8074.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.44 ML"}]},{"description":"AZITHROMYCIN 100 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15796","type":"CDM"},{"code":"59762311001","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"AZITHROMYCIN 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15797","type":"CDM"},{"code":"93202694","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 = 22.5 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22.5 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22.5 ML"}]},{"description":"AZITHROMYCIN 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15797","type":"CDM"},{"code":"70710146002","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 = 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"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"AZITHROMYCIN 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15797","type":"CDM"},{"code":"93202631","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.31,"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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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| NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15898","type":"CDM"},{"code":"173051900","type":"NDC"}],"standard_charges":[{"gross_charge":54.17,"discounted_cash":21.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15898","type":"CDM"},{"code":"66215040201","type":"NDC"}],"standard_charges":[{"gross_charge":61.47,"discounted_cash":24.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV 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NDC EA = 100 EACH"}]},{"description":"DENOSUMAB-BBDZ 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"159021","type":"CDM"},{"code":"61314022894","type":"NDC"}],"standard_charges":[{"gross_charge":915.3,"discounted_cash":366.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.7 ML"},{"gross_charge":723.27,"discounted_cash":289.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.7 ML"}]},{"description":"GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15906","type":"CDM"},{"code":"338050348","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 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pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16052","type":"CDM"},{"code":"68084060611","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.97,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":"DESMOPRESSIN ACETATE 0.1 MG OR 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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":"DESMOPRESSIN ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16052","type":"CDM"},{"code":"60687072111","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":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16052","type":"CDM"},{"code":"60687010911","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16053","type":"CDM"},{"code":"51079044601","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 EACH"},{"gross_charge":3.60,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16053","type":"CDM"},{"code":"68084060411","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 EACH"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16053","type":"CDM"},{"code":"68001057500","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 = 100 EACH"},{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16053","type":"CDM"},{"code":"60687073211","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16053","type":"CDM"},{"code":"60687012011","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16070","type":"CDM"},{"code":"54004544","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 = 30 ML"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16071","type":"CDM"},{"code":"24208039915","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":2.2,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"FAMCICLOVIR 250 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16124","type":"CDM"},{"code":"67877028660","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 = 60 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RILUZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16124","type":"CDM"},{"code":"64980019106","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RILUZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16124","type":"CDM"},{"code":"75770060","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 = 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"}]},{"description":"RILUZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16124","type":"CDM"},{"code":"68084090825","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ANASTROZOLE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16205","type":"CDM"},{"code":"16729003510","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 = 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"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ANASTROZOLE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16205","type":"CDM"},{"code":"51991062010","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 = 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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"ANASTROZOLE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16205","type":"CDM"},{"code":"16729003515","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"ANASTROZOLE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16205","type":"CDM"},{"code":"60687011221","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 = 30 EACH"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CALCITRIOL 1 MCG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16218","type":"CDM"},{"code":"54312041","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 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| NDC EA = 1 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"51079014101","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":0.12,"discounted_cash":0.05,"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":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"51079014120","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":0.10,"discounted_cash":0.04,"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"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"60687080711","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":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"60687080701","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 = 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":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"555015904","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 = 500 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1623","type":"CDM"},{"code":"555015902","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1624","type":"CDM"},{"code":"51079037420","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":0.13,"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"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1624","type":"CDM"},{"code":"555015802","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1624","type":"CDM"},{"code":"51079037401","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":0.58,"discounted_cash":0.23,"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"}]},{"description":"GOSERELIN ACETATE 10.8 MG SC IMPL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16254","type":"CDM"},{"code":"310095130","type":"NDC"}],"standard_charges":[{"gross_charge":287.39,"discounted_cash":114.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16299","type":"CDM"},{"code":"904535431","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 = 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":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16299","type":"CDM"},{"code":"45802035803","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 = 28 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16299","type":"CDM"},{"code":"113062264","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 = 28 G"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"CHLOROPROCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1634","type":"CDM"},{"code":"63323047637","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"CHLOROPROCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1634","type":"CDM"},{"code":"63323047727","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 = 20 ML"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"GLIMEPIRIDE 1 MG OR 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Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CHORIONIC GONADOTROPIN 10000 UNIT IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1676","type":"CDM"},{"code":"63323002510","type":"NDC"}],"standard_charges":[{"gross_charge":113.70,"discounted_cash":45.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELATONIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16830","type":"CDM"},{"code":"50035061501","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"}]},{"description":"MELATONIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16830","type":"CDM"},{"code":"20555003601","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MELATONIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16830","type":"CDM"},{"code":"57896086406","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 = 60 EACH"}]},{"description":"MELATONIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16830","type":"CDM"},{"code":"68094011059","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NEOSPORIN ORIGINAL 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16839","type":"CDM"},{"code":"46122041405","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 = 14.2 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"NEOSPORIN ORIGINAL 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16839","type":"CDM"},{"code":"68001048346","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 = 14.2 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"RANITIDINE HCL 75 MG OR 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Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"MUPIROCIN CALCIUM 2 % NA OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16958","type":"CDM"},{"code":"29152611","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":6.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"ADAPALENE 0.1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16983","type":"CDM"},{"code":"68462040355","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"BLEOMYCIN SULFATE 30 UNIT IJ 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| NDC EA = 1 EACH"},{"gross_charge":35.28,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BLEOMYCIN SULFATE 30 UNIT IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17012","type":"CDM"},{"code":"63323013720","type":"NDC"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":56.37,"discounted_cash":22.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":35.24,"discounted_cash":14.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BLEOMYCIN SULFATE 30 UNIT IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17012","type":"CDM"},{"code":"61703032322","type":"NDC"}],"standard_charges":[{"gross_charge":46.74,"discounted_cash":18.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":69.61,"discounted_cash":27.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":39.42,"discounted_cash":15.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BLEOMYCIN SULFATE 30 UNIT IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17012","type":"CDM"},{"code":"71288010720","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17380","type":"CDM"},{"code":"44567014601","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEROPENEM 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17380","type":"CDM"},{"code":"70121145301","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 = 1 EACH"},{"gross_charge":7.05,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEROPENEM 1 GM IV 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= 30 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17387","type":"CDM"},{"code":"93714756","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.45,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17387","type":"CDM"},{"code":"68180086306","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 = 30 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17387","type":"CDM"},{"code":"60687031495","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 = 1 EACH"},{"gross_charge":3.03,"discounted_cash":1.21,"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":"CLINDAMYCIN HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1740","type":"CDM"},{"code":"68084024311","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 = 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"},{"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":"CLINDAMYCIN HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1740","type":"CDM"},{"code":"68462014301","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLINDAMYCIN HCL 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1740","type":"CDM"},{"code":"904595961","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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NEVIRAPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17403","type":"CDM"},{"code":"47781010060","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 EACH"}]},{"description":"NEVIRAPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17403","type":"CDM"},{"code":"378405091","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 = 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"}]},{"description":"NEVIRAPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17403","type":"CDM"},{"code":"31722050560","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 = 60 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NEVIRAPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17403","type":"CDM"},{"code":"51991033106","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 = 60 EACH"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17405","type":"CDM"},{"code":"2773701","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO (HUMAN) 100 UNIT/ML SC SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17405","type":"CDM"},{"code":"2751001","type":"NDC"}],"standard_charges":[{"gross_charge":6.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO (HUMAN) 100 UNIT/ML SC SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17405","type":"CDM"},{"code":"2751017","type":"NDC"}],"standard_charges":[{"gross_charge":24.73,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":2.10,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1742","type":"CDM"},{"code":"21922000201","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 = 60 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1742","type":"CDM"},{"code":"168020160","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 = 60 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1742","type":"CDM"},{"code":"45802056202","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 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1742","type":"CDM"},{"code":"472098792","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 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EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ETOPOSIDE PHOSPHATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17451","type":"CDM"},{"code":"61269041020","type":"NDC"}],"standard_charges":[{"gross_charge":107.43,"discounted_cash":42.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":118.44,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":154.02,"discounted_cash":61.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIRTAZAPINE 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17465","type":"CDM"},{"code":"13107000334","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 = 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"},{"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":"MIRTAZAPINE 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17465","type":"CDM"},{"code":"68084012001","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIRTAZAPINE 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17465","type":"CDM"},{"code":"68084012011","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIRTAZAPINE 15 MG OR 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500 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"MIRTAZAPINE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17466","type":"CDM"},{"code":"51079008601","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 = 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":"MIRTAZAPINE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17466","type":"CDM"},{"code":"51079008620","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":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIRTAZAPINE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17466","type":"CDM"},{"code":"57237000830","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 = 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"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17482","type":"CDM"},{"code":"68180086206","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":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17482","type":"CDM"},{"code":"69452017213","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 = 30 EACH"},{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17482","type":"CDM"},{"code":"60687075311","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":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AZITHROMYCIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17482","type":"CDM"},{"code":"59762307001","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 = 3 EACH"}]},{"description":"AZITHROMYCIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17482","type":"CDM"},{"code":"50268009913","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CAFFEINE ANHYDROUS POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17500","type":"CDM"},{"code":"51552020005","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 = 100 G"}]},{"description":"CAFFEINE ANHYDROUS POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17500","type":"CDM"},{"code":"38779041908","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 G"}]},{"description":"CAFFEINE ANHYDROUS POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17500","type":"CDM"},{"code":"38779041905","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 = 100 G"}]},{"description":"CANDIDA ALBICANS SKN TST ANTGN ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17524","type":"CDM"},{"code":"59584013801","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":291.13,"discounted_cash":116.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CANDIDA ALBICANS SKN TST ANTGN ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17524","type":"CDM"},{"code":"49643013801","type":"NDC"}],"standard_charges":[{"gross_charge":266.49,"discounted_cash":106.60,"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":"1753","type":"CDM"},{"code":"64980069003","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":8.13,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"68001023700","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"},{"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":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"68001023703","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 = 500 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"60687011311","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"228212710","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 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":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"60687011301","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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"904565661","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"52817018000","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 = 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":"CLONIDINE HCL 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1755","type":"CDM"},{"code":"51079029920","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":"CLONIDINE HCL 0.2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1756","type":"CDM"},{"code":"52817018110","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":"CLONIDINE HCL 0.3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1757","type":"CDM"},{"code":"68001023900","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 = 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":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLONIDINE HCL 0.3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1757","type":"CDM"},{"code":"904565861","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":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLONIDINE HCL 0.3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1757","type":"CDM"},{"code":"50268019411","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"}]},{"description":"CLONIDINE HCL 0.3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1757","type":"CDM"},{"code":"228212910","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"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":"CLORAZEPATE DIPOTASSIUM 3.75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1759","type":"CDM"},{"code":"378003001","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 = 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"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"407222366","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 = 150 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"65219038304","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 = 100 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"65219038306","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 = 150 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"65219038302","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":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"407222319","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 = 150 ML"},{"gross_charge":0.89,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"407222317","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 = 100 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"407222362","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17595","type":"CDM"},{"code":"407222316","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 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1760","type":"CDM"},{"code":"378004001","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"},{"gross_charge":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1760","type":"CDM"},{"code":"51672404301","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 = 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":"CETAPHIL MOISTURIZING EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17624","type":"CDM"},{"code":"299391816","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":"CETAPHIL MOISTURIZING EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17624","type":"CDM"},{"code":"299024132","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 = 237 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"45802043411","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 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"904782231","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 = 28.35 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"24385020501","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 = 14.2 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"536126526","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 = 45 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"68001047547","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 = 28.4 G"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"24385020503","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 = 28.4 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"51672200202","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 = 30 G"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"51672127502","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 = 30 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"70954003620","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"93024831","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 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"51672126003","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 = 30 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"51672203701","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 = 10 ML"},{"gross_charge":3.97,"discounted_cash":1.59,"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":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"71399050001","type":"NDC"}],"standard_charges":[{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1768","type":"CDM"},{"code":"71399050003","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 = 30 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1769","type":"CDM"},{"code":"472022063","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 = 45 G"},{"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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1769","type":"CDM"},{"code":"51672200306","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 = 45 G"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1769","type":"CDM"},{"code":"61269022063","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 = 45 G"},{"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1769","type":"CDM"},{"code":"472022041","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17770","type":"CDM"},{"code":"832046515","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 = 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"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17770","type":"CDM"},{"code":"574200815","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 = 15 G"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17770","type":"CDM"},{"code":"68382037001","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 G"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17770","type":"CDM"},{"code":"68308015215","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 G"},{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"ACETIC ACID 2 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17801","type":"CDM"},{"code":"52817081615","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.99,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 2 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17801","type":"CDM"},{"code":"50383088915","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 = 15 ML"},{"gross_charge":0.81,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 2 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17801","type":"CDM"},{"code":"60432074115","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"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"173068224","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 G"},{"gross_charge":0.4,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 G"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"59310057922","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 = 8.5 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"781729685","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"},{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"60687066291","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 = 6.7 G"},{"gross_charge":1.73,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"33261087501","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 = 8.5 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"54074287","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 = 6.7 G"},{"gross_charge":0.9,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"45802008801","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 = 8.5 G"},{"gross_charge":3.83,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"},{"gross_charge":1.85,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"66993001968","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 G"},{"gross_charge":1.81,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"},{"gross_charge":2.07,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"93317431","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 = 8.5 G"},{"gross_charge":3.07,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"173068220","type":"NDC"}],"standard_charges":[{"gross_charge":0.4,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 G"},{"gross_charge":2.86,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 G"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"173068221","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 = 8 G"}]},{"description":"ALBUTEROL SULFATE 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17837","type":"CDM"},{"code":"85113201","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 = 6.7 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"}]},{"description":"DEXTROSE-NACL 5-0.225 % IV SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17858","type":"CDM"},{"code":"409792402","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE-NACL 5-0.225 % IV SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17858","type":"CDM"},{"code":"409792403","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":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17881","type":"CDM"},{"code":"24208041105","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"},{"gross_charge":2.62,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17881","type":"CDM"},{"code":"70069023101","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 = 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":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17881","type":"CDM"},{"code":"24208041115","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":2.64,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17881","type":"CDM"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"COCAINE HCL 4 % EX SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1792","type":"CDM"},{"code":"527172874","type":"NDC"}],"standard_charges":[{"gross_charge":38.47,"discounted_cash":15.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"CHOLESTYRAMINE LIGHT 4 GM/DOSE OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17926","type":"CDM"},{"code":"49884093767","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 = 210 G"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 210 G"}]},{"description":"OLANZAPINE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17936","type":"CDM"},{"code":"904637761","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OLANZAPINE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17936","type":"CDM"},{"code":"33342006807","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 = 30 EACH"},{"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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OLANZAPINE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17936","type":"CDM"},{"code":"68084072311","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 = 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"}]},{"description":"OLANZAPINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17937","type":"CDM"},{"code":"68084074011","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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OLANZAPINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17937","type":"CDM"},{"code":"69543038390","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 = 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"},{"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":"OLANZAPINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17937","type":"CDM"},{"code":"43598016630","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":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OLANZAPINE 10 MG OR 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= 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"},{"gross_charge":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ZAFIRLUKAST 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17960","type":"CDM"},{"code":"68084005911","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 = 1 EACH"},{"gross_charge":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CODEINE SULFATE 15 MG OR 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= 100 EACH"},{"gross_charge":0.74,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CODEINE SULFATE 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1802","type":"CDM"},{"code":"527169801","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 = 100 EACH"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CODEINE SULFATE 60 MG OR 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NDC EA = 100 EACH"}]},{"description":"SENNA 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"904672559","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":"SENNA 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"904725260","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":"SENNOSIDES 8.6 MG OR 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| NDC EA = 100 EACH"}]},{"description":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"57896041501","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 = 100 EACH"}]},{"description":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"57896045101","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 EACH"}]},{"description":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"69618004801","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":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"57896045401","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 = 100 EACH"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"69374098750","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 = 500 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"55150019520","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 = 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"},{"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":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"63323028510","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"25021067187","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 = 200 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"63323028564","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 = 200 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"409930010","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 = 10 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"409930021","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 = 20 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18192","type":"CDM"},{"code":"25021067120","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 = 20 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18195","type":"CDM"},{"code":"70069006401","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 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ 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= 30 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18195","type":"CDM"},{"code":"63323028635","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 ML"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18195","type":"CDM"},{"code":"55150019830","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 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"COLCHICINE 0.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1821","type":"CDM"},{"code":"60687072721","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18786","type":"CDM"},{"code":"904647761","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":0.12,"discounted_cash":0.05,"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":"DONEPEZIL HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18786","type":"CDM"},{"code":"68084072501","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18786","type":"CDM"},{"code":"904640861","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":"DONEPEZIL HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18787","type":"CDM"},{"code":"904640961","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DONEPEZIL HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18787","type":"CDM"},{"code":"60687030311","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DONEPEZIL HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18787","type":"CDM"},{"code":"33342002810","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 = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"DONEPEZIL HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18787","type":"CDM"},{"code":"904647861","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIPHENHYDRAMINE-APAP (SLEEP) 25-500 MG OR 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Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"LEVOFLOXACIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18919","type":"CDM"},{"code":"72578009918","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 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"TOPIRAMATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18920","type":"CDM"},{"code":"69097012215","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18921","type":"CDM"},{"code":"68084034521","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 = 30 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TOPIRAMATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18921","type":"CDM"},{"code":"68084034511","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 = 1 EACH"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18922","type":"CDM"},{"code":"68084034401","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 = 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"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TOPIRAMATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18922","type":"CDM"},{"code":"68084034411","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18922","type":"CDM"},{"code":"68382014005","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 = 500 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"TOPIRAMATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18922","type":"CDM"},{"code":"68382014014","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 = 60 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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NDC EA = 100 EACH"}]},{"description":"COPPER CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1900","type":"CDM"},{"code":"409409201","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 = 10 ML"},{"gross_charge":2.81,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEEDLE (DISP) 25G X 5/8\" MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19000","type":"CDM"},{"code":"8290305122","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 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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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ATORVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19176","type":"CDM"},{"code":"378395005","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 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"ATORVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19176","type":"CDM"},{"code":"904629061","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":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ATORVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19176","type":"CDM"},{"code":"60505257809","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 = 90 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"60505258009","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 = 90 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"55111012390","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":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"60505258008","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 = 1000 EACH"}]},{"description":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"904629261","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":0.10,"discounted_cash":0.04,"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":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"68084009901","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"378395277","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 = 90 EACH"},{"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":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"378212177","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 = 90 EACH"}]},{"description":"ATORVASTATIN CALCIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19177","type":"CDM"},{"code":"68084009911","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 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ATORVASTATIN CALCIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19178","type":"CDM"},{"code":"378395177","type":"NDC"}],"standard_charges":[{"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":0.05,"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":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"ATORVASTATIN CALCIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19178","type":"CDM"},{"code":"63304082890","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":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"ATORVASTATIN CALCIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19178","type":"CDM"},{"code":"378395105","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19179","type":"CDM"},{"code":"59651021430","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 ML"},{"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 ML"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19179","type":"CDM"},{"code":"60505083305","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 = 30 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"INSULIN REGULAR HUMAN 500 UNIT/ML (CONC) SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19180","type":"CDM"},{"code":"2850101","type":"NDC"}],"standard_charges":[{"gross_charge":67.22,"discounted_cash":26.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CABERGOLINE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19226","type":"CDM"},{"code":"59762100501","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CABERGOLINE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19226","type":"CDM"},{"code":"50742011808","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 = 8 EACH"},{"gross_charge":2.83,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CABERGOLINE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19226","type":"CDM"},{"code":"93542088","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 = 8 EACH"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CABERGOLINE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19226","type":"CDM"},{"code":"23155082373","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 = 8 EACH"},{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19333","type":"CDM"},{"code":"39822200001","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 = 10 ML"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19333","type":"CDM"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.96,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19333","type":"CDM"},{"code":"143972401","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.40,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"WARFARIN SODIUM 6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19434","type":"CDM"},{"code":"51672403301","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 = 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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19451","type":"CDM"},{"code":"58160081011","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":39.24,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19451","type":"CDM"},{"code":"58160081001","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":39.24,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19451","type":"CDM"},{"code":"58160081043","type":"NDC"}],"standard_charges":[{"gross_charge":18.11,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":53.94,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":45.87,"discounted_cash":18.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19451","type":"CDM"},{"code":"58160081052","type":"NDC"}],"standard_charges":[{"gross_charge":45.87,"discounted_cash":18.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":53.94,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":39.25,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19452","type":"CDM"},{"code":"61314027105","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 = 5 ML"},{"gross_charge":35.69,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19452","type":"CDM"},{"code":"17478010505","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 = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19452","type":"CDM"},{"code":"60505057501","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 = 5 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19452","type":"CDM"},{"code":"70512052005","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 = 5 ML"},{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19483","type":"CDM"},{"code":"904546052","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 = 60 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"BACITRACIN 500 UNIT/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19582","type":"CDM"},{"code":"574402235","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":11.94,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":24.43,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"BACITRACIN-POLYMYXIN B OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19584","type":"CDM"},{"code":"574402135","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"DEXAMETHASONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19596","type":"CDM"},{"code":"82667060005","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19596","type":"CDM"},{"code":"78092525","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":12.56,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19596","type":"CDM"},{"code":"998061505","type":"NDC"}],"standard_charges":[{"gross_charge":14.26,"discounted_cash":5.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19604","type":"CDM"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":7.60,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":7.53,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":7.57,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19604","type":"CDM"},{"code":"54288012301","type":"NDC"}],"standard_charges":[{"gross_charge":6.39,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.86,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 1 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19632","type":"CDM"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.28,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19636","type":"CDM"},{"code":"42702010305","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.13,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":7.2,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19636","type":"CDM"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.79,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19636","type":"CDM"},{"code":"99923019636","type":"NDC"}],"standard_charges":[{"gross_charge":6.60,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19636","type":"CDM"},{"code":"17478020605","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":6.76,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ZINC OXIDE 40 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19672","type":"CDM"},{"code":"74300000068","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 = 28 G"}]},{"description":"BENZOCAINE 20 % MT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19691","type":"CDM"},{"code":"10310028340","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 = 7 G"}]},{"description":"BENZOCAINE 20 % MT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19691","type":"CDM"},{"code":"10310031805","type":"NDC"}],"standard_charges":[{"gross_charge":0.4,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9.4 G"}]},{"description":"BENZOCAINE 20 % MT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19691","type":"CDM"},{"code":"10310028313","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 = 11.9 G"}]},{"description":"BENZOCAINE 7.5 % MT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19692","type":"CDM"},{"code":"10310003313","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 = 9.4 G"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9.4 G"}]},{"description":"BENZOCAINE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19696","type":"CDM"},{"code":"283061026","type":"NDC"}],"standard_charges":[{"gross_charge":9.52,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":9.13,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"},{"gross_charge":11.59,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 EACH"}]},{"description":"BENZOCAINE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19696","type":"CDM"},{"code":"283061011","type":"NDC"}],"standard_charges":[{"gross_charge":9.74,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":10.16,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":12.36,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"BENZOCAINE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19696","type":"CDM"},{"code":"283061043","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.52,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.13,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BENZOCAINE 20 % MT AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19696","type":"CDM"},{"code":"283067902","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"}]},{"description":"BETAXOLOL HCL 0.25 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19703","type":"CDM"},{"code":"65024610","type":"NDC"}],"standard_charges":[{"gross_charge":27.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"BETAXOLOL HCL 0.25 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19703","type":"CDM"},{"code":"78072910","type":"NDC"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":14.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CARBACHOL 0.01 % IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19704","type":"CDM"},{"code":"65002315","type":"NDC"}],"standard_charges":[{"gross_charge":28.01,"discounted_cash":11.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"DIAZOXIDE (DIABETIC USE) 50 MG/ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19713","type":"CDM"},{"code":"575620030","type":"NDC"}],"standard_charges":[{"gross_charge":14.66,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"DIAZOXIDE (DIABETIC USE) 50 MG/ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19713","type":"CDM"},{"code":"13517010030","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":3.96,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":9.33,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19714","type":"CDM"},{"code":"61314001425","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":0.3,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19714","type":"CDM"},{"code":"16571010125","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 = 2.5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19714","type":"CDM"},{"code":"61314001405","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 = 5 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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NDC EA = 5 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19733","type":"CDM"},{"code":"47335022090","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":5.62,"discounted_cash":2.25,"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"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19741","type":"CDM"},{"code":"115147446","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":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19741","type":"CDM"},{"code":"781707819","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 = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19741","type":"CDM"},{"code":"51672411606","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 = 45 G"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19741","type":"CDM"},{"code":"66993096245","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 = 45 G"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":2.76,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"NORETHINDRONE (CONTRACEPTIVE) 0.35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19743","type":"CDM"},{"code":"378729253","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 = 28 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"OFLOXACIN 0.3 % OP 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19746","type":"CDM"},{"code":"64980051505","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 = 5 ML"},{"gross_charge":2.71,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19746","type":"CDM"},{"code":"70756060730","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 = 5 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FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19749","type":"CDM"},{"code":"51862018015","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":2.01,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"SODIUM FLUORIDE 1.1 % DT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19760","type":"CDM"},{"code":"64980030760","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 = 56 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 56 G"}]},{"description":"SODIUM FLUORIDE 1.1 % DT GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19760","type":"CDM"},{"code":"60258015101","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 = 56 G"}]},{"description":"TOBRAMYCIN SULFATE 0.3 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19769","type":"CDM"},{"code":"78081301","type":"NDC"}],"standard_charges":[{"gross_charge":63.29,"discounted_cash":25.32,"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":"TOBRAMYCIN SULFATE 0.3 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19769","type":"CDM"},{"code":"65064435","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":48.30,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"UREA 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19775","type":"CDM"},{"code":"58980060530","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 = 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"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"}]},{"description":"UREA 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19775","type":"CDM"},{"code":"11701002214","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 = 142 G"}]},{"description":"UREA 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19775","type":"CDM"},{"code":"187147003","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 = 85 G"}]},{"description":"POVIDONE-IODINE 5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19791","type":"CDM"},{"code":"65041130","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":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ZINC OXIDE 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19799","type":"CDM"},{"code":"11917007773","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 = 113 G"}]},{"description":"SODIUM FLUORIDE 1.1 % DT CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19803","type":"CDM"},{"code":"126028766","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 = 51 G"}]},{"description":"CROMOLYN SODIUM 100 MG/5ML OR CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19809","type":"CDM"},{"code":"76204002596","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 = 5 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1985","type":"CDM"},{"code":"409409211","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1985","type":"CDM"},{"code":"70069050601","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1985","type":"CDM"},{"code":"72819023406","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 = 10 ML"},{"gross_charge":1.83,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1985","type":"CDM"},{"code":"72819023416","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.12,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"COPPER CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1985","type":"CDM"},{"code":"409409201","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 = 10 ML"},{"gross_charge":2.81,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1986","type":"CDM"},{"code":"517621025","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":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"68084018011","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"68180097801","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 = 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":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"60687023101","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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"60687023111","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 = 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":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"68180035103","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"},{"gross_charge":0.02,"discounted_cash":0.008,"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":"SERTRALINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19882","type":"CDM"},{"code":"65862001130","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 = 30 EACH"},{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"INTERFERON ALFA-2B 10000000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19898","type":"CDM"},{"code":"85113301","type":"NDC"}],"standard_charges":[{"gross_charge":43.42,"discounted_cash":17.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.2 ML"},{"gross_charge":43.44,"discounted_cash":17.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.2 ML"}]},{"description":"ITRACONAZOLE 10 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19928","type":"CDM"},{"code":"31722000631","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.69,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"ITRACONAZOLE 10 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19928","type":"CDM"},{"code":"50458029515","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 = 150 ML"}]},{"description":"NELFINAVIR MESYLATE 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20032","type":"CDM"},{"code":"63010001030","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 = 300 EACH"},{"gross_charge":3.66,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 EACH"},{"gross_charge":2.16,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 EACH"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"517003225","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 = 10 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"70069000501","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 ML"},{"gross_charge":1.53,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"25021050201","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"71288030302","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 = 1 ML"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"71288030301","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 = 1 ML"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"69680011201","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"517003125","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 = 1 ML"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2.88,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2007","type":"CDM"},{"code":"143962125","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MESNA 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20077","type":"CDM"},{"code":"67108356509","type":"NDC"}],"standard_charges":[{"gross_charge":32.55,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":37.20,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":67.81,"discounted_cash":27.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"CYANOCOBALAMIN 1000 MCG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2013","type":"CDM"},{"code":"87701040732","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"}]},{"description":"HYDROPHOR EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20140","type":"CDM"},{"code":"54162050001","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 454 G"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 454 G"}]},{"description":"CYTARABINE 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20156","type":"CDM"},{"code":"63323012020","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 = 20 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CYTARABINE 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20156","type":"CDM"},{"code":"61703031922","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 = 20 ML"},{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CYTARABINE 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20156","type":"CDM"},{"code":"25021022320","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 = 20 ML"},{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CYTARABINE 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20156","type":"CDM"},{"code":"71288010920","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 = 20 ML"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2017","type":"CDM"},{"code":"43547040010","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":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2017","type":"CDM"},{"code":"51079064401","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":"CYCLOBENZAPRINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2017","type":"CDM"},{"code":"52817033250","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 = 500 EACH"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2017","type":"CDM"},{"code":"69097084607","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 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":"CYCLOBENZAPRINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2017","type":"CDM"},{"code":"60687055811","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 = 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"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.89,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.06,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"24208073501","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 = 2 ML"},{"gross_charge":5.47,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"24208073506","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 = 15 ML"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"17478010012","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 = 15 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":1.19,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"65039615","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2025","type":"CDM"},{"code":"17478010002","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 = 2 ML"},{"gross_charge":1.28,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"OPTICHAMBER DIAMOND-MD MASK MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"203","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":"203","type":"CDM"},{"code":"8373982700","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":16.94,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.53,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CYPROHEPTADINE HCL 2 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2032","type":"CDM"},{"code":"121078816","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 = 473 ML"}]},{"description":"CYPROHEPTADINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2033","type":"CDM"},{"code":"51991083801","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"},{"gross_charge":0.02,"discounted_cash":0.0084,"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":"CYPROHEPTADINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2033","type":"CDM"},{"code":"50742019001","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":0.03,"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":"CYPROHEPTADINE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2033","type":"CDM"},{"code":"70710111001","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":0.008,"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":"CYSTEINE HCL 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2034","type":"CDM"},{"code":"781894070","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 = 10 ML"},{"gross_charge":2.69,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ANAGRELIDE HCL 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20446","type":"CDM"},{"code":"13668045301","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":0.75,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ANAGRELIDE HCL 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20446","type":"CDM"},{"code":"172524160","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":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ANAGRELIDE HCL 1 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20447","type":"CDM"},{"code":"13668046201","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.65,"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"},{"gross_charge":1.46,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CYTARABINE 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2045","type":"CDM"},{"code":"55390080610","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CYTARABINE 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2046","type":"CDM"},{"code":"55390080710","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"517078010","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 = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"55150022220","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 = 20 ML"},{"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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"65219044702","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 = 20 ML"},{"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":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"65219044510","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 = 10 ML"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"68382054507","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"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"67457090200","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 = 10 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"67457047710","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 = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"55150022110","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 = 10 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"409669501","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 = 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":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"143950610","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 = 10 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"143950601","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 = 10 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"409669512","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 = 20 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"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":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20544","type":"CDM"},{"code":"24385048478","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 = 100 EACH"},{"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":0.03,"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":"20544","type":"CDM"},{"code":"24385048471","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 = 50 EACH"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20544","type":"CDM"},{"code":"904672080","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 = 1000 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20544","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":"20544","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":"20544","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":"MELOXICAM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20566","type":"CDM"},{"code":"68382005005","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 = 500 EACH"}]},{"description":"MELOXICAM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20566","type":"CDM"},{"code":"50268052511","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 = 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":"MELOXICAM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20566","type":"CDM"},{"code":"63739070110","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":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MELOXICAM 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20566","type":"CDM"},{"code":"68382005001","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MELOXICAM 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20580","type":"CDM"},{"code":"60687019911","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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20580","type":"CDM"},{"code":"68382005101","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":"MELOXICAM 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20580","type":"CDM"},{"code":"68382005105","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"}]},{"description":"MELOXICAM 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20580","type":"CDM"},{"code":"60687019901","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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVONORGESTREL-ETHINYL ESTRAD 0.1-20 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20638","type":"CDM"},{"code":"555904558","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 = 28 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"METRONIDAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20708","type":"CDM"},{"code":"187520260","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"IMIQUIMOD 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20718","type":"CDM"},{"code":"51672414508","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 = 1 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMIQUIMOD 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20718","type":"CDM"},{"code":"45802036853","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.86,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":13.30,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20781","type":"CDM"},{"code":"74300000414","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 = 118 ML"}]},{"description":"BELLADONNA-OPIUM 16.2-30 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20828","type":"CDM"},{"code":"574704512","type":"NDC"}],"standard_charges":[{"gross_charge":16.50,"discounted_cash":6.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":19.90,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":15.21,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20887","type":"CDM"},{"code":"143963701","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 = 5 ML"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV 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= 5 ML"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20887","type":"CDM"},{"code":"143978501","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 = 5 ML"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.14,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2090","type":"CDM"},{"code":"63323012710","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":7.83,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.66,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2091","type":"CDM"},{"code":"63323012820","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":10.84,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.06,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2091","type":"CDM"},{"code":"703507501","type":"NDC"}],"standard_charges":[{"gross_charge":14.79,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2091","type":"CDM"},{"code":"143924501","type":"NDC"}],"standard_charges":[{"gross_charge":3.80,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":7.68,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5.36,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"781808926","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"59762219807","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 = 30 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"60687074201","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":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"50268009811","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 = 1 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"60687028211","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.45,"discounted_cash":0.18,"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":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"59762306003","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 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"781577631","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 = 30 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"904640506","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 = 50 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"904640561","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"50111078710","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"60687074211","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 = 1 EACH"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"62332025130","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 = 30 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"65862064169","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 = 6 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"AZITHROMYCIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20943","type":"CDM"},{"code":"51224002230","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 = 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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LEVOCARNITINE 330 MG OR 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EA = 90 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOCARNITINE 330 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20952","type":"CDM"},{"code":"64980013009","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOCARNITINE 200 MG/ML IV 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EA = 5 ML"},{"gross_charge":2.89,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOCARNITINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20954","type":"CDM"},{"code":"517104501","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":4.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOCARNITINE 200 MG/ML IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":613.92,"discounted_cash":245.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21045","type":"CDM"},{"code":"74334603","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 = 1 EACH"},{"gross_charge":480.27,"discounted_cash":192.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":298.36,"discounted_cash":119.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OLANZAPINE 2.5 MG OR 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EA = 1 EACH"},{"gross_charge":5.27,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZOLMITRIPTAN 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21588","type":"CDM"},{"code":"64896067151","type":"NDC"}],"standard_charges":[{"gross_charge":116.50,"discounted_cash":46.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"CARMUSTINE IN POLIFEPROSAN 7.7 MG IL 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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":"ROPINIROLE HCL 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21688","type":"CDM"},{"code":"60687057711","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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ROPINIROLE HCL 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21688","type":"CDM"},{"code":"43547026810","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":0.11,"discounted_cash":0.04,"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":"ROPINIROLE HCL 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21688","type":"CDM"},{"code":"904637361","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 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":"ROPINIROLE HCL 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21688","type":"CDM"},{"code":"62332003031","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ROPINIROLE HCL 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21689","type":"CDM"},{"code":"60687058811","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 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":"ROPINIROLE HCL 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21689","type":"CDM"},{"code":"54011825","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":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ROPINIROLE HCL 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21689","type":"CDM"},{"code":"904637461","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":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ROPINIROLE HCL 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21689","type":"CDM"},{"code":"43547027010","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":0.02,"discounted_cash":0.0072,"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":"ROPINIROLE HCL 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21689","type":"CDM"},{"code":"62332003231","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM 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Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":104.01,"discounted_cash":41.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":119.88,"discounted_cash":47.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21810","type":"CDM"},{"code":"31722050660","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 = 60 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.41,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21810","type":"CDM"},{"code":"49702020229","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21810","type":"CDM"},{"code":"378518091","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 = 60 EACH"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21810","type":"CDM"},{"code":"49702020218","type":"NDC"}],"standard_charges":[{"gross_charge":7.47,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":9.49,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":13.53,"discounted_cash":5.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21810","type":"CDM"},{"code":"93538506","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"60687032701","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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"904627761","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 = 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":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"904663861","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 = 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":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"47335090288","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 = 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":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"60687032711","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 = 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":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"29300014701","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":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"67877024201","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":"QUETIAPINE FUMARATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21823","type":"CDM"},{"code":"68001018500","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"QUETIAPINE FUMARATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21824","type":"CDM"},{"code":"68001018400","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":0.07,"discounted_cash":0.03,"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":"QUETIAPINE FUMARATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21824","type":"CDM"},{"code":"904627961","type":"NDC"}],"standard_charges":[{"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":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"54022225","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"}]},{"description":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"16571072001","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"68084053311","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"60687036011","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"60687036001","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"},{"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":"QUETIAPINE FUMARATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21825","type":"CDM"},{"code":"67877024601","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":0.03,"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":"IRBESARTAN 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21848","type":"CDM"},{"code":"43547027809","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 = 90 EACH"}]},{"description":"METYRAPONE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21867","type":"CDM"},{"code":"76336045517","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"}]},{"description":"METYRAPONE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21867","type":"CDM"},{"code":"76336045518","type":"NDC"}],"standard_charges":[{"gross_charge":46.30,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21900","type":"CDM"},{"code":"62756023301","type":"NDC"}],"standard_charges":[{"gross_charge":179.91,"discounted_cash":71.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":65.21,"discounted_cash":26.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21900","type":"CDM"},{"code":"55150036501","type":"NDC"}],"standard_charges":[{"gross_charge":83.24,"discounted_cash":33.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":108.5,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21900","type":"CDM"},{"code":"469305130","type":"NDC"}],"standard_charges":[{"gross_charge":287.79,"discounted_cash":115.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":68.29,"discounted_cash":27.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":57.17,"discounted_cash":22.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE FUROATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21905","type":"CDM"},{"code":"85128801","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 = 17 G"},{"gross_charge":13.32,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 17 G"}]},{"description":"MOMETASONE FUROATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21905","type":"CDM"},{"code":"60505083001","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 17 G"},{"gross_charge":0.86,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 17 G"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 17 G"}]},{"description":"RABIES VACCINE, PCEC IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22120","type":"CDM"},{"code":"53905050101","type":"NDC"}],"standard_charges":[{"gross_charge":256.97,"discounted_cash":102.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RABIES VACCINE, PCEC IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22120","type":"CDM"},{"code":"58160096412","type":"NDC"}],"standard_charges":[{"gross_charge":276.53,"discounted_cash":110.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":290.06,"discounted_cash":116.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":293.12,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22142","type":"CDM"},{"code":"68084053601","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 = 100 EACH"},{"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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22142","type":"CDM"},{"code":"65862035790","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":0.02,"discounted_cash":0.0092,"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":"CLOPIDOGREL BISULFATE 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22142","type":"CDM"},{"code":"904629461","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":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22142","type":"CDM"},{"code":"65862035705","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 = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"RALOXIFENE HCL 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22143","type":"CDM"},{"code":"2416530","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 = 30 EACH"},{"gross_charge":6.15,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"RALOXIFENE HCL 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22143","type":"CDM"},{"code":"43598050530","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 EACH"},{"gross_charge":0.59,"discounted_cash":0.24,"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":"ACARBOSE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22148","type":"CDM"},{"code":"54014025","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":0.05,"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":"ACARBOSE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22148","type":"CDM"},{"code":"47781034001","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":"ACARBOSE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22148","type":"CDM"},{"code":"115115001","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"}]},{"description":"FOMEPIZOLE 1 GM/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22185","type":"CDM"},{"code":"67457021102","type":"NDC"}],"standard_charges":[{"gross_charge":350.11,"discounted_cash":140.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":594.29,"discounted_cash":237.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":250.39,"discounted_cash":100.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"FOMEPIZOLE 1 GM/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22185","type":"CDM"},{"code":"39822071001","type":"NDC"}],"standard_charges":[{"gross_charge":297.37,"discounted_cash":118.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"ZOLMITRIPTAN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22219","type":"CDM"},{"code":"68462049833","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 = 3 EACH"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":4.51,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"ZOLMITRIPTAN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22219","type":"CDM"},{"code":"68001025018","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 = 1 EACH"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.65,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZOLMITRIPTAN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22219","type":"CDM"},{"code":"64980020413","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 = 3 EACH"}]},{"description":"ZOLMITRIPTAN 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22219","type":"CDM"},{"code":"64896067250","type":"NDC"}],"standard_charges":[{"gross_charge":116.58,"discounted_cash":46.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"TOBRAMYCIN 300 MG/5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22240","type":"CDM"},{"code":"47335017148","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 = 5 ML"},{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 300 MG/5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22240","type":"CDM"},{"code":"60687073179","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.75,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22257","type":"CDM"},{"code":"60505036301","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 = 5 ML"},{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":9.40,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22257","type":"CDM"},{"code":"69238161503","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 = 5 ML"},{"gross_charge":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.71,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22257","type":"CDM"},{"code":"70756060915","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 = 5 ML"},{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22257","type":"CDM"},{"code":"50383002505","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":2.52,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22257","type":"CDM"},{"code":"24208041005","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.82,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"CEFDINIR 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22289","type":"CDM"},{"code":"60687069921","type":"NDC"}],"standard_charges":[{"gross_charge":2.40,"discounted_cash":0.96,"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":"CEFDINIR 300 MG OR 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1 EACH"},{"gross_charge":2.40,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFDINIR 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22289","type":"CDM"},{"code":"781217660","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 = 60 EACH"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CEFDINIR 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22289","type":"CDM"},{"code":"68001015006","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 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CEFDINIR 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22289","type":"CDM"},{"code":"68001036206","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 = 60 EACH"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CEFDINIR 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22289","type":"CDM"},{"code":"68180071160","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 = 60 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CEFDINIR 125 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22290","type":"CDM"},{"code":"93413664","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"BUTALBITAL-ASA-CAFFEINE 50-325-40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22294","type":"CDM"},{"code":"68084093433","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 = 1 EACH"}]},{"description":"SIMETHICONE 40 MG/0.6ML OR 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NDC EA = 1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22472","type":"CDM"},{"code":"64679075702","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22472","type":"CDM"},{"code":"409379325","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 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22588","type":"CDM"},{"code":"65862020399","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 = 1000 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"LOSARTAN POTASSIUM 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22588","type":"CDM"},{"code":"31722070210","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 = 1000 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1100-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22646","type":"CDM"},{"code":"60258000316","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 = 473 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1100-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22646","type":"CDM"},{"code":"17856067601","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1100-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22646","type":"CDM"},{"code":"121067616","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"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"58914078510","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":4.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"49884041201","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":1.28,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"115152401","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"60687052711","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 = 1 EACH"},{"gross_charge":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"68084089295","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"68001037700","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 = 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":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"60687052721","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 = 30 EACH"},{"gross_charge":0.81,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":"URSODIOL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22660","type":"CDM"},{"code":"68001034300","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"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22661","type":"CDM"},{"code":"703523313","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":4.17,"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"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22661","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":10.43,"discounted_cash":4.17,"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"}]},{"description":"PILL SPLITTER MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22705","type":"CDM"},{"code":"79573001115","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 = 1 EACH"},{"gross_charge":2.15,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LOTEPREDNOL ETABONATE 0.2 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22709","type":"CDM"},{"code":"24208035305","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":54.89,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22710","type":"CDM"},{"code":"82260029905","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":25.26,"discounted_cash":10.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22710","type":"CDM"},{"code":"24208029905","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":23.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22710","type":"CDM"},{"code":"68682029905","type":"NDC"}],"standard_charges":[{"gross_charge":38.64,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.81,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22719","type":"CDM"},{"code":"68462033290","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 = 90 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"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":"PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22719","type":"CDM"},{"code":"13668009390","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 = 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":"COCAINE HCL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22776","type":"CDM"},{"code":"38779072306","type":"NDC"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"COCAINE HCL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22776","type":"CDM"},{"code":"38779072303","type":"NDC"}],"standard_charges":[{"gross_charge":123.48,"discounted_cash":49.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"}]},{"description":"TOLTERODINE TARTRATE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22782","type":"CDM"},{"code":"31722080560","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 = 60 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"TOLTERODINE TARTRATE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22782","type":"CDM"},{"code":"59762017006","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"TOLTERODINE TARTRATE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22782","type":"CDM"},{"code":"29300023916","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 = 60 EACH"},{"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":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"TOLTERODINE TARTRATE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22782","type":"CDM"},{"code":"93205606","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 = 60 EACH"},{"gross_charge":1.22,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"TOLTERODINE TARTRATE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22782","type":"CDM"},{"code":"93001006","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 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":"TOLTERODINE TARTRATE 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22783","type":"CDM"},{"code":"9454402","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DESIPRAMINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2283","type":"CDM"},{"code":"50742011201","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 = 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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SILDENAFIL CITRATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22836","type":"CDM"},{"code":"65862068930","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":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SILDENAFIL CITRATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22836","type":"CDM"},{"code":"69420030","type":"NDC"}],"standard_charges":[{"gross_charge":79.04,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SILDENAFIL CITRATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22836","type":"CDM"},{"code":"59762003401","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 = 30 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SILDENAFIL CITRATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22837","type":"CDM"},{"code":"31722071030","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 = 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"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SILDENAFIL CITRATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22837","type":"CDM"},{"code":"69421030","type":"NDC"}],"standard_charges":[{"gross_charge":79.04,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"SILDENAFIL CITRATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22838","type":"CDM"},{"code":"31722071130","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 = 30 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DESIPRAMINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2286","type":"CDM"},{"code":"45963034202","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":0.98,"discounted_cash":0.39,"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":"DESIPRAMINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2286","type":"CDM"},{"code":"68084097295","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 = 1 EACH"}]},{"description":"DESIPRAMINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2286","type":"CDM"},{"code":"50742011301","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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DESIPRAMINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2286","type":"CDM"},{"code":"781197201","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 = 100 EACH"}]},{"description":"DILTIAZEM HCL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22862","type":"CDM"},{"code":"38779022705","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DESONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2291","type":"CDM"},{"code":"72578008602","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 = 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":"DESONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2291","type":"CDM"},{"code":"45802042235","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 = 15 G"}]},{"description":"DESONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2291","type":"CDM"},{"code":"51672128003","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 = 60 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"BRINZOLAMIDE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22953","type":"CDM"},{"code":"65027510","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":12.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"BRINZOLAMIDE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22953","type":"CDM"},{"code":"781601470","type":"NDC"}],"standard_charges":[{"gross_charge":26.02,"discounted_cash":10.41,"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":"BRINZOLAMIDE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22953","type":"CDM"},{"code":"68682046410","type":"NDC"}],"standard_charges":[{"gross_charge":10.00,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.63,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"PAROXETINE HCL 10 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22959","type":"CDM"},{"code":"70954031910","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 = 250 ML"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"PAROXETINE HCL 10 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22959","type":"CDM"},{"code":"60505040205","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DESOXIMETASONE 0.25 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2296","type":"CDM"},{"code":"51672127001","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":1.83,"discounted_cash":0.73,"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":"AMPHOTERICIN B LIPID 5 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22981","type":"CDM"},{"code":"57665010141","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":3.12,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":4.75,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"DORZOLAMIDE-TIMOLOL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22982","type":"CDM"},{"code":"70069005101","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 = 10 ML"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE-TIMOLOL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22982","type":"CDM"},{"code":"24208048610","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 = 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"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE-TIMOLOL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22982","type":"CDM"},{"code":"65862094601","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.72,"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":"DORZOLAMIDE-TIMOLOL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22982","type":"CDM"},{"code":"82584060510","type":"NDC"}],"standard_charges":[{"gross_charge":21.90,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.83,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN-HYDROCORTISONE 0.2-1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22986","type":"CDM"},{"code":"78085526","type":"NDC"}],"standard_charges":[{"gross_charge":33.16,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN-HYDROCORTISONE 0.2-1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22986","type":"CDM"},{"code":"65853110","type":"NDC"}],"standard_charges":[{"gross_charge":28.47,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN-HYDROCORTISONE 0.2-1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22986","type":"CDM"},{"code":"66758008770","type":"NDC"}],"standard_charges":[{"gross_charge":29.66,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN 250 MG/5ML (5%) OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22987","type":"CDM"},{"code":"50419077701","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 ML"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":1.18,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"CAPECITABINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22993","type":"CDM"},{"code":"55111049660","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 = 60 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CAPECITABINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22993","type":"CDM"},{"code":"378251191","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 EACH"},{"gross_charge":0.89,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CAPECITABINE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22994","type":"CDM"},{"code":"72205000792","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 = 120 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CAPECITABINE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22994","type":"CDM"},{"code":"55111049704","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 = 120 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CAPECITABINE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22994","type":"CDM"},{"code":"54027223","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CAPECITABINE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22994","type":"CDM"},{"code":"16729007329","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 = 120 EACH"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CAPECITABINE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22994","type":"CDM"},{"code":"93747489","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 = 120 EACH"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"HYDROXYUREA 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23009","type":"CDM"},{"code":"3633517","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 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"HYDROXYUREA 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23010","type":"CDM"},{"code":"3633617","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 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"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":"POTASSIUM HYDROXIDE 10 % SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23036","type":"CDM"},{"code":"51552007105","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 ML"}]},{"description":"CLINISOL SF 15 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23068","type":"CDM"},{"code":"338050206","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 = 2000 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2000 ML"}]},{"description":"CLINISOL SF 15 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23068","type":"CDM"},{"code":"409717117","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 = 2000 ML"}]},{"description":"BASILIXIMAB 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23082","type":"CDM"},{"code":"78033184","type":"NDC"}],"standard_charges":[{"gross_charge":4510.84,"discounted_cash":1804.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":801.21,"discounted_cash":320.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":662.88,"discounted_cash":265.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROGESTERONE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23122","type":"CDM"},{"code":"32170801","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"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"55150015520","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 = 20 ML"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"55150015410","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 = 10 ML"},{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"55150015411","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 = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"63323032510","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 = 10 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"63323032503","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 = 10 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"55150015521","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 = 20 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23128","type":"CDM"},{"code":"65219062202","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 = 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":"VERAPAMIL HCL ER (DAILY) 180 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23150","type":"CDM"},{"code":"378638001","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 = 100 EACH"},{"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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CLINIMIX E/DEXTROSE (2.75/5) 2.75 % IV 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NDC EA = 1 EACH"}]},{"description":"DEXAMETHASONE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2324","type":"CDM"},{"code":"54418125","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":0.12,"discounted_cash":0.05,"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":"DEXAMETHASONE 1 MG OR 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= 100 EACH"},{"gross_charge":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXAMETHASONE 6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2328","type":"CDM"},{"code":"54418625","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 = 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"},{"gross_charge":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2331","type":"CDM"},{"code":"641036721","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 = 1 ML"},{"gross_charge":1.16,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"55150023701","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 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"67457042300","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 = 1 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"641614525","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 = 1 ML"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"63323016501","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 = 1 ML"},{"gross_charge":2.16,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"63323016502","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 = 1 ML"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2332","type":"CDM"},{"code":"67457042312","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 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2335","type":"CDM"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23376","type":"CDM"},{"code":"68462046599","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 = 18 EACH"},{"gross_charge":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"},{"gross_charge":1.09,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23377","type":"CDM"},{"code":"68462046699","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 = 18 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 EACH"}]},{"description":"AMOXICILLIN 875 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23458","type":"CDM"},{"code":"65862001501","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"},{"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":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"24357070215","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 = 15 G"}]},{"description":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"39328002515","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"43199005415","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 = 15 G"}]},{"description":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"496088315","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"71399005002","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 = 30 G"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE (ANORECTAL) 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23460","type":"CDM"},{"code":"47781057172","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 = 15 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"24357070130","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 = 30 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"39328002430","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"71399004903","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 = 30 G"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"496088206","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"24357070105","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"},{"gross_charge":2.96,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23461","type":"CDM"},{"code":"496088205","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 = 5 G"},{"gross_charge":3.60,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"},{"gross_charge":7.21,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 G"}]},{"description":"CITALOPRAM HYDROBROMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23490","type":"CDM"},{"code":"904608661","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":"CALFACTANT IN NACL 35 MG/ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23500","type":"CDM"},{"code":"61938045606","type":"NDC"}],"standard_charges":[{"gross_charge":150.62,"discounted_cash":60.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"CALFACTANT IN NACL 35 MG/ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23500","type":"CDM"},{"code":"61938045603","type":"NDC"}],"standard_charges":[{"gross_charge":170.2,"discounted_cash":68.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"DEXTROAMPHETAMINE SULFATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2354","type":"CDM"},{"code":"555095202","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXTROAMPHETAMINE SULFATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2354","type":"CDM"},{"code":"13107003501","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":0.39,"discounted_cash":0.15,"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":"DEXTROAMPHETAMINE SULFATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2354","type":"CDM"},{"code":"10702006501","type":"NDC"}],"standard_charges":[{"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":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXTROMETHORPHAN HBR 10 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2355","type":"CDM"},{"code":"11169004908","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 = 237 ML"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2357","type":"CDM"},{"code":"338002303","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":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2357","type":"CDM"},{"code":"338002302","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 = 250 ML"}]},{"description":"DEXTROSE 20 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2359","type":"CDM"},{"code":"409793519","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 = 500 ML"}]},{"description":"THALIDOMIDE 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23599","type":"CDM"},{"code":"59572020594","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 = 28 EACH"}]},{"description":"DEXTROSE 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2360","type":"CDM"},{"code":"99922002360","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":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2360","type":"CDM"},{"code":"409177510","type":"NDC"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.86,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2361","type":"CDM"},{"code":"409177510","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 = 10 ML"},{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23617","type":"CDM"},{"code":"25021082850","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":70.52,"discounted_cash":28.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23617","type":"CDM"},{"code":"70436012080","type":"NDC"}],"standard_charges":[{"gross_charge":55.62,"discounted_cash":22.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":40.37,"discounted_cash":16.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23617","type":"CDM"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":23.51,"discounted_cash":9.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":38.43,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338001738","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 = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338001731","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"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"990792313","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":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338001702","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 = 250 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338001741","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"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338055111","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 = 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":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"338001748","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 = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2364","type":"CDM"},{"code":"990792320","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 = 25 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Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":6.21,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":4.60,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"}]},{"description":"LEFLUNOMIDE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23872","type":"CDM"},{"code":"23155004303","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 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"}]},{"description":"LEFLUNOMIDE 10 MG OR 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Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LEFLUNOMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23873","type":"CDM"},{"code":"23155004403","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 = 30 EACH"},{"gross_charge":0.19,"discounted_cash":0.07,"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"}]},{"description":"LEFLUNOMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23873","type":"CDM"},{"code":"88216130","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 = 30 EACH"},{"gross_charge":45.04,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23876","type":"CDM"},{"code":"409741914","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"},{"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":"DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23876","type":"CDM"},{"code":"409741903","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 = 500 ML"},{"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":"EFAVIRENZ 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23898","type":"CDM"},{"code":"56047030","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 = 30 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= 1 EACH"}]},{"description":"OXALIPLATIN 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23929","type":"CDM"},{"code":"45963061159","type":"NDC"}],"standard_charges":[{"gross_charge":174.66,"discounted_cash":69.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":28.56,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":23.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MYCOPHENOLATE MOFETIL HCL 500 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.18,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23968","type":"CDM"},{"code":"71288080320","type":"NDC"}],"standard_charges":[{"gross_charge":22.60,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.88,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23968","type":"CDM"},{"code":"4029830","type":"NDC"}],"standard_charges":[{"gross_charge":104.74,"discounted_cash":41.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.75,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23968","type":"CDM"},{"code":"17478042240","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.91,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":44.78,"discounted_cash":17.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2401","type":"CDM"},{"code":"409127332","type":"NDC"}],"standard_charges":[{"gross_charge":14.51,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":3.74,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":4.67,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ 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ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2401","type":"CDM"},{"code":"69339013603","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":6.98,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2401","type":"CDM"},{"code":"641624401","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":6.80,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2401","type":"CDM"},{"code":"409127303","type":"NDC"}],"standard_charges":[{"gross_charge":14.51,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":4.67,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DIAZEPAM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2403","type":"CDM"},{"code":"51079028601","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2403","type":"CDM"},{"code":"51079028620","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIAZEPAM 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2404","type":"CDM"},{"code":"51079028420","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIAZEPAM 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2404","type":"CDM"},{"code":"51079028401","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2404","type":"CDM"},{"code":"172392560","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIAZEPAM 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2405","type":"CDM"},{"code":"172392660","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIAZEPAM 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2405","type":"CDM"},{"code":"51079028520","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"}]},{"description":"DIAZEPAM 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2405","type":"CDM"},{"code":"51079028501","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 = 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":"DIAZEPAM 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2405","type":"CDM"},{"code":"904588061","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":"TRASTUZUMAB 440 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24053","type":"CDM"},{"code":"50242013468","type":"NDC"}],"standard_charges":[{"gross_charge":1689.89,"discounted_cash":675.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB 440 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24053","type":"CDM"},{"code":"50242005656","type":"NDC"}],"standard_charges":[{"gross_charge":1670.26,"discounted_cash":668.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NEVIRAPINE 50 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24119","type":"CDM"},{"code":"65862005724","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 = 240 ML"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"}]},{"description":"NEVIRAPINE 50 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24119","type":"CDM"},{"code":"54045058","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 = 240 ML"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2412","type":"CDM"},{"code":"536121195","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 = 28 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2412","type":"CDM"},{"code":"54162001101","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 = 28 G"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"DICLOXACILLIN SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2414","type":"CDM"},{"code":"93312301","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 = 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":"DICLOXACILLIN SODIUM 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2415","type":"CDM"},{"code":"781225801","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":"DICLOXACILLIN SODIUM 500 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2415","type":"CDM"},{"code":"93312501","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":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2417","type":"CDM"},{"code":"70069043101","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"574015004","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 = 118 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"54356699","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 = 118 ML"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"60687057640","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":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"99917241760","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 = 0.5 ML"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG OR 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NDC EA = 1 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"60687036901","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":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"832605310","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 = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"527058601","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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"591079401","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"},{"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":"PSYLLIUM 100 % OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24190","type":"CDM"},{"code":"224180100","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 = 1 EACH"}]},{"description":"PSYLLIUM 100 % OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24190","type":"CDM"},{"code":"224180124","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":"PSYLLIUM 100 % OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24190","type":"CDM"},{"code":"224180184","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 = 30 EACH"}]},{"description":"ISOSORBIDE MONONITRATE CR 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24268","type":"CDM"},{"code":"904645061","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":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE CR 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24268","type":"CDM"},{"code":"50742017601","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":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE CR 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24268","type":"CDM"},{"code":"68084059201","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":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE CR 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24268","type":"CDM"},{"code":"68084059211","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ETANERCEPT 25 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24276","type":"CDM"},{"code":"58406042534","type":"NDC"}],"standard_charges":[{"gross_charge":129.81,"discounted_cash":51.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24329","type":"CDM"},{"code":"264958720","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 = 250 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24329","type":"CDM"},{"code":"409779362","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 = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24329","type":"CDM"},{"code":"409452002","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 = 250 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"TELMISARTAN 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24335","type":"CDM"},{"code":"597004037","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TELMISARTAN 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24335","type":"CDM"},{"code":"43547028403","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 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1 EACH"}]},{"description":"TELMISARTAN 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24336","type":"CDM"},{"code":"67877048433","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":"LEUPROLIDE ACETATE 1 MG/0.2ML IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24362","type":"CDM"},{"code":"781400332","type":"NDC"}],"standard_charges":[{"gross_charge":39.62,"discounted_cash":15.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":504.14,"discounted_cash":201.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24362","type":"CDM"},{"code":"41616093640","type":"NDC"}],"standard_charges":[{"gross_charge":73.93,"discounted_cash":29.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1-2 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24385","type":"CDM"},{"code":"472088282","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 = 10 ML"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1-2 % OT 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| NDC EA = 10 ML"},{"gross_charge":6.73,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.15,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"METFORMIN HCL 1000 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24398","type":"CDM"},{"code":"65862001005","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 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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NDC EA = 1 EACH"}]},{"description":"ABACAVIR SULFATE 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24438","type":"CDM"},{"code":"51079020406","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":2.47,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":5.80,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ABACAVIR SULFATE 300 MG OR 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NDC EA = 60 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ABACAVIR SULFATE 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24438","type":"CDM"},{"code":"68084002111","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.23,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ABACAVIR SULFATE 20 MG/ML OR 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NDC EA = 240 ML"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"}]},{"description":"DIGOXIN 0.125 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2444","type":"CDM"},{"code":"143124001","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIGOXIN 0.125 MG OR 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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":"NEOSPORIN ORIGINAL 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24696","type":"CDM"},{"code":"68001048346","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 = 14.2 G"},{"gross_charge":0.09,"discounted_cash":0.04,"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":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX 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= 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"}]},{"description":"MODAFINIL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24703","type":"CDM"},{"code":"62332010690","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 = 90 EACH"}]},{"description":"MODAFINIL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24703","type":"CDM"},{"code":"62332010630","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 = 30 EACH"}]},{"description":"MODAFINIL 200 MG OR 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= 90 EACH"}]},{"description":"LISINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24711","type":"CDM"},{"code":"68180051801","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":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DILTIAZEM HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2475","type":"CDM"},{"code":"51079074501","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 = 1 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24933","type":"CDM"},{"code":"64067021601","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MIRTAZAPINE 45 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24945","type":"CDM"},{"code":"57664050183","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 = 30 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24984","type":"CDM"},{"code":"11523723402","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 = 119 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 119 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24984","type":"CDM"},{"code":"68001050569","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 = 510 G"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 510 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24984","type":"CDM"},{"code":"46122001433","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 = 238 G"},{"gross_charge":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 238 G"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 238 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24984","type":"CDM"},{"code":"11523723404","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 = 510 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 510 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24984","type":"CDM"},{"code":"574041202","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 = 255 G"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN 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NDC EA = 3 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"CDM"},{"code":"60687039579","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 = 3 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN 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NDC EA = 3 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25005","type":"CDM"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 160 ML"},{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 160 ML"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 160 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML OR 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1 ML"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2508","type":"CDM"},{"code":"67457012410","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":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2508","type":"CDM"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":2.18,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2508","type":"CDM"},{"code":"72485010125","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 = 1 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| NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2508","type":"CDM"},{"code":"25021048101","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 ML"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2508","type":"CDM"},{"code":"63323066400","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2509","type":"CDM"},{"code":"904723761","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":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2509","type":"CDM"},{"code":"46122044078","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"251","type":"CDM"},{"code":"50383074120","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"251","type":"CDM"},{"code":"69374033005","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2510","type":"CDM"},{"code":"904205661","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":0.01,"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":"DIPHENHYDRAMINE HCL 12.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2511","type":"CDM"},{"code":"99917002511","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 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2511","type":"CDM"},{"code":"121097810","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 = 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"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2511","type":"CDM"},{"code":"121048910","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"},{"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":"DIPHENHYDRAMINE HCL 12.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2511","type":"CDM"},{"code":"121048905","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"}]},{"description":"CIPROFLOXACIN HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25118","type":"CDM"},{"code":"143992701","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CIPROFLOXACIN HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25118","type":"CDM"},{"code":"68084006911","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"},{"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":"CIPROFLOXACIN HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25118","type":"CDM"},{"code":"68084006901","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CIPROFLOXACIN HCL 250 MG OR 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NDC EA = 50 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG OR TABS OR CAPS CUSTOM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2513","type":"CDM"},{"code":"46122044162","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 = 24 EACH"},{"gross_charge":0.02,"discounted_cash":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG OR 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100 EACH"}]},{"description":"DIPYRIDAMOLE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2528","type":"CDM"},{"code":"54043425","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":"DIPYRIDAMOLE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2528","type":"CDM"},{"code":"115107001","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":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIPYRIDAMOLE 25 MG OR 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1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"46122026378","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":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"46122069378","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"54629060101","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":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"904728160","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 = 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":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"536375710","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"}]},{"description":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"904699960","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":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"536106401","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":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"536106410","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 = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"DOCUSATE SODIUM 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2567","type":"CDM"},{"code":"536375701","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":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOCUSATE SODIUM 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2568","type":"CDM"},{"code":"67618010060","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 = 60 EACH"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"121054410","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 = 10 ML"},{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"121187000","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 = 10 ML"},{"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":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"121187010","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 = 10 ML"},{"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":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"536130485","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 = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"904727966","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"54838011680","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":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2569","type":"CDM"},{"code":"50383077110","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"}]},{"description":"ALCOHOL 98 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"257","type":"CDM"},{"code":"17478050305","type":"NDC"}],"standard_charges":[{"gross_charge":7.40,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":6.30,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":17.43,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TROPHAMINE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25798","type":"CDM"},{"code":"264193310","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 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NDC EA = 500 ML"}]},{"description":"IVERMECTIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25820","type":"CDM"},{"code":"6003220","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":3.22,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"IVERMECTIN 3 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25820","type":"CDM"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":1.56,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":2.03,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"60687050711","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 = 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"},{"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":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"68001000600","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":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"68001041100","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":0.06,"discounted_cash":0.02,"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":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"68001041103","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 = 500 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"60687050701","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":0.36,"discounted_cash":0.14,"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":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"68084079701","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 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"}]},{"description":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"68084079711","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 = 1 EACH"},{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"51224002160","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 = 500 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"GABAPENTIN 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25855","type":"CDM"},{"code":"228263650","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 = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"GABAPENTIN 800 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25856","type":"CDM"},{"code":"65862052405","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 = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.0092,"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":"SOMATROPIN 24 MG IJ CART","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25862","type":"CDM"},{"code":"2814901","type":"NDC"}],"standard_charges":[{"gross_charge":3610.73,"discounted_cash":1444.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":261.61,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":975.38,"discounted_cash":390.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMOZOLOMIDE 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25892","type":"CDM"},{"code":"93759941","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 = 14 EACH"},{"gross_charge":9.04,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25892","type":"CDM"},{"code":"16729004853","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 = 5 EACH"},{"gross_charge":0.6,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":2.4,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25892","type":"CDM"},{"code":"16729004854","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 = 14 EACH"},{"gross_charge":2.4,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25892","type":"CDM"},{"code":"85300402","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25892","type":"CDM"},{"code":"67877053714","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.14,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"85151904","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 = 14 EACH"},{"gross_charge":1.56,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"16729004953","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":5.54,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"16571081751","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"85151902","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"67877053807","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR 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NDC EA = 20 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25894","type":"CDM"},{"code":"51862008514","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 = 14 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25894","type":"CDM"},{"code":"67877053914","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 = 14 EACH"},{"gross_charge":14.43,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG OR 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NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25895","type":"CDM"},{"code":"85141702","type":"NDC"}],"standard_charges":[{"gross_charge":141.79,"discounted_cash":56.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1026.47,"discounted_cash":410.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":112.01,"discounted_cash":44.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 250 MG OR 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NDC EA = 30 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"RABEPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25896","type":"CDM"},{"code":"62856024330","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 = 30 EACH"},{"gross_charge":1.07,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DOPAMINE HCL 160 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2594","type":"CDM"},{"code":"517130525","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 = 5 ML"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2595","type":"CDM"},{"code":"143925201","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 = 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":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2596","type":"CDM"},{"code":"409426501","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ZALEPLON 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25997","type":"CDM"},{"code":"29300013101","type":"NDC"}],"standard_charges":[{"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ZALEPLON 10 MG OR 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EA = 20 ML"},{"gross_charge":1.82,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"DOXAPRAM HCL 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2607","type":"CDM"},{"code":"641601806","type":"NDC"}],"standard_charges":[{"gross_charge":2.40,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":1.82,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"DOXEPIN HCL 10 MG OR 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= 1 EACH"}]},{"description":"DOXEPIN HCL 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2609","type":"CDM"},{"code":"378641001","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":1.34,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOXEPIN HCL 25 MG OR 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100 EACH"}]},{"description":"DOXEPIN HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2612","type":"CDM"},{"code":"51079043820","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.34,"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"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOXEPIN HCL 10 MG/ML OR CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2614","type":"CDM"},{"code":"60432065104","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 = 118 ML"}]},{"description":"DOXEPIN HCL 10 MG/ML OR CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2614","type":"CDM"},{"code":"54838051240","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 = 120 ML"},{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV 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100 ML"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"45963073360","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 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV 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| NDC EA = 1 EACH"},{"gross_charge":127.73,"discounted_cash":51.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXORUBICIN HCL 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2619","type":"CDM"},{"code":"143927701","type":"NDC"}],"standard_charges":[{"gross_charge":34.27,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":214.03,"discounted_cash":85.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":31.38,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV 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NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2622","type":"CDM"},{"code":"63323013013","type":"NDC"}],"standard_charges":[{"gross_charge":19.01,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2622","type":"CDM"},{"code":"67457043700","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":15.07,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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NDC EA = 1 EACH"},{"gross_charge":11.06,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"50268063611","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 = 1 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"64679043304","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 = 90 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"50268063615","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 = 50 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR 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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"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"60687072501","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR 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NDC EA = 1 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"45963056908","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 = 90 EACH"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26224","type":"CDM"},{"code":"13668009690","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 = 90 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 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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":"ROPINIROLE HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26429","type":"CDM"},{"code":"62332003531","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":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ROPINIROLE HCL 4 MG OR 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NDC EA = 100 EACH"}]},{"description":"IMIGLUCERASE 400 UNIT IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26431","type":"CDM"},{"code":"58468466301","type":"NDC"}],"standard_charges":[{"gross_charge":1207.71,"discounted_cash":483.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUTICASONE-SALMETEROL 100-50 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26537","type":"CDM"},{"code":"173069504","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 = 14 EACH"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"FLUTICASONE-SALMETEROL 100-50 MCG/ACT IN 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30 EACH"}]},{"description":"EXEMESTANE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26551","type":"CDM"},{"code":"69097031602","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 = 30 EACH"},{"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":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EXEMESTANE 25 MG OR 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26795","type":"CDM"},{"code":"55150018703","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.8,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26795","type":"CDM"},{"code":"42571024469","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 ML"}]},{"description":"CAFFEINE CITRATE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26795","type":"CDM"},{"code":"25021060103","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 = 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":"CAFFEINE CITRATE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26795","type":"CDM"},{"code":"51754050001","type":"NDC"}],"standard_charges":[{"gross_charge":3.30,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"LEVETIRACETAM 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26816","type":"CDM"},{"code":"904605161","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"60687065711","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 = 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"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"904605261","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":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"904712461","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 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"},{"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":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"31722053705","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 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"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"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"51079082120","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":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68180011309","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"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68180011316","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 = 120 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68084087011","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"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68001040307","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 = 120 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68001040303","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 = 500 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"60687065701","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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"31722053712","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 = 120 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"68001011707","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 = 120 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LEVETIRACETAM 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26817","type":"CDM"},{"code":"51079082101","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":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVETIRACETAM 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26818","type":"CDM"},{"code":"50474059640","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 = 120 EACH"},{"gross_charge":12.40,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"LEVETIRACETAM 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26818","type":"CDM"},{"code":"68001040403","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 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"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"LEVETIRACETAM 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26818","type":"CDM"},{"code":"51079082220","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 = 100 EACH"}]},{"description":"LEVETIRACETAM 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26818","type":"CDM"},{"code":"65862024708","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 = 120 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"MOXIFLOXACIN HCL 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26854","type":"CDM"},{"code":"72205000130","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":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MOXIFLOXACIN HCL 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26854","type":"CDM"},{"code":"65862060330","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 = 30 EACH"},{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.66,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MOXIFLOXACIN HCL 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26854","type":"CDM"},{"code":"93738756","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 = 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"}]},{"description":"BENZONATATE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26953","type":"CDM"},{"code":"42806071501","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BENZONATATE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26953","type":"CDM"},{"code":"68382009101","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"42794004410","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"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":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"16729049012","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"69452013117","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 = 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"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"59651011860","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 = 60 EACH"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"51862012560","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 = 60 EACH"},{"gross_charge":3.10,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.19,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"47335006186","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 EACH"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.40,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"72205003960","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 = 60 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"69580061","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 = 14 EACH"}]},{"description":"DOFETILIDE 125 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26965","type":"CDM"},{"code":"69580043","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"DOFETILIDE 250 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26966","type":"CDM"},{"code":"59762003802","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 = 60 EACH"}]},{"description":"DOFETILIDE 250 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26966","type":"CDM"},{"code":"69581043","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 EACH"},{"gross_charge":10.97,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"DOFETILIDE 250 MCG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26966","type":"CDM"},{"code":"72205004060","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 = 60 EACH"},{"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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ACETAMINOPHEN 160 MG/5ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26969","type":"CDM"},{"code":"904198500","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":"VITAMIN C 500 MG/5ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27008","type":"CDM"},{"code":"57896084216","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 = 473 ML"}]},{"description":"BUDESONIDE (NASAL) 32 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27022","type":"CDM"},{"code":"60505612902","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.43 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.43 ML"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.43 ML"}]},{"description":"TERBINAFINE HCL 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27023","type":"CDM"},{"code":"24385052403","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 = 28.4 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27023","type":"CDM"},{"code":"51672208001","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 = 15 G"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27023","type":"CDM"},{"code":"24385052405","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 G"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"METHACHOLINE CHLORIDE 100 MG IN SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27032","type":"CDM"},{"code":"64281010006","type":"NDC"}],"standard_charges":[{"gross_charge":71.86,"discounted_cash":28.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":82.27,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PREDNISOLONE ACETATE 0.12 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27038","type":"CDM"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"gross_charge":29.00,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE ACETATE 0.12 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27038","type":"CDM"},{"code":"11980017410","type":"NDC"}],"standard_charges":[{"gross_charge":29.00,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"PORACTANT ALFA 240 MG/3ML INTRATRACHEA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27047","type":"CDM"},{"code":"10122051003","type":"NDC"}],"standard_charges":[{"gross_charge":355.94,"discounted_cash":142.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":217.14,"discounted_cash":86.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":138.62,"discounted_cash":55.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"PORACTANT ALFA 120 MG/1.5ML INTRATRACHEA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27047","type":"CDM"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"gross_charge":138.62,"discounted_cash":55.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":217.14,"discounted_cash":86.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"gross_charge":361.01,"discounted_cash":144.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"68084084511","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":0.12,"discounted_cash":0.05,"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":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"68462013701","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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"54009720","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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"62584014201","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"}]},{"description":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"60687071101","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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXCARBAZEPINE 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27049","type":"CDM"},{"code":"51991029201","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":0.02,"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":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"28595055049","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 = 4.9 G"},{"gross_charge":39.64,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"},{"gross_charge":5.51,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"},{"gross_charge":31.04,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"28595055012","type":"NDC"}],"standard_charges":[{"gross_charge":30.13,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"66993024150","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 = 4.9 G"},{"gross_charge":34.52,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"28595012049","type":"NDC"}],"standard_charges":[{"gross_charge":34.52,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"24338030065","type":"NDC"}],"standard_charges":[{"gross_charge":41.01,"discounted_cash":16.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27096","type":"CDM"},{"code":"70003030065","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 = 4.9 G"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"574012174","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 = 120 ML"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"574012004","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 = 120 ML"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"574012104","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 = 120 ML"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"66689020204","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 = 120 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"574052174","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 = 120 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"CHARCOAL ACTIVATED OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27099","type":"CDM"},{"code":"574052104","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 = 120 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 500 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27113","type":"CDM"},{"code":"63323042710","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 500 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27113","type":"CDM"},{"code":"39822201001","type":"NDC"}],"standard_charges":[{"gross_charge":5.44,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":8.82,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":6.64,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG (PED) IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27123","type":"CDM"},{"code":"74210803","type":"NDC"}],"standard_charges":[{"gross_charge":315.62,"discounted_cash":126.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":263.75,"discounted_cash":105.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1958.96,"discounted_cash":783.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CICLOPIROX 8 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27158","type":"CDM"},{"code":"21922005351","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 = 6.6 ML"},{"gross_charge":1.84,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.6 ML"}]},{"description":"NIACIN (ANTIHYPERLIPIDEMIC) 500 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27181","type":"CDM"},{"code":"62175032046","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":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NIACIN (ANTIHYPERLIPIDEMIC) 500 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27181","type":"CDM"},{"code":"68084075635","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":3.09,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NIACIN (ANTIHYPERLIPIDEMIC) 500 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27181","type":"CDM"},{"code":"47335053981","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"},{"gross_charge":0.20,"discounted_cash":0.08,"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":"NIACIN (ANTIHYPERLIPIDEMIC) 500 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27181","type":"CDM"},{"code":"68084075695","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.09,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NIACIN (ANTIHYPERLIPIDEMIC) 1000 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27183","type":"CDM"},{"code":"65162032309","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":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"MULTI-DELYN OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27209","type":"CDM"},{"code":"54838000805","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"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"MULTI-DELYN OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27209","type":"CDM"},{"code":"54838000880","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"}]},{"description":"AMPICILLIN SODIUM 2 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27281","type":"CDM"},{"code":"409372010","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN SODIUM 2 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27281","type":"CDM"},{"code":"67457035202","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.26,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.73,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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NDC EA = 30 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27473","type":"CDM"},{"code":"85331503","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27473","type":"CDM"},{"code":"85331535","type":"NDC"}],"standard_charges":[{"gross_charge":3.56,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27473","type":"CDM"},{"code":"50742051501","type":"NDC"}],"standard_charges":[{"gross_charge":47.91,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27473","type":"CDM"},{"code":"85331530","type":"NDC"}],"standard_charges":[{"gross_charge":3.56,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27473","type":"CDM"},{"code":"85331504","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27474","type":"CDM"},{"code":"378911293","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 = 30 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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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":"FELODIPINE 2.5 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27489","type":"CDM"},{"code":"378501101","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":"FELODIPINE 5 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27490","type":"CDM"},{"code":"51079046720","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":"NISOLDIPINE 20 MG OR 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NDC EA = 120 EACH"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CARBAMAZEPINE 300 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27633","type":"CDM"},{"code":"60505280707","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 = 120 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 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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":"CARBAMAZEPINE 100 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27634","type":"CDM"},{"code":"832602211","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 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 100 MG OR 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NDC EA = 1 EACH"},{"gross_charge":2.12,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27635","type":"CDM"},{"code":"832602311","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.17,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR 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= 30 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ASPIRIN-DIPYRIDAMOLE 25-200 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27644","type":"CDM"},{"code":"43598033960","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 = 60 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ASPIRIN-DIPYRIDAMOLE 25-200 MG OR 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pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE CR OSMOTIC 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27659","type":"CDM"},{"code":"93517301","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":"NIFEDIPINE CR OSMOTIC 90 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27660","type":"CDM"},{"code":"69267066","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":11.93,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NIFEDIPINE CR OSMOTIC 90 MG OR 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pharmacy | NDC EA = 100 EACH"}]},{"description":"AMINOSALICYLIC ACID 4 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27661","type":"CDM"},{"code":"49938010704","type":"NDC"}],"standard_charges":[{"gross_charge":6.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.01,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FLUORESCEIN SODIUM 0.6 MG OP STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27662","type":"CDM"},{"code":"17478040303","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 = 300 EACH"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP 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EA = 30 EACH"}]},{"description":"LANSOPRAZOLE 30 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27692","type":"CDM"},{"code":"781214801","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LANSOPRAZOLE 30 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27692","type":"CDM"},{"code":"67877027590","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 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NDC EA = 100 EACH"}]},{"description":"OMEPRAZOLE 20 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27694","type":"CDM"},{"code":"904568461","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"}]},{"description":"OMEPRAZOLE 20 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27694","type":"CDM"},{"code":"68462039630","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 = 30 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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":"OMEPRAZOLE 40 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27695","type":"CDM"},{"code":"68382050010","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 = 1000 EACH"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"ONDANSETRON 4 MG OR 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= 30 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON 4 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27697","type":"CDM"},{"code":"68001024616","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":0.41,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON 4 MG OR 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= 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"},{"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":"ONDANSETRON 4 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27697","type":"CDM"},{"code":"57237007730","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27698","type":"CDM"},{"code":"781523906","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":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON 8 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27698","type":"CDM"},{"code":"62756035660","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.21,"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 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NDC EA = 90 EACH"}]},{"description":"VENLAFAXINE HCL 75 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27858","type":"CDM"},{"code":"59762018102","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":"VENLAFAXINE HCL 75 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27858","type":"CDM"},{"code":"68084070901","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27859","type":"CDM"},{"code":"68084071311","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 = 1 EACH"},{"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":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VENLAFAXINE HCL 150 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27859","type":"CDM"},{"code":"65862069790","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 = 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"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"VENLAFAXINE HCL 150 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27859","type":"CDM"},{"code":"65862069730","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 = 30 EACH"},{"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":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VENLAFAXINE HCL 150 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27859","type":"CDM"},{"code":"904647061","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"}]},{"description":"VENLAFAXINE HCL 150 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27859","type":"CDM"},{"code":"93738698","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 = 90 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICOTINE 7 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27860","type":"CDM"},{"code":"68001043290","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 = 14 EACH"},{"gross_charge":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 7 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27860","type":"CDM"},{"code":"43598044671","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 = 1 EACH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27862","type":"CDM"},{"code":"43598044774","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 = 14 EACH"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27862","type":"CDM"},{"code":"68001043390","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 = 14 EACH"},{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27862","type":"CDM"},{"code":"536589588","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 = 14 EACH"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27862","type":"CDM"},{"code":"43598044771","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 = 1 EACH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27863","type":"CDM"},{"code":"68001043490","type":"NDC"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27863","type":"CDM"},{"code":"43598044874","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27863","type":"CDM"},{"code":"43598044871","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 = 1 EACH"},{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27863","type":"CDM"},{"code":"536589688","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"ACETAMINOPHEN CHILDRENS 80 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27883","type":"CDM"},{"code":"904579146","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":0.05,"discounted_cash":0.02,"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":"POVIDONE-IODINE 10 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27886","type":"CDM"},{"code":"67618015303","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 = 3 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"POVIDONE-IODINE 10 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27886","type":"CDM"},{"code":"52380410101","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 = 50 EACH"}]},{"description":"POVIDONE-IODINE 10 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27886","type":"CDM"},{"code":"5332949726","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 = 1 EACH"}]},{"description":"POVIDONE-IODINE 10 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27886","type":"CDM"},{"code":"67618015301","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"50383077517","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 = 15 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"60687087044","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 = 15 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"50383077515","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 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"50383077504","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 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"121495015","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"},{"gross_charge":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"54350049","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 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":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"60687087064","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 = 15 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"54350015","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 = 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":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"62135071242","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 ML"},{"gross_charge":0.89,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"72888012515","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"},{"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":"LIDOCAINE VISCOUS 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"72888012526","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 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":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"378912198","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.18,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"406912576","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":2.39,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"60505700600","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":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"60505700602","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 = 5 EACH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"378912116","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.38,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27905","type":"CDM"},{"code":"406902576","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27906","type":"CDM"},{"code":"60505700702","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27906","type":"CDM"},{"code":"60505700700","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27906","type":"CDM"},{"code":"406905076","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27906","type":"CDM"},{"code":"378912216","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.45,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27906","type":"CDM"},{"code":"378912298","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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5 EACH"},{"gross_charge":4.83,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27908","type":"CDM"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 100 MCG/HR TD 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pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27991","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 SODIUM 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27991","type":"CDM"},{"code":"23548750","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 = 50 EACH"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 1 % OP 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NDC EA = 454 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 454 G"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML CO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27999","type":"CDM"},{"code":"46287000660","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 = 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":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML OR 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pharmacy | NDC EA = 1 EACH"}]},{"description":"OLANZAPINE ODT 5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28159","type":"CDM"},{"code":"64380017201","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 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":"OLANZAPINE ODT 5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28159","type":"CDM"},{"code":"60505327503","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 = 30 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pharmacy | NDC EA = 30 EACH"}]},{"description":"OLANZAPINE ODT 10 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28160","type":"CDM"},{"code":"60505327600","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.95,"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"},{"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":"OLANZAPINE ODT 10 MG OR 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= 1 EACH"}]},{"description":"OLANZAPINE ODT 15 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28161","type":"CDM"},{"code":"49884032255","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OLANZAPINE ODT 15 MG OR 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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":"OLANZAPINE ODT 15 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28161","type":"CDM"},{"code":"60505327703","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 = 30 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OLANZAPINE ODT 20 MG OR 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28188","type":"CDM"},{"code":"234057504","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 = 118 ML"}]},{"description":"LIDOCAINE 5 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"65162079104","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.34,"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":"LIDOCAINE 5 % EX 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NDC EA = 30 EACH"}]},{"description":"LIDOCAINE 5 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"61959000101","type":"NDC"}],"standard_charges":[{"gross_charge":25.14,"discounted_cash":10.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE 5 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"61959000130","type":"NDC"}],"standard_charges":[{"gross_charge":25.14,"discounted_cash":10.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LIDOCAINE 5 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"63481068706","type":"NDC"}],"standard_charges":[{"gross_charge":19.78,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LIDOCAINE 5 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"82347050505","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 = 30 EACH"},{"gross_charge":2.50,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LIDOCAINE 5 % EX 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20 EACH"}]},{"description":"LINEZOLID 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"42292000801","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":"LINEZOLID 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"60687018911","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LINEZOLID 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"60687030911","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.94,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LINEZOLID 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"42292000803","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 = 30 EACH"}]},{"description":"LINEZOLID 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"67877041933","type":"NDC"}],"standard_charges":[{"gross_charge":2.40,"discounted_cash":0.96,"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"},{"gross_charge":4.68,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LINEZOLID 100 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28225","type":"CDM"},{"code":"9513601","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":1.04,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"PENTAMIDINE ISETHIONATE 300 MG IN SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28235","type":"CDM"},{"code":"63323087715","type":"NDC"}],"standard_charges":[{"gross_charge":66.55,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":87.58,"discounted_cash":35.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":78.9,"discounted_cash":31.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PENTAMIDINE ISETHIONATE 300 MG IN SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28235","type":"CDM"},{"code":"13925052201","type":"NDC"}],"standard_charges":[{"gross_charge":57.55,"discounted_cash":23.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":57.37,"discounted_cash":22.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SALMETEROL XINAFOATE 50 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28246","type":"CDM"},{"code":"173052000","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":13.62,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"SALMETEROL XINAFOATE 50 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28246","type":"CDM"},{"code":"173052100","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 = 60 EACH"},{"gross_charge":6.38,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CARBIDOPA-LEVODOPA CR 25-100 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28264","type":"CDM"},{"code":"51079097801","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 = 1 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| NDC EA = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28278","type":"CDM"},{"code":"55111035260","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 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28278","type":"CDM"},{"code":"51991079306","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 = 60 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28278","type":"CDM"},{"code":"33342008909","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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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":"RIVASTIGMINE TARTRATE 1.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28278","type":"CDM"},{"code":"781261460","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 = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28279","type":"CDM"},{"code":"33342009009","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 = 60 EACH"},{"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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28279","type":"CDM"},{"code":"63739057710","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 = 100 EACH"},{"gross_charge":3.12,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.18,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28279","type":"CDM"},{"code":"62332006460","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 = 60 EACH"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28279","type":"CDM"},{"code":"51991079406","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 = 60 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28282","type":"CDM"},{"code":"88222033","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.98,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28282","type":"CDM"},{"code":"99917928282","type":"NDC"}],"standard_charges":[{"gross_charge":26.30,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CAFFEINE CITRATE 20 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28289","type":"CDM"},{"code":"25021060203","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.91,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":3.78,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 20 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28289","type":"CDM"},{"code":"51754050103","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 = 3 ML"},{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 20 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28289","type":"CDM"},{"code":"63323040603","type":"NDC"}],"standard_charges":[{"gross_charge":4.30,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":2.86,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":7.52,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"FREESTYLE LANCETS MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28314","type":"CDM"},{"code":"99073013001","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2833","type":"CDM"},{"code":"17478051500","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 = 1 ML"},{"gross_charge":3.25,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"FERRIC SUBSULFATE 259 MG/GM EX 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EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28384","type":"CDM"},{"code":"406012523","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28384","type":"CDM"},{"code":"406012562","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":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28384","type":"CDM"},{"code":"406036762","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":"HYDROCODONE-ACETAMINOPHEN 10-325 MG OR 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28774","type":"CDM"},{"code":"487960101","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.86,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28774","type":"CDM"},{"code":"93681573","type":"NDC"}],"standard_charges":[{"gross_charge":3.30,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28774","type":"CDM"},{"code":"93681545","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 = 2 ML"},{"gross_charge":3.30,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28774","type":"CDM"},{"code":"69097031886","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 = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN 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EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28775","type":"CDM"},{"code":"186198904","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":2.05,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28775","type":"CDM"},{"code":"487970101","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 = 2 ML"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":4.21,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28775","type":"CDM"},{"code":"60687052479","type":"NDC"}],"standard_charges":[{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":2.80,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28775","type":"CDM"},{"code":"6909731986","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE (INHALATION) 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28775","type":"CDM"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":2.80,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"68084041593","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 = 1 EACH"},{"gross_charge":1.16,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"68001010600","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"},{"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":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"65862059501","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":0.07,"discounted_cash":0.03,"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":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"51079076708","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"},{"gross_charge":1.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"51079076701","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"904636445","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 = 80 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"}]},{"description":"GLYCERIN LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28815","type":"CDM"},{"code":"395103196","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 = 177 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 177 ML"}]},{"description":"GLYCERIN LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28815","type":"CDM"},{"code":"31722013747","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 = 473 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 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pharmacy | NDC EA = 355 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28836","type":"CDM"},{"code":"121043130","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 = 30 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28836","type":"CDM"},{"code":"60687042945","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 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"78024615","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"74646332","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 = 30 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"78024661","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.66,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"93574019","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 = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"93574065","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 = 30 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG OR 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NDC EA = 30 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28843","type":"CDM"},{"code":"74310932","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.49,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.21,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG OR 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NDC EA = 50 ML"},{"gross_charge":11.59,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":2.29,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROCORTISONE ACE-PRAMOXINE 1-1 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28847","type":"CDM"},{"code":"45802014464","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE ACE-PRAMOXINE 1-1 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28847","type":"CDM"},{"code":"49908015030","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE ACE-PRAMOXINE 2.5-1 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28848","type":"CDM"},{"code":"45802047264","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":3.77,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":2.96,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE ACE-PRAMOXINE 1-1 % RE FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28849","type":"CDM"},{"code":"37682210","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 G"},{"gross_charge":5.65,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 G"},{"gross_charge":6.73,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"48102005711","type":"NDC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"574402435","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":2.81,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":1.00,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"574402411","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"574402450","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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G"},{"gross_charge":7.37,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"17478007035","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP 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G"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":3.44,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"ERYTHROMYCIN BASE 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2889","type":"CDM"},{"code":"69238148401","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":5.78,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.14,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ERYTHROMYCIN BASE 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2889","type":"CDM"},{"code":"69238148403","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.00,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":9.63,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERYTHROMYCIN BASE 250 MG OR 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| NDC EA = 100 EACH"},{"gross_charge":7.32,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ERYTHROMYCIN BASE 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2889","type":"CDM"},{"code":"93557156","type":"NDC"}],"standard_charges":[{"gross_charge":4.60,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERYTHROMYCIN BASE 250 MG OR 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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"}]},{"description":"OXYCODONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28899","type":"CDM"},{"code":"406851501","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":0.20,"discounted_cash":0.08,"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":"OXYCODONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28899","type":"CDM"},{"code":"904644561","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 = 100 EACH"}]},{"description":"OXYCODONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28899","type":"CDM"},{"code":"68084018401","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL 15 MG OR 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| NDC EA = 100 EACH"}]},{"description":"ERYTHROMYCIN BASE 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2890","type":"CDM"},{"code":"69238148503","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.02,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":10.46,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERYTHROMYCIN BASE 500 MG OR 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EA = 100 EACH"}]},{"description":"OXYCODONE HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28900","type":"CDM"},{"code":"68084018501","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28900","type":"CDM"},{"code":"68084018511","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 EACH"}]},{"description":"OXYCODONE HCL 30 MG OR 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EA = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"METFORMIN HCL 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28995","type":"CDM"},{"code":"70010049105","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 = 500 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"METFORMIN HCL 500 MG OR 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pharmacy | NDC EA = 1 EACH"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2903","type":"CDM"},{"code":"14789011607","type":"NDC"}],"standard_charges":[{"gross_charge":54.49,"discounted_cash":21.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERYTHROMYCIN STEARATE 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2904","type":"CDM"},{"code":"24338010620","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.67,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ALENDRONATE SODIUM 70 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29048","type":"CDM"},{"code":"64980034214","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 = 4 EACH"},{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"54879002710","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 = 10 ML"},{"gross_charge":8.56,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"68382099701","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.88,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"63459060010","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"63459060001","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"70121148301","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.56,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"70121148307","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.56,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":38.45,"discounted_cash":15.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"14789060010","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 = 10 ML"},{"gross_charge":45.20,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29071","type":"CDM"},{"code":"14789060007","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 = 10 ML"},{"gross_charge":45.20,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ALENDRONATE SODIUM 35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29072","type":"CDM"},{"code":"76439013012","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":"ALENDRONATE SODIUM 35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29072","type":"CDM"},{"code":"76439013004","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 = 4 EACH"}]},{"description":"ALENDRONATE SODIUM 35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29072","type":"CDM"},{"code":"93517244","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 = 4 EACH"}]},{"description":"DICLOFENAC SODIUM 3 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29090","type":"CDM"},{"code":"10337080301","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DIDANOSINE 250 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29109","type":"CDM"},{"code":"555058901","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 = 30 EACH"}]},{"description":"DIDANOSINE 400 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29110","type":"CDM"},{"code":"555059001","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"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"67457063900","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.80,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"517234010","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":11.74,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":5.06,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"781348675","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"781348770","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"76329920205","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.54,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"517232501","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":5.06,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":4.70,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"517232510","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":4.51,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":11.75,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"67457063800","type":"NDC"}],"standard_charges":[{"gross_charge":4.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.88,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"67457063810","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":5.79,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"517231001","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.06,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29132","type":"CDM"},{"code":"517231005","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":11.74,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29167","type":"CDM"},{"code":"49702021718","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":24.15,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":13.13,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29167","type":"CDM"},{"code":"68180028607","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":7.45,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"121213406","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 = 6 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"59762505007","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 = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"59762502501","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 = 470 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"50383031147","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 = 470 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"42192060806","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 = 6 ML"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"42192060845","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 = 5 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"42192060840","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 = 6 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"65162069890","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 = 473 ML"},{"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":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"42192060816","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 = 470 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 470 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29169","type":"CDM"},{"code":"42192060805","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 = 5 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE 15 MG OR 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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":"QUETIAPINE FUMARATE 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29267","type":"CDM"},{"code":"60687037111","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":0.53,"discounted_cash":0.21,"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":"QUETIAPINE FUMARATE 300 MG OR 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| NDC EA = 280 EACH"}]},{"description":"ESTRADIOL VALERATE 10 MG/ML IM OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2930","type":"CDM"},{"code":"42023011001","type":"NDC"}],"standard_charges":[{"gross_charge":24.00,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.91,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.33,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ESTRADIOL VALERATE 10 MG/ML IM 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| NDC EA = 90 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"59762004801","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"51079019803","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR 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NDC EA = 30 EACH"}]},{"description":"NATEGLINIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29437","type":"CDM"},{"code":"16571075809","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 = 90 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NATEGLINIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29437","type":"CDM"},{"code":"68084045821","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 = 30 EACH"}]},{"description":"NATEGLINIDE 60 MG OR 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30 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29443","type":"CDM"},{"code":"68462053435","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 = 30 G"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":2.76,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29443","type":"CDM"},{"code":"68462053465","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 = 60 G"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"BOTULINUM TOXIN TYPE B 5000 UNIT/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29449","type":"CDM"},{"code":"10454071110","type":"NDC"}],"standard_charges":[{"gross_charge":419.17,"discounted_cash":167.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":635.08,"discounted_cash":254.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":471.9,"discounted_cash":188.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"BOTULINUM TOXIN TYPE B 5000 UNIT/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29449","type":"CDM"},{"code":"10454071210","type":"NDC"}],"standard_charges":[{"gross_charge":420.86,"discounted_cash":168.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":469.61,"discounted_cash":187.84,"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":"29464","type":"CDM"},{"code":"641602010","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29464","type":"CDM"},{"code":"409381412","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29464","type":"CDM"},{"code":"409381411","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ETHYL CHLORIDE EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2951","type":"CDM"},{"code":"386000102","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 = 116 ML"}]},{"description":"FLUOROURACIL 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29517","type":"CDM"},{"code":"378807849","type":"NDC"}],"standard_charges":[{"gross_charge":34.57,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"CLINDAMYCIN PHOS-BENZOYL PEROX 1-5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29518","type":"CDM"},{"code":"378868854","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 G"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 G"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 G"}]},{"description":"MIRTAZAPINE 15 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29531","type":"CDM"},{"code":"65862002106","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":0.22,"discounted_cash":0.09,"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"}]},{"description":"MIRTAZAPINE 15 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29531","type":"CDM"},{"code":"57237001106","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":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MIRTAZAPINE 30 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29532","type":"CDM"},{"code":"65862002206","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 = 30 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CASPOFUNGIN ACETATE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29567","type":"CDM"},{"code":"6382210","type":"NDC"}],"standard_charges":[{"gross_charge":50.71,"discounted_cash":20.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":303.94,"discounted_cash":121.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":37.99,"discounted_cash":15.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29676","type":"CDM"},{"code":"904386575","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 = 44 ML"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 44 ML"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 44 ML"}]},{"description":"SODIUM CHLORIDE 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29676","type":"CDM"},{"code":"536250676","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 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NDC EA = 60 EACH"}]},{"description":"ZIPRASIDONE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29778","type":"CDM"},{"code":"68084010311","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 = 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"},{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZIPRASIDONE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29778","type":"CDM"},{"code":"51079035116","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 = 60 EACH"}]},{"description":"ZIPRASIDONE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29778","type":"CDM"},{"code":"68001045006","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"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"}]},{"description":"ZIPRASIDONE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29779","type":"CDM"},{"code":"68001045106","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 = 60 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ZIPRASIDONE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29779","type":"CDM"},{"code":"904627008","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":3.68,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"ZIPRASIDONE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29779","type":"CDM"},{"code":"68084010411","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":2.19,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZIPRASIDONE HCL 60 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29780","type":"CDM"},{"code":"68084010511","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":2.19,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.59,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZIPRASIDONE HCL 60 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29780","type":"CDM"},{"code":"68001045206","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 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ZIPRASIDONE HCL 60 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29780","type":"CDM"},{"code":"68001013806","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"}]},{"description":"ZIPRASIDONE HCL 60 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29780","type":"CDM"},{"code":"904627108","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":2.58,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"ZIPRASIDONE HCL 80 MG OR 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EA = 40 EACH"},{"gross_charge":2.29,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"ZIPRASIDONE HCL 80 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29781","type":"CDM"},{"code":"68001045306","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 = 60 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.64,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ZIPRASIDONE HCL 80 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29781","type":"CDM"},{"code":"68084010611","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":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.19,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZIPRASIDONE HCL 80 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29781","type":"CDM"},{"code":"68180033407","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 = 60 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"44567045001","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 = 250 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"25021030884","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 = 250 ML"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"70121171601","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 = 250 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"67457065725","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 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"55150042001","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 = 250 ML"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29805","type":"CDM"},{"code":"10019005561","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 = 250 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29806","type":"CDM"},{"code":"65862045860","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 = 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"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29806","type":"CDM"},{"code":"51079085203","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 = 30 EACH"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29806","type":"CDM"},{"code":"51079085201","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 = 1 EACH"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29806","type":"CDM"},{"code":"68084072911","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":1.21,"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":"GALANTAMINE HYDROBROMIDE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29806","type":"CDM"},{"code":"54009021","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 = 60 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR 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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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"72516003001","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0076,"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":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"51079016901","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 = 1 EACH"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"527260037","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"55111046605","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 = 500 EACH"},{"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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"60687039001","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 = 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"},{"gross_charge":0.75,"discounted_cash":0.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"60687039011","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.3,"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"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 6 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29898","type":"CDM"},{"code":"44206041706","type":"NDC"}],"standard_charges":[{"gross_charge":196.61,"discounted_cash":78.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BIMATOPROST 0.03 % OP 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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":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3000","type":"CDM"},{"code":"904649120","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 = 118 ML"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3000","type":"CDM"},{"code":"10119000252","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 = 118 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"METOPROLOL SUCCINATE 50 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30070","type":"CDM"},{"code":"68001046900","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":0.20,"discounted_cash":0.08,"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":"METOPROLOL SUCCINATE 100 MG OR 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| NDC EA = 100 EACH"},{"gross_charge":1.1,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOPROLOL SUCCINATE 100 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30071","type":"CDM"},{"code":"60687041311","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 EACH"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METOPROLOL SUCCINATE 100 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30071","type":"CDM"},{"code":"68001050200","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":0.21,"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"}]},{"description":"METOPROLOL SUCCINATE 100 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30071","type":"CDM"},{"code":"68084067311","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":"FACTOR IX COMPLEX 500 UNIT IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3013","type":"CDM"},{"code":"68516320101","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 = 500 UNITS"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"55111076260","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 = 60 EACH"},{"gross_charge":21.18,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.56,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"68084096595","type":"NDC"}],"standard_charges":[{"gross_charge":34.47,"discounted_cash":13.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.71,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":10.12,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"68084096525","type":"NDC"}],"standard_charges":[{"gross_charge":34.47,"discounted_cash":13.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":8.71,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":10.12,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"65862075360","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 = 60 EACH"},{"gross_charge":1.08,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"31722083260","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":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"50268078711","type":"NDC"}],"standard_charges":[{"gross_charge":8.24,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.58,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30148","type":"CDM"},{"code":"4003822","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":10.27,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":16.40,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LIDOCAINE-TRANSPARENT DRESSING 4 % EX KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30183","type":"CDM"},{"code":"496088207","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.61,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30264","type":"CDM"},{"code":"904608461","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"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30264","type":"CDM"},{"code":"13668000901","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":0.02,"discounted_cash":0.0084,"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"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"302785","type":"CDM"},{"code":"99918027838","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 = 1000 ML"}]},{"description":"INFUVITE ADULT IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30302","type":"CDM"},{"code":"54643564901","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":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DROSPIRENONE-ETHINYL ESTRADIOL 3-0.03 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30433","type":"CDM"},{"code":"68180086873","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 = 28 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NDC EA = 250 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30479","type":"CDM"},{"code":"31722068725","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 = 250 ML"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30479","type":"CDM"},{"code":"78035752","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN 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pharmacy | NDC EA = 3 ML"}]},{"description":"FERRIC SUBSULFATE SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3059","type":"CDM"},{"code":"38779128408","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 = 500 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"FERRIC SUBSULFATE SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3059","type":"CDM"},{"code":"51552035703","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 = 100 ML"}]},{"description":"FERROUS GLUCONATE 324 MG OR 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pharmacy | NDC EA = 5 ML"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FERROUS SULFATE 325 (65 FE) MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3074","type":"CDM"},{"code":"904759060","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 EACH"}]},{"description":"FERROUS SULFATE 325 (65 FE) MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3074","type":"CDM"},{"code":"904759161","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":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO 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100 EACH"}]},{"description":"ALLOPURINOL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"310","type":"CDM"},{"code":"904704161","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":0.20,"discounted_cash":0.08,"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":"ALLOPURINOL 100 MG OR 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= 100 EACH"}]},{"description":"ALLOPURINOL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"310","type":"CDM"},{"code":"51079020501","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 = 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":"FREESTYLE LANCETS MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3101","type":"CDM"},{"code":"99073013001","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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100 EACH"}]},{"description":"ALLOPURINOL 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"311","type":"CDM"},{"code":"29300035001","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ALLOPURINOL 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"311","type":"CDM"},{"code":"51079020601","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 = 1 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EA = 10 ML"},{"gross_charge":27.72,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31158","type":"CDM"},{"code":"60505056401","type":"NDC"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":4.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP 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pharmacy | NDC EA = 66 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERE 1.1 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31270","type":"CDM"},{"code":"11994001116","type":"NDC"}],"standard_charges":[{"gross_charge":57.31,"discounted_cash":22.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERE 1.1 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31270","type":"CDM"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":54.85,"discounted_cash":21.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERE 1.1 MG/ML IV 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CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3183","type":"CDM"},{"code":"52565003115","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":2.23,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINOLONE ACETONIDE 0.01 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3183","type":"CDM"},{"code":"713022315","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.59,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3186","type":"CDM"},{"code":"21922000301","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 = 60 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3186","type":"CDM"},{"code":"51672136504","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 = 60 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3186","type":"CDM"},{"code":"52565001259","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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NDC EA = 30 G"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3187","type":"CDM"},{"code":"51672125301","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3187","type":"CDM"},{"code":"51672138601","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 = 15 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15 G"}]},{"description":"FLUOCINONIDE 0.05 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3188","type":"CDM"},{"code":"47781053372","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 = 15 G"},{"gross_charge":2.86,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"43199002960","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 = 60 G"}]},{"description":"FLUOCINONIDE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"51672126401","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"43199002930","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 = 30 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OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"51672126403","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 = 60 G"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"FLUOCINONIDE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"70700014617","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31906","type":"CDM"},{"code":"85173701","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 = 250 ML"}]},{"description":"MOXIFLOXACIN HCL IN NACL 400 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31906","type":"CDM"},{"code":"67457032325","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":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"FLUOCINONIDE-E 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3191","type":"CDM"},{"code":"93026330","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 = 30 G"},{"gross_charge":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31921","type":"CDM"},{"code":"63323056984","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.66,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"ERTAPENEM SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31922","type":"CDM"},{"code":"409351022","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":31.69,"discounted_cash":12.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":23.42,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31922","type":"CDM"},{"code":"409351021","type":"NDC"}],"standard_charges":[{"gross_charge":23.42,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31922","type":"CDM"},{"code":"72266015910","type":"NDC"}],"standard_charges":[{"gross_charge":18.83,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":23.09,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"31922","type":"CDM"},{"code":"143939810","type":"NDC"}],"standard_charges":[{"gross_charge":48.66,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":18.99,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.86,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM SODIUM 1 GM IJ 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| NDC EA = 10 ML"},{"gross_charge":1.17,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ALPRAZOLAM 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"326","type":"CDM"},{"code":"228203110","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 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":"ALPRAZOLAM 1 MG OR 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Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PAROXETINE HCL 12.5 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32631","type":"CDM"},{"code":"378200393","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 = 30 EACH"}]},{"description":"PAROXETINE HCL 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32632","type":"CDM"},{"code":"72241003022","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PAROXETINE HCL 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32632","type":"CDM"},{"code":"60505367403","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 = 30 EACH"}]},{"description":"PAROXETINE HCL 25 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32632","type":"CDM"},{"code":"378200493","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.32,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FREAMINE III 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3264","type":"CDM"},{"code":"264901055","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 = 1000 ML"}]},{"description":"METHYLPHENIDATE HCL 27 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32654","type":"CDM"},{"code":"406012701","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.62,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.61,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ALPRAZOLAM 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"327","type":"CDM"},{"code":"65862067901","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ALPRAZOLAM 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"327","type":"CDM"},{"code":"228203910","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32761","type":"CDM"},{"code":"65597010130","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 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OLMESARTAN MEDOXOMIL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32762","type":"CDM"},{"code":"68462043730","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 = 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"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32855","type":"CDM"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.68,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32855","type":"CDM"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"gross_charge":8.46,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.06,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32893","type":"CDM"},{"code":"62935075375","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":37.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":429.11,"discounted_cash":171.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RISEDRONATE SODIUM 35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32895","type":"CDM"},{"code":"430047207","type":"NDC"}],"standard_charges":[{"gross_charge":77.56,"discounted_cash":31.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":2.46,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"RISEDRONATE SODIUM 35 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32895","type":"CDM"},{"code":"430047203","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 = 4 EACH"},{"gross_charge":77.07,"discounted_cash":30.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"55150032401","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 = 10 ML"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"63323028001","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 = 2 ML"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"63323028003","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 = 4 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EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"55150032201","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 = 2 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409610226","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 = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"23155047332","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 = 4 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"25021031102","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 = 2 ML"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"36000028425","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"517570425","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 = 4 ML"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409610210","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 = 10 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409610202","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409163910","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.51,"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":"3291","type":"CDM"},{"code":"409610218","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 = 4 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"143915501","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 = 2 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"23155047333","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"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020304","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 = 4 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020303","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 = 2 ML"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020302","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"64679075910","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 = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020305","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 = 4 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020311","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"71288020310","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"64679075901","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 = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"63323028010","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 = 10 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3292","type":"CDM"},{"code":"54329446","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 ML"},{"gross_charge":0.09,"discounted_cash":0.03,"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":"FUROSEMIDE 10 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3292","type":"CDM"},{"code":"60432061360","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 = 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":"FUROSEMIDE 10 MG/ML OR 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Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FUROSEMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3294","type":"CDM"},{"code":"904717761","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":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FUROSEMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3294","type":"CDM"},{"code":"51079007220","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 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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":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"30698006001","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"69315011701","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 = 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":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"51079007320","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"}]},{"description":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"54429931","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"}]},{"description":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"64980056301","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 = 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":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"69315011710","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 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FUROSEMIDE 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3295","type":"CDM"},{"code":"51079007301","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"}]},{"description":"FUROSEMIDE 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3296","type":"CDM"},{"code":"64980056401","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":"ANTIHEMOPHILIC FACTOR (RECOMB) 500 UNIT IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32960","type":"CDM"},{"code":"53813202","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 UNITS"}]},{"description":"ANTIHEMOPHILIC FACTOR (RECOMB) 500 UNIT IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32960","type":"CDM"},{"code":"26379330","type":"NDC"}],"standard_charges":[{"gross_charge":501.5,"discounted_cash":200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ANTIHEMOPHILIC FACTOR (RECOMB) 500 UNIT IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32960","type":"CDM"},{"code":"26378335","type":"NDC"}],"standard_charges":[{"gross_charge":1145.05,"discounted_cash":458.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":577.31,"discounted_cash":230.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":628.95,"discounted_cash":251.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ANTIHEMOPHILIC FACTOR (RECOMB) 1000 UNIT IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32961","type":"CDM"},{"code":"53813302","type":"NDC"}],"standard_charges":[{"gross_charge":725.04,"discounted_cash":290.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ANTIHEMOPHILIC FACTOR (RECOMB) 1000 UNIT IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32961","type":"CDM"},{"code":"26378555","type":"NDC"}],"standard_charges":[{"gross_charge":1256.63,"discounted_cash":502.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1046.12,"discounted_cash":418.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2196.5,"discounted_cash":878.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IMATINIB MESYLATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32979","type":"CDM"},{"code":"59651024090","type":"NDC"}],"standard_charges":[{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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"}]},{"description":"IMATINIB MESYLATE 100 MG OR 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NDC EA = 90 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE 15 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33006","type":"CDM"},{"code":"42858021501","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 = 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"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE 15 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33006","type":"CDM"},{"code":"54092038501","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.78,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"68462057230","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 = 30 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"51079016403","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.04,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"60687029411","type":"NDC"}],"standard_charges":[{"gross_charge":4.27,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":7.93,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"51079016401","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.04,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"59762093401","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VORICONAZOLE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33008","type":"CDM"},{"code":"93528956","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 = 30 EACH"}]},{"description":"VORICONAZOLE 200 MG OR 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= 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":"GEMFIBROZIL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3378","type":"CDM"},{"code":"65862062460","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 = 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"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"GEMFIBROZIL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3378","type":"CDM"},{"code":"68084047301","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 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":"GEMFIBROZIL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3378","type":"CDM"},{"code":"69097082103","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ADEFOVIR DIPIVOXIL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33816","type":"CDM"},{"code":"42794000308","type":"NDC"}],"standard_charges":[{"gross_charge":4.10,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":26.41,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":9.07,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ADEFOVIR DIPIVOXIL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33816","type":"CDM"},{"code":"61958050101","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.72,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"OXANDROLONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33826","type":"CDM"},{"code":"49884030202","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":2.90,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"OXANDROLONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33826","type":"CDM"},{"code":"68084042511","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXANDROLONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33826","type":"CDM"},{"code":"245027206","type":"NDC"}],"standard_charges":[{"gross_charge":8.49,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":2.18,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":2.39,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 1000-62.5 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33862","type":"CDM"},{"code":"781194382","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":5.52,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 1000-62.5 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33862","type":"CDM"},{"code":"43598022040","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 = 40 EACH"}]},{"description":"PAMIDRONATE DISODIUM 6 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33886","type":"CDM"},{"code":"61703032518","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33963","type":"CDM"},{"code":"68084013521","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 = 30 EACH"},{"gross_charge":3.87,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"METAXALONE 800 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33963","type":"CDM"},{"code":"64720032110","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":"METAXALONE 800 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33963","type":"CDM"},{"code":"65162055310","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METAXALONE 800 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33963","type":"CDM"},{"code":"68084013511","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.16,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PEGINTERFERON ALFA-2A 180 MCG/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34034","type":"CDM"},{"code":"4035009","type":"NDC"}],"standard_charges":[{"gross_charge":170.5,"discounted_cash":68.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":245.55,"discounted_cash":98.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"93565556","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":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"173071204","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 = 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":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"31722013130","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"},{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"173071215","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 = 30 EACH"},{"gross_charge":5.95,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"60505387703","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":"DUTASTERIDE 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34089","type":"CDM"},{"code":"42806054930","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 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"INFLUENZA VIRUS VACC SPLIT PF IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34122","type":"CDM"},{"code":"49281000710","type":"NDC"}],"standard_charges":[{"gross_charge":33.76,"discounted_cash":13.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"69238115403","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":0.03,"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":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"67877049090","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.11,"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"},{"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":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"67877049030","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 = 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"},{"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":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"66582041428","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 = 100 EACH"},{"gross_charge":9.70,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"59651005290","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 = 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"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"59651005230","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 = 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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"51660020005","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"EZETIMIBE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34153","type":"CDM"},{"code":"591371319","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 = 90 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3423","type":"CDM"},{"code":"45802005635","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.95,"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3423","type":"CDM"},{"code":"713068331","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 = 30 G"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3423","type":"CDM"},{"code":"45802005611","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 = 30 G"},{"gross_charge":2.38,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3424","type":"CDM"},{"code":"713068231","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 = 30 G"},{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3424","type":"CDM"},{"code":"45802004611","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 G"},{"gross_charge":2.38,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3424","type":"CDM"},{"code":"713068215","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 = 15 G"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"CLINDAMYCIN-BENZOYL PER (REFR) 1-5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34247","type":"CDM"},{"code":"45802073684","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3425","type":"CDM"},{"code":"63323017301","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 = 2 ML"},{"gross_charge":2.78,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3425","type":"CDM"},{"code":"63323017302","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 = 2 ML"},{"gross_charge":2.78,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"63323001003","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 = 20 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"63323001002","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 = 2 ML"},{"gross_charge":2.09,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"63323001020","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 = 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":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"63323001001","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 = 2 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"409120703","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 = 2 ML"},{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"409120725","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 = 2 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3426","type":"CDM"},{"code":"55150040201","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 = 2 ML"},{"gross_charge":0.87,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3427","type":"CDM"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"gross_charge":1.10,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.97,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":7.02,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3428","type":"CDM"},{"code":"60758018805","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 = 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"},{"gross_charge":0.79,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3428","type":"CDM"},{"code":"61314063305","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 = 5 ML"},{"gross_charge":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.82,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"GENTIAN VIOLET 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3430","type":"CDM"},{"code":"395100392","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 = 59 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 59 ML"}]},{"description":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"43598055630","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 = 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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"65162089803","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 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"},{"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":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"62332009931","type":"NDC"}],"standard_charges":[{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"62332009930","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 = 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":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"60687017911","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":"ARIPIPRAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34369","type":"CDM"},{"code":"60505267403","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.34,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34370","type":"CDM"},{"code":"43598055730","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 = 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":"ARIPIPRAZOLE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34370","type":"CDM"},{"code":"59148000935","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":4.09,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARIPIPRAZOLE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34370","type":"CDM"},{"code":"62332010031","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":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"ARIPIPRAZOLE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34370","type":"CDM"},{"code":"62332010030","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 = 30 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34371","type":"CDM"},{"code":"59148001013","type":"NDC"}],"standard_charges":[{"gross_charge":12.60,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.60,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":24.88,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34372","type":"CDM"},{"code":"59148001113","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":24.88,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":12.85,"discounted_cash":5.14,"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":"34403","type":"CDM"},{"code":"65702072910","type":"NDC"}],"standard_charges":[{"gross_charge":21.59,"discounted_cash":8.64,"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":21.66,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FREESTYLE LITE W/DEVICE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34403","type":"CDM"},{"code":"99073070805","type":"NDC"}],"standard_charges":[{"gross_charge":13.57,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":16.5,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRUE METRIX METER W/DEVICE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34403","type":"CDM"},{"code":"56151147002","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 250 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34418","type":"CDM"},{"code":"74382611","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 250 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34418","type":"CDM"},{"code":"68084031011","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":"DIVALPROEX ER (DAILY) 250 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34418","type":"CDM"},{"code":"68084031001","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.40,"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":"DIVALPROEX ER (DAILY) 250 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34418","type":"CDM"},{"code":"55111053301","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIVALPROEX ER (DAILY) 250 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34418","type":"CDM"},{"code":"68001010500","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 = 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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ATOMOXETINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34444","type":"CDM"},{"code":"2322730","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":1.12,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.99,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATOMOXETINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34444","type":"CDM"},{"code":"64980037303","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":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATOMOXETINE HCL 18 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34445","type":"CDM"},{"code":"64980037403","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":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.39,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34544","type":"CDM"},{"code":"406012401","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":0.06,"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":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG OR 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pharmacy | NDC EA = 0.5 ML"},{"gross_charge":140.27,"discounted_cash":56.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34594","type":"CDM"},{"code":"64764054330","type":"NDC"}],"standard_charges":[{"gross_charge":12.51,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.07,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSOPRAZOLE 15 MG PO 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pharmacy | NDC EA = 500 EACH"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35134","type":"CDM"},{"code":"50268070911","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.17,"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"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35134","type":"CDM"},{"code":"57237016999","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"52817033050","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 = 500 EACH"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"43547039910","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 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"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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NDC EA = 30 EACH"}]},{"description":"CYCLOSPORINE 0.05 % OP EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35209","type":"CDM"},{"code":"10702080803","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 = 30 EACH"},{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CYCLOSPORINE 0.05 % OP EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35209","type":"CDM"},{"code":"60505620201","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 = 30 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