{"hospital_name":"UCI Health - Placentia Linda","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["UCI Health - Placentia Linda"],"hospital_address":["101 City Drive South, Orange, CA 92868"],"license_information":{"license_number":"060000148","state":"CA"},"type_2_npi":["1700817756"],"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 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 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."}]}],"standard_charge_information":[{"description":"SEMI-PRIVATE ROOM","code_information":[{"code":"001990002","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":7912.0,"discounted_cash":3164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: UCI - Placentia-Linda 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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 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EA = 237 ML"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"}]},{"description":"FELBAMATE 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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.14,"discounted_cash":0.06,"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":0.35,"discounted_cash":0.14,"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":0.92,"discounted_cash":0.37,"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":3.98,"discounted_cash":1.59,"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":"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":0.68,"discounted_cash":0.27,"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":0.50,"discounted_cash":0.20,"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":"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":0.45,"discounted_cash":0.18,"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"}]},{"description":"FILGRASTIM 300 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10036","type":"CDM"},{"code":"55513053010","type":"NDC"}],"standard_charges":[{"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":43.90,"discounted_cash":17.56,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10036","type":"CDM"},{"code":"55513053001","type":"NDC"}],"standard_charges":[{"gross_charge":305.08,"discounted_cash":122.03,"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":43.90,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"60687042865","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 = 50 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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"}]},{"description":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"68084039911","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"65862014990","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":0.03,"discounted_cash":0.01,"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":0.02,"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"},{"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":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"45963050002","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":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"51079032101","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"51079032120","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 EACH"}]},{"description":"FINASTERIDE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10037","type":"CDM"},{"code":"60687042811","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"54001120","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":0.85,"discounted_cash":0.34,"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":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"57237006401","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":0.85,"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":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"54001121","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 = 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"},{"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":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"50268032115","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 = 50 EACH"},{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"42291029401","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 = 100 EACH"}]},{"description":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"65162064210","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":"FLECAINIDE ACETATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10041","type":"CDM"},{"code":"62559038101","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":0.12,"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":"FLECAINIDE ACETATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10043","type":"CDM"},{"code":"65862062101","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":0.39,"discounted_cash":0.16,"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":"FLECAINIDE ACETATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10043","type":"CDM"},{"code":"54001020","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":0.03,"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":"FLECAINIDE ACETATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10043","type":"CDM"},{"code":"42806081701","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLECAINIDE ACETATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10043","type":"CDM"},{"code":"65162064110","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":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"68084072811","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 = 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":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"904650061","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 = 100 EACH"},{"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":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"59762501601","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"62559099130","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FLUCONAZOLE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10044","type":"CDM"},{"code":"68084072801","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":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUCONAZOLE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10045","type":"CDM"},{"code":"68084073501","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 = 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":1.89,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUCONAZOLE 200 MG OR 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10054","type":"CDM"},{"code":"68084028865","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 = 50 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10054","type":"CDM"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10054","type":"CDM"},{"code":"50268033011","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":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10054","type":"CDM"},{"code":"115703302","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":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG OR 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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":"LURASIDONE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100549","type":"CDM"},{"code":"72205020730","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 = 30 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"LURASIDONE HCL 20 MG PO 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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":"LURASIDONE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"100549","type":"CDM"},{"code":"60687074711","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.41,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUORESCEIN SODIUM 10 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10059","type":"CDM"},{"code":"81298866001","type":"NDC"}],"standard_charges":[{"gross_charge":9.80,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN SODIUM 10 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10059","type":"CDM"},{"code":"17478025310","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":13.06,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN SODIUM 10 % IJ 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NDC EA = 5 ML"}]},{"description":"FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10061","type":"CDM"},{"code":"59390020605","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUOROURACIL 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10065","type":"CDM"},{"code":"378479106","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 G"},{"gross_charge":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 G"},{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 G"}]},{"description":"FLUOROURACIL 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10065","type":"CDM"},{"code":"66530024940","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 = 40 G"}]},{"description":"FLUOROURACIL 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10065","type":"CDM"},{"code":"51672411806","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 = 40 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10069","type":"CDM"},{"code":"904578461","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":"FLUOXETINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10069","type":"CDM"},{"code":"50111064701","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":"FLUOXETINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10069","type":"CDM"},{"code":"68001039900","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":0.0072,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"50111064801","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"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":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"904578561","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"68001040008","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":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"FLUOXETINE HCL 20 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10070","type":"CDM"},{"code":"904734661","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLURBIPROFEN SODIUM 0.03 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10080","type":"CDM"},{"code":"24208031425","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 = 2.5 ML"}]},{"description":"FLURBIPROFEN SODIUM 0.03 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10080","type":"CDM"},{"code":"69292072225","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 = 2.5 ML"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":11.08,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"FLUTAMIDE 125 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10081","type":"CDM"},{"code":"49884075313","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 = 180 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"FLUVOXAMINE MALEATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10085","type":"CDM"},{"code":"51079099220","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":"FLUVOXAMINE MALEATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10085","type":"CDM"},{"code":"51079099201","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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUVOXAMINE MALEATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10085","type":"CDM"},{"code":"62559015901","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"FLUVOXAMINE MALEATE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10085","type":"CDM"},{"code":"60505016501","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"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":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SITAGLIP PHOS-METFORMIN HCL ER 50-1000 MG PO 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NDC EA = 100 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"24385048447","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"102","type":"CDM"},{"code":"904673080","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"ACETAMINOPHEN 500 MG OR 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20 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"68001052194","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"},{"gross_charge":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 240 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"60687074340","type":"NDC"}],"standard_charges":[{"gross_charge":0.1,"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":"68094060061","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR 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":"68094003701","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 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"60687074317","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"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 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"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":"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 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"121183605","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"472127094","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"IBUPROFEN 100 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10246","type":"CDM"},{"code":"904530909","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"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 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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":"10019092582","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.99,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":30.69,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"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":33.18,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.41,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10248","type":"CDM"},{"code":"10019092501","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":30.69,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10249","type":"CDM"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":50.9,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":89.52,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.52,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10249","type":"CDM"},{"code":"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":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"},{"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":"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":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) 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":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) 5 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10261","type":"CDM"},{"code":"944265603","type":"NDC"}],"standard_charges":[{"gross_charge":770.76,"discounted_cash":308.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":733.95,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INDAPAMIDE 1.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10264","type":"CDM"},{"code":"378006901","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"INDOMETHACIN SODIUM 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10267","type":"CDM"},{"code":"409111301","type":"NDC"}],"standard_charges":[{"gross_charge":237.04,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":180.12,"discounted_cash":72.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":"63323065903","type":"NDC"}],"standard_charges":[{"gross_charge":478.21,"discounted_cash":191.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":187.94,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":208.97,"discounted_cash":83.59,"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":"168005515","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":1.41,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1027","type":"CDM"},{"code":"168005546","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"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":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"},{"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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 ML"}]},{"description":"INSULIN ISOPHANE HUMAN 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10284","type":"CDM"},{"code":"169183411","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ISOPHANE HUMAN 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10284","type":"CDM"},{"code":"2831517","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"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 & 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 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 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":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"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"}]},{"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":"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":"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":0.05,"discounted_cash":0.02,"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":0.40,"discounted_cash":0.16,"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 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"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1029","type":"CDM"},{"code":"472038115","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"INTERFERON ALFA-2B 10 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10299","type":"CDM"},{"code":"85057102","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 10 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10299","type":"CDM"},{"code":"85435001","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"713011850","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"45802073200","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103","type":"CDM"},{"code":"713011806","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 18000000 UNIT IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10300","type":"CDM"},{"code":"85111001","type":"NDC"}],"standard_charges":[{"gross_charge":500.32,"discounted_cash":200.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 50 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10304","type":"CDM"},{"code":"85435201","type":"NDC"}],"standard_charges":[{"gross_charge":268.27,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":299.17,"discounted_cash":119.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INTERFERON ALFA-2B 50 MU IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10304","type":"CDM"},{"code":"85053901","type":"NDC"}],"standard_charges":[{"gross_charge":340.28,"discounted_cash":136.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CULTURELLE KIDS PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103062","type":"CDM"},{"code":"49100040008","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10319","type":"CDM"},{"code":"407141110","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10319","type":"CDM"},{"code":"407141120","type":"NDC"}],"standard_charges":[{"gross_charge":2.00,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141493","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141491","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 ML"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141490","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141494","type":"NDC"}],"standard_charges":[{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141498","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141489","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141472","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOHEXOL 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10323","type":"CDM"},{"code":"407141488","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131630","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131635","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10328","type":"CDM"},{"code":"270131652","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 17.2 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10330","type":"CDM"},{"code":"19086207","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10333","type":"CDM"},{"code":"19095315","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10333","type":"CDM"},{"code":"19095309","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"MITOMYCIN 0.2 MG OP KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103375","type":"CDM"},{"code":"49771000201","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103425","type":"CDM"},{"code":"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":"68455012712","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"AQUACEL FOAM 4\"X4\" EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103425","type":"CDM"},{"code":"40565012137","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"PERTUZUMAB 420 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103474","type":"CDM"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":270.58,"discounted_cash":108.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":230.84,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"},{"gross_charge":454.70,"discounted_cash":181.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 ML"}]},{"description":"ISOSORBIDE MONONITRATE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10356","type":"CDM"},{"code":"228263111","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"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":"81665010310","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"62175010701","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"228262011","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10357","type":"CDM"},{"code":"143133301","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":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 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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":"10147170003","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.92,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ITRACONAZOLE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10364","type":"CDM"},{"code":"67877045430","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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":"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":"BACLOFEN 20000 MCG/20ML IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103652","type":"CDM"},{"code":"45945015602","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"BACLOFEN 20000 MCG/20ML IT 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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"},{"gross_charge":0.10,"discounted_cash":0.04,"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":0.10,"discounted_cash":0.04,"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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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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 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 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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":0.51,"discounted_cash":0.20,"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":"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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"409226754","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 = 40 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"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":"409226725","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"409226720","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10372","type":"CDM"},{"code":"143962201","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"},{"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":"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":"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":"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":"72266010301","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 = 40 ML"},{"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.12,"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"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"68001020500","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"49884012201","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":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LABETALOL HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10373","type":"CDM"},{"code":"904592861","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"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":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"68001038203","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"LABETALOL HCL 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10374","type":"CDM"},{"code":"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":"60687045011","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":0.4,"discounted_cash":0.16,"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":0.23,"discounted_cash":0.09,"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":0.40,"discounted_cash":0.16,"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":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10380","type":"CDM"},{"code":"45802041954","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 225 G"}]},{"description":"LEUPROLIDE ACETATE 11.25 MG IM 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":3917.06,"discounted_cash":1566.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":508.67,"discounted_cash":203.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10392","type":"CDM"},{"code":"74364203","type":"NDC"}],"standard_charges":[{"gross_charge":92.83,"discounted_cash":37.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":99.46,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":160.09,"discounted_cash":64.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOBUNOLOL HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10394","type":"CDM"},{"code":"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10394","type":"CDM"},{"code":"60758006005","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":19.21,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"45963079056","type":"NDC"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"16729026765","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":1.86,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":18.42,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"43598038957","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":13.73,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"103988","type":"CDM"},{"code":"16729023165","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"5167221160","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"713016450","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"713016406","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"713016412","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 = 12 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104","type":"CDM"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"69238183301","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"74659490","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"378180777","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"60687048611","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10403","type":"CDM"},{"code":"68180096809","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"378181101","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"60687050801","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.42,"discounted_cash":0.17,"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":"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":0.08,"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":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10404","type":"CDM"},{"code":"68180097009","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10405","type":"CDM"},{"code":"68180097209","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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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104056","type":"CDM"},{"code":"703367591","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"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":"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":"61703040841","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 = 40 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pharmacy | NDC EA = 50 ML"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"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: 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":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048257","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":0.24,"discounted_cash":0.09,"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":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048217","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.05,"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":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"409317802","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10427","type":"CDM"},{"code":"409000701","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":0.05,"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":"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 | NDC EA = 20 ML"}]},{"description":"CALCIUM CARB-CHOLECALCIFEROL 250-125 MG-UNIT PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104279","type":"CDM"},{"code":"20555002500","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MIRABEGRON ER 25 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104283","type":"CDM"},{"code":"469260130","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 = 30 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pharmacy | NDC EA = 30 EACH"}]},{"description":"MIRABEGRON ER 50 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104284","type":"CDM"},{"code":"70710116009","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 = 90 EACH"},{"gross_charge":11.98,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10429","type":"CDM"},{"code":"409120901","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 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10429","type":"CDM"},{"code":"409120970","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 = 5 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"66312017616","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 = 1.7 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10430","type":"CDM"},{"code":"409318201","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"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 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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":"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":0.7,"discounted_cash":0.28,"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":"RANIBIZUMAB 0.3 MG/0.05ML IZ 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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":"LIOTHYRONINE SODIUM 5 MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10443","type":"CDM"},{"code":"42794001802","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":"LISINOPRIL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10449","type":"CDM"},{"code":"68001033400","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 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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":0.03,"discounted_cash":0.01,"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"}]},{"description":"MAGNESIUM OXIDE 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10491","type":"CDM"},{"code":"68585000641","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":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104975","type":"CDM"},{"code":"703011301","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 = 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":1.01,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104975","type":"CDM"},{"code":"703011303","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 = 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":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104996","type":"CDM"},{"code":"64980033901","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104996","type":"CDM"},{"code":"57896063412","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 = 120 EACH"}]},{"description":"MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104996","type":"CDM"},{"code":"904660961","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"}]},{"description":"MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"104996","type":"CDM"},{"code":"536352141","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"}]},{"description":"ACETAMINOPHEN 650 MG RE 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= 12 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"105","type":"CDM"},{"code":"45802073000","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 = 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"}]},{"description":"MALATHION 0.5 % EX 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NDC EA = 480 ML"}]},{"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":"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":135.62,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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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":"MELPHALAN HCL 50 MG IV 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 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":101.64,"discounted_cash":40.66,"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 SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"70860021461","type":"NDC"}],"standard_charges":[{"gross_charge":143.29,"discounted_cash":57.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10522","type":"CDM"},{"code":"43598039248","type":"NDC"}],"standard_charges":[{"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":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":"45963068602","type":"NDC"}],"standard_charges":[{"gross_charge":184.69,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":182.95,"discounted_cash":73.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":293.08,"discounted_cash":117.23,"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 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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":"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 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= 100 EACH"}]},{"description":"METHIMAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10552","type":"CDM"},{"code":"68084027611","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 = 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":"METHIMAZOLE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10552","type":"CDM"},{"code":"60687037011","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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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":"METOLAZONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10588","type":"CDM"},{"code":"51079002420","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 = 100 EACH"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOLAZONE 5 MG OR 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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":"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 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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":"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 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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":"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 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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 SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10632","type":"CDM"},{"code":"72819015205","type":"NDC"}],"standard_charges":[{"gross_charge":83.35,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":83.34,"discounted_cash":33.34,"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":"25021025020","type":"NDC"}],"standard_charges":[{"gross_charge":49.73,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.87,"discounted_cash":9.95,"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":"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10633","type":"CDM"},{"code":"15308060","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 = 100 EACH"}]},{"description":"PONATINIB HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106330","type":"CDM"},{"code":"63020053530","type":"NDC"}],"standard_charges":[{"gross_charge":48.44,"discounted_cash":19.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":"PONATINIB HCL 45 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106331","type":"CDM"},{"code":"63020053430","type":"NDC"}],"standard_charges":[{"gross_charge":626.97,"discounted_cash":250.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":450.98,"discounted_cash":180.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"H-CHLOR 12 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106429","type":"CDM"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"45802025742","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"67405010045","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10646","type":"CDM"},{"code":"713063415","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10648","type":"CDM"},{"code":"713063537","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106539","type":"CDM"},{"code":"3089331","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 = 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":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"APIXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106539","type":"CDM"},{"code":"3089321","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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":"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":"APIXABAN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106572","type":"CDM"},{"code":"3089421","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"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"},{"gross_charge":9.14,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LEVONORGESTREL 13.5 MG IU IUD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"106628","type":"CDM"},{"code":"50419042201","type":"NDC"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":494.12,"discounted_cash":197.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":910.24,"discounted_cash":364.10,"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":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":54.03,"discounted_cash":21.61,"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":"81033002099","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"81033003201","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 = 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":"45802011222","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 = 22 G"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.06,"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":"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":"904728454","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 = 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":"93101042","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 = 22 G"},{"gross_charge":0.36,"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":"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":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.34,"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"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"50268056811","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"50268056815","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"},{"gross_charge":2.25,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10674","type":"CDM"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 22 G"},{"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":"51672131201","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 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"},{"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":"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":3.60,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 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":"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":"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":"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":"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":"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":"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":"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 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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"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"51224020650","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":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":0.96,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NALTREXONE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10685","type":"CDM"},{"code":"16729008110","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"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":0.28,"discounted_cash":0.11,"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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NATAMYCIN 5 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10692","type":"CDM"},{"code":"65064515","type":"NDC"}],"standard_charges":[{"gross_charge":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":3.95,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"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":0.01,"discounted_cash":0.004,"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":"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":0.81,"discounted_cash":0.32,"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"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"60687055633","type":"NDC"}],"standard_charges":[{"gross_charge":3.70,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.77,"discounted_cash":1.91,"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":"430075327","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 180 EACH"}]},{"description":"MESALAMINE 400 MG PO CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107021","type":"CDM"},{"code":"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":"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 OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10707","type":"CDM"},{"code":"78077101","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":53.41,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10707","type":"CDM"},{"code":"24208079535","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 = 3.5 G"},{"gross_charge":3.59,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":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"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"998063006","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":20.37,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10708","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.54,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.69,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"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":1.48,"discounted_cash":0.59,"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"}]},{"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 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 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":0.75,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":3.01,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536302925","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":"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":0.15,"discounted_cash":0.06,"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":0.19,"discounted_cash":0.08,"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":"536136223","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 110 EACH"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10717","type":"CDM"},{"code":"536136225","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG IV 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100 EACH"}]},{"description":"NIMODIPINE 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10722","type":"CDM"},{"code":"23155010830","type":"NDC"}],"standard_charges":[{"gross_charge":6.14,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"NITROFURANTOIN 25 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10723","type":"CDM"},{"code":"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 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NDC 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":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107328","type":"CDM"},{"code":"409189003","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 = 1 ML"},{"gross_charge":1.92,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV 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= 20 ML"}]},{"description":"NORETHIN ACE-ETH ESTRAD-FE 1-20 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10735","type":"CDM"},{"code":"555902658","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 = 28 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"NORETHIN ACE-ETH ESTRAD-FE 1-20 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10735","type":"CDM"},{"code":"65862094088","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 = 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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"NORETHINDRONE-ETH ESTRADIOL 1-35 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10742","type":"CDM"},{"code":"52544055228","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 = 28 EACH"}]},{"description":"NORETHINDRONE ACET-ETHINYL EST 1-20 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10745","type":"CDM"},{"code":"68462013281","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 = 21 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 21 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 21 EACH"}]},{"description":"NORETHINDRONE ACETATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10747","type":"CDM"},{"code":"51285042410","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":5.46,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":3.04,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"NORETHINDRONE ACETATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10747","type":"CDM"},{"code":"68462030450","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 = 50 EACH"},{"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":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"NORETHINDRONE ACETATE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10747","type":"CDM"},{"code":"555021110","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 = 50 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10749","type":"CDM"},{"code":"555901658","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 EACH"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"68084022001","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 = 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":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"60687063611","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"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":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"68462010530","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"68084022011","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 = 1 EACH"},{"gross_charge":0.31,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"60687063601","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"51079052420","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"51079052401","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"904655161","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":0.45,"discounted_cash":0.18,"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":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ONDANSETRON HCL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10778","type":"CDM"},{"code":"57237007550","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"904655261","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"50268062215","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 = 50 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"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":"50268062211","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ONDANSETRON HCL 8 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10779","type":"CDM"},{"code":"68084022111","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":0.37,"discounted_cash":0.15,"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":"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":0.62,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.31,"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":"57237007630","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 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":0.01,"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":"57237007650","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 = 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":"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":"60687064711","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":0.68,"discounted_cash":0.27,"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":"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":0.0092,"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":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":0.46,"discounted_cash":0.19,"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"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 36000-114000 UNITS PO 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TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1079","type":"CDM"},{"code":"904674860","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BROMFENAC SODIUM 0.07 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"107956","type":"CDM"},{"code":"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":11.57,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"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":"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":"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":"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":"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":"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 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pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"70121171201","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108023","type":"CDM"},{"code":"143952501","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"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":3.25,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.46,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXANDROLONE 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10803","type":"CDM"},{"code":"49884030101","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.89,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXIDIZED CELLULOSE EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10806","type":"CDM"},{"code":"63713005025","type":"NDC"}],"standard_charges":[{"gross_charge":54.62,"discounted_cash":21.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10810","type":"CDM"},{"code":"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":"OXYBUTYNIN CHLORIDE 5 MG/5ML OR 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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":"OXYCODONE HCL 5 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10813","type":"CDM"},{"code":"60687040640","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":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.72,"discounted_cash":0.29,"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":"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":"121482705","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 = 5 ML"},{"gross_charge":0.8,"discounted_cash":0.32,"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":"10813","type":"CDM"},{"code":"406855605","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"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10813","type":"CDM"},{"code":"60687040677","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":0.11,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10814","type":"CDM"},{"code":"904644461","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":0.04,"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":"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":"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":"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":0.06,"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":"OXYCODONE HCL 5 MG OR 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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":"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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 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100 EACH"}]},{"description":"TRACE MINERALSCRCUFFEIMNMOSEZN IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108223","type":"CDM"},{"code":"63323014397","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"VITAMIN B1 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"108226","type":"CDM"},{"code":"904719106","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"VITAMIN B1 100 MG PO 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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":"51079077420","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PAROXETINE HCL 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10855","type":"CDM"},{"code":"904567761","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP 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 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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 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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"}]},{"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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pharmacy | NDC EA = 1 EACH"},{"gross_charge":190.91,"discounted_cash":76.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"109092","type":"CDM"},{"code":"25021046910","type":"NDC"}],"standard_charges":[{"gross_charge":100.36,"discounted_cash":40.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":121.38,"discounted_cash":48.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG IV 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pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.21,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"PHENELZINE SULFATE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10933","type":"CDM"},{"code":"43386036021","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"GOLIMUMAB 50 MG/4ML IV 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pharmacy | NDC EA = 15 ML"},{"gross_charge":93.20,"discounted_cash":37.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":37.96,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"PHENOXYBENZAMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10945","type":"CDM"},{"code":"66993006602","type":"NDC"}],"standard_charges":[{"gross_charge":24.86,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PHENOXYBENZAMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10945","type":"CDM"},{"code":"54034925","type":"NDC"}],"standard_charges":[{"gross_charge":19.31,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":92.36,"discounted_cash":36.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":19.34,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10947","type":"CDM"},{"code":"143956401","type":"NDC"}],"standard_charges":[{"gross_charge":368.15,"discounted_cash":147.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":331.41,"discounted_cash":132.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":287.12,"discounted_cash":114.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10947","type":"CDM"},{"code":"68094010120","type":"NDC"}],"standard_charges":[{"gross_charge":269.26,"discounted_cash":107.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":361.79,"discounted_cash":144.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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NDC EA = 30 EACH"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TACROLIMUS 1 MG PO CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"109581","type":"CDM"},{"code":"469067773","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VINCRISTINE SULFATE LIPOSOME 5 MG/31ML IV 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pharmacy | NDC EA = 8.9 G"}]},{"description":"INFLUENZA VAC RECOMB HA (PF) IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110025","type":"CDM"},{"code":"42874001501","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":28.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"INFLUENZA VAC RECOMB HA (PF) IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110025","type":"CDM"},{"code":"42874001510","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":28.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"ROTAVIRUS VAC LIVE PENTAVALENT PO 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NDC EA = 30 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110029","type":"CDM"},{"code":"63323047201","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 = 30 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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":"409158218","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"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110029","type":"CDM"},{"code":"55150017230","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":0.14,"discounted_cash":0.06,"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":"63323047237","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 = 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110030","type":"CDM"},{"code":"409204501","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 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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":"143971810","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 = 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"},{"gross_charge":0.07,"discounted_cash":0.03,"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 10 MG/10ML IV 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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":"143971010","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110032","type":"CDM"},{"code":"70069080701","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":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110033","type":"CDM"},{"code":"143970910","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 = 20 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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NDC EA = 50 ML"},{"gross_charge":0.23,"discounted_cash":0.09,"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":"63323061750","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.36,"discounted_cash":0.14,"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":"ETOPOSIDE 500 MG/25ML IV 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T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110047","type":"CDM"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL ER 20 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110047","type":"CDM"},{"code":"69238229601","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.26,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL ER 40 MG PO 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T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110049","type":"CDM"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"gross_charge":16.36,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OXYCODONE HCL ER 40 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110049","type":"CDM"},{"code":"93573301","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"}]},{"description":"OXYCODONE HCL ER 60 MG PO 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pharmacy | NDC EA = 4 EACH"},{"gross_charge":13.60,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"PHENYTOIN 50 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11018","type":"CDM"},{"code":"60687015695","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 = 1 EACH"},{"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":"PHENYTOIN 50 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11018","type":"CDM"},{"code":"71000740","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 = 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"},{"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":"PHENYTOIN 50 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11018","type":"CDM"},{"code":"51079012901","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 = 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CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11018","type":"CDM"},{"code":"51672414601","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":"PHENYTOIN 50 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11018","type":"CDM"},{"code":"60687015625","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11019","type":"CDM"},{"code":"71374066","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.49,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"591292102","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 = 75 G"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"},{"gross_charge":2.19,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"832112142","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"},{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"51848888","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 = 75 G"}]},{"description":"TESTOSTERONE 12.5 MG/ACT (1%) TD GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110209","type":"CDM"},{"code":"45802011602","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"BERACTANT IN NACL 25 MG/ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11021","type":"CDM"},{"code":"74104008","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":76.61,"discounted_cash":30.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":41.68,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"BERACTANT IN NACL 25 MG/ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11021","type":"CDM"},{"code":"74104004","type":"NDC"}],"standard_charges":[{"gross_charge":86.57,"discounted_cash":34.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":41.82,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":41.68,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ 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= 1 ML"},{"gross_charge":17.18,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11023","type":"CDM"},{"code":"409915801","type":"NDC"}],"standard_charges":[{"gross_charge":21.07,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":21.00,"discounted_cash":8.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":37.97,"discounted_cash":15.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11023","type":"CDM"},{"code":"409915825","type":"NDC"}],"standard_charges":[{"gross_charge":19.06,"discounted_cash":7.62,"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":"187170405","type":"NDC"}],"standard_charges":[{"gross_charge":44.74,"discounted_cash":17.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"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 EACH"},{"gross_charge":36.16,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.18,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PHYTONADIONE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11024","type":"CDM"},{"code":"70710101403","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":9.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":3.16,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"70860060541","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.57,"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"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"16729023930","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.41,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"16729023993","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.41,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"409163832","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"409163802","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 = 2 ML"},{"gross_charge":2.58,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"42023014625","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.54,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.48,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"70860060503","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 = 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":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"71288050502","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110240","type":"CDM"},{"code":"67457025102","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 = 2 ML"},{"gross_charge":1.07,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.23,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"25021024410","type":"NDC"}],"standard_charges":[{"gross_charge":24.41,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"55150033701","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":27.13,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"143909801","type":"NDC"}],"standard_charges":[{"gross_charge":12.91,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":15.83,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":965.03,"discounted_cash":386.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":37.97,"discounted_cash":15.19,"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":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110261","type":"CDM"},{"code":"63323082110","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":31.65,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VORTIOXETINE HBR 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110331","type":"CDM"},{"code":"64764072030","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":15.50,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.93,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VORTIOXETINE HBR 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110332","type":"CDM"},{"code":"64764073030","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 = 30 EACH"},{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":15.50,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/50ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110341","type":"CDM"},{"code":"44206045593","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 = 50 ML"},{"gross_charge":14.02,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/50ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110341","type":"CDM"},{"code":"44206045510","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":11.94,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11037","type":"CDM"},{"code":"6494300","type":"NDC"}],"standard_charges":[{"gross_charge":199.07,"discounted_cash":79.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":211.03,"discounted_cash":84.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":210.89,"discounted_cash":84.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11037","type":"CDM"},{"code":"6483701","type":"NDC"}],"standard_charges":[{"gross_charge":211.71,"discounted_cash":84.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":211.03,"discounted_cash":84.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11037","type":"CDM"},{"code":"6494301","type":"NDC"}],"standard_charges":[{"gross_charge":211.03,"discounted_cash":84.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110443","type":"CDM"},{"code":"66215050130","type":"NDC"}],"standard_charges":[{"gross_charge":471.72,"discounted_cash":188.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MACITENTAN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110443","type":"CDM"},{"code":"66215050115","type":"NDC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 EACH"}]},{"description":"ENLITE GLUCOSE SENSOR MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110481","type":"CDM"},{"code":"57599084400","type":"NDC"}],"standard_charges":[{"gross_charge":85.05,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":69.9,"discounted_cash":27.96,"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":"110481","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":"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":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 57 G"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11074","type":"CDM"},{"code":"14789010916","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 ML"},{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11074","type":"CDM"},{"code":"990707426","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":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11074","type":"CDM"},{"code":"338070948","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11075","type":"CDM"},{"code":"14789010808","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 = 50 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11075","type":"CDM"},{"code":"990707514","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":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11076","type":"CDM"},{"code":"990707526","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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11076","type":"CDM"},{"code":"14789010816","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 = 100 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11076","type":"CDM"},{"code":"409707526","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 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV 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30 EACH"},{"gross_charge":18.63,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PERAMPANEL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110760","type":"CDM"},{"code":"480706256","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":5.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":16.17,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PERAMPANEL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110761","type":"CDM"},{"code":"62856027430","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":36.81,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.83,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PERAMPANEL 6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110762","type":"CDM"},{"code":"62856027630","type":"NDC"}],"standard_charges":[{"gross_charge":36.81,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":15.32,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.83,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110774","type":"CDM"},{"code":"63459091015","type":"NDC"}],"standard_charges":[{"gross_charge":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":76.8,"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"}]},{"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":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":76.76,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":364.08,"discounted_cash":145.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110774","type":"CDM"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":102.74,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":76.76,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":364.08,"discounted_cash":145.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":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":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":102.08,"discounted_cash":40.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091212","type":"NDC"}],"standard_charges":[{"gross_charge":76.82,"discounted_cash":30.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":388.69,"discounted_cash":155.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110775","type":"CDM"},{"code":"63459091215","type":"NDC"}],"standard_charges":[{"gross_charge":102.07,"discounted_cash":40.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"},{"gross_charge":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":388.69,"discounted_cash":155.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.8 ML"}]},{"description":"OBINUTUZUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110777","type":"CDM"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":225.01,"discounted_cash":90.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":111.30,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":131.54,"discounted_cash":52.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.02,"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":"990707726","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"},{"gross_charge":0.01,"discounted_cash":0.004,"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":1.29,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"527213335","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.33,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"POSACONAZOLE 100 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"110895","type":"CDM"},{"code":"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":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"60687016911","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"60687088611","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"904589161","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":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"68462019590","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11110","type":"CDM"},{"code":"69097078805","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"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":0.41,"discounted_cash":0.16,"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":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"69097078905","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"68462019690","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAVASTATIN SODIUM 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11111","type":"CDM"},{"code":"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":"904589261","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":0.51,"discounted_cash":0.20,"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":"68084050111","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.40,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRAVASTATIN SODIUM 40 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11112","type":"CDM"},{"code":"69097079105","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PRAZIQUANTEL 600 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11113","type":"CDM"},{"code":"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":"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":28.39,"discounted_cash":11.36,"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":60.06,"discounted_cash":24.02,"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":36.98,"discounted_cash":14.79,"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"}]},{"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":0.05,"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":"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":0.10,"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"},{"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":"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":"310620530","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111214","type":"CDM"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.41,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"gross_charge":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":"310621030","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":16.01,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111215","type":"CDM"},{"code":"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":"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":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PRIMIDONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11129","type":"CDM"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":"50268068611","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":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROCARBAZINE HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11136","type":"CDM"},{"code":"54482005301","type":"NDC"}],"standard_charges":[{"gross_charge":81.61,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROCARBAZINE HCL 50 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11136","type":"CDM"},{"code":"54482005401","type":"NDC"}],"standard_charges":[{"gross_charge":81.61,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"713013512","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"713013506","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11138","type":"CDM"},{"code":"574722612","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.50,"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":1.40,"discounted_cash":0.56,"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":1.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.32,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 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":7.84,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":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":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"},{"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 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":11.63,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":40.60,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":12.65,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111401","type":"CDM"},{"code":"68180029207","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ESLICARBAZEPINE ACETATE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111402","type":"CDM"},{"code":"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":12.42,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.58,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"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":"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":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.85,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":5.08,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11144","type":"CDM"},{"code":"713052612","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11144","type":"CDM"},{"code":"713052606","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.44,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11145","type":"CDM"},{"code":"70436015542","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5ML OR SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11145","type":"CDM"},{"code":"27808005701","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"62559023001","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"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":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"51079099601","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"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":"60687070901","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":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11146","type":"CDM"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.24,"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"}]},{"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":"51079099620","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 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":"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":0.23,"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"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PROPAFENONE HCL 225 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11147","type":"CDM"},{"code":"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":"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":"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":"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":"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":0.76,"discounted_cash":0.30,"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"}]},{"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":0.89,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.13,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.41,"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":"63323010401","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 = 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":"HYLAN G-F 20 16 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111686","type":"CDM"},{"code":"58468009002","type":"NDC"}],"standard_charges":[{"gross_charge":221.42,"discounted_cash":88.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"HYLAN G-F 20 16 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111686","type":"CDM"},{"code":"58468009001","type":"NDC"}],"standard_charges":[{"gross_charge":221.42,"discounted_cash":88.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":205.72,"discounted_cash":82.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"HYLAN G-F 20 48 MG/6ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111687","type":"CDM"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":205.72,"discounted_cash":82.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"},{"gross_charge":206.38,"discounted_cash":82.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 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":"CETIRIZINE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111689","type":"CDM"},{"code":"51672407008","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 = 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":"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 ML"},{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":5.65,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111707","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 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111707","type":"CDM"},{"code":"169633910","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 GLARGINE 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111709","type":"CDM"},{"code":"88221905","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 = 3 ML"},{"gross_charge":5.81,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111709","type":"CDM"},{"code":"2771501","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":6.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":21.10,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLULISINE 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111711","type":"CDM"},{"code":"88250205","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":6.58,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN DETEMIR 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111715","type":"CDM"},{"code":"169643210","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":6.30,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN DETEMIR 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111715","type":"CDM"},{"code":"169643810","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 = 3 ML"},{"gross_charge":5.90,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"LIRAGLUTIDE 18 MG/3ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111717","type":"CDM"},{"code":"169406012","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"},{"gross_charge":81.90,"discounted_cash":32.76,"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 SUPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111718","type":"CDM"},{"code":"169369619","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":8.42,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111719","type":"CDM"},{"code":"9001103","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.68,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111719","type":"CDM"},{"code":"9001104","type":"NDC"}],"standard_charges":[{"gross_charge":21.35,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111720","type":"CDM"},{"code":"9001306","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":15.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111720","type":"CDM"},{"code":"9001305","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":40.19,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FAMOTIDINE 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111723","type":"CDM"},{"code":"641602225","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 = 2 ML"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"FAMOTIDINE 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111723","type":"CDM"},{"code":"63323073912","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 = 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"},{"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":"FAMOTIDINE 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111724","type":"CDM"},{"code":"67457044800","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":0.30,"discounted_cash":0.12,"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":"67457044843","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 = 4 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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":"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 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pharmacy | NDC EA = 16.7 ML"},{"gross_charge":2.25,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"85433101","type":"NDC"}],"standard_charges":[{"gross_charge":21.40,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":28.72,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":18.23,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"42023019501","type":"NDC"}],"standard_charges":[{"gross_charge":6.34,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"},{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16.7 ML"}]},{"description":"POSACONAZOLE 300 MG/16.7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"111881","type":"CDM"},{"code":"55150038801","type":"NDC"}],"standard_charges":[{"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"},{"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"}]},{"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":"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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAZOLAMIDE 125 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112","type":"CDM"},{"code":"23155028701","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":102.55,"discounted_cash":41.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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"}]},{"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":8.88,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"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"}]},{"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":"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 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 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":"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":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"},{"gross_charge":1.52,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11240","type":"CDM"},{"code":"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":"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":"69413033030","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":750.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PYRIMETHAMINE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11246","type":"CDM"},{"code":"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":"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":"68180055609","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"QUINAPRIL HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11254","type":"CDM"},{"code":"31722026790","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"RABIES IMMUNE GLOBULIN 150 UNIT/ML IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11256","type":"CDM"},{"code":"13533061802","type":"NDC"}],"standard_charges":[{"gross_charge":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":293.31,"discounted_cash":117.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":259.53,"discounted_cash":103.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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 CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11259","type":"CDM"},{"code":"61570012001","type":"NDC"}],"standard_charges":[{"gross_charge":7.10,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RAMIPRIL 5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11261","type":"CDM"},{"code":"61570011201","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RANITIDINE HCL 150 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11265","type":"CDM"},{"code":"51079087901","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"VEDOLIZUMAB 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112674","type":"CDM"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":3947.91,"discounted_cash":1579.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4700.95,"discounted_cash":1880.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9359.91,"discounted_cash":3743.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"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":904.1,"discounted_cash":361.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":723.28,"discounted_cash":289.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"EFINACONAZOLE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112846","type":"CDM"},{"code":"187540008","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":174.32,"discounted_cash":69.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"},{"gross_charge":15.89,"discounted_cash":6.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"RIBAVIRIN 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11286","type":"CDM"},{"code":"68084017911","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RIBAVIRIN 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11286","type":"CDM"},{"code":"68084017965","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"RIBAVIRIN 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11287","type":"CDM"},{"code":"65862020768","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 168 EACH"}]},{"description":"RIBOFLAVIN 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11288","type":"CDM"},{"code":"11845007141","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RIBOFLAVIN 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11289","type":"CDM"},{"code":"35046000120","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RALTEGRAVIR POTASSIUM 100 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112892","type":"CDM"},{"code":"6360361","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.43,"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":3.22,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"112899","type":"CDM"},{"code":"54879002101","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.93,"discounted_cash":0.37,"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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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113303","type":"CDM"},{"code":"597015337","type":"NDC"}],"standard_charges":[{"gross_charge":17.26,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":18.97,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TRUE METRIX METER W/DEVICE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113376","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":"SARGRAMOSTIM 250 MCG IV 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Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11349","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":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11349","type":"CDM"},{"code":"46122070278","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11349","type":"CDM"},{"code":"904725261","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":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11349","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":"11349","type":"CDM"},{"code":"46122057578","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":0.01,"discounted_cash":0.0044,"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":"11349","type":"CDM"},{"code":"904652261","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":0.0096,"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":"11349","type":"CDM"},{"code":"904643480","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"SERTRALINE HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11350","type":"CDM"},{"code":"65862001301","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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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11350","type":"CDM"},{"code":"60687025311","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":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":0.29,"discounted_cash":0.12,"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 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| 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":0.25,"discounted_cash":0.10,"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":"16729021616","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":0.08,"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":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"SERTRALINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11351","type":"CDM"},{"code":"65862001230","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":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":"68084018101","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NILOTINIB HCL 150 MG PO 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pharmacy | NDC EA = 2 ML"},{"gross_charge":215.39,"discounted_cash":86.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"USTEKINUMAB 45 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113527","type":"CDM"},{"code":"57894006003","type":"NDC"}],"standard_charges":[{"gross_charge":28276.94,"discounted_cash":11310.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":7332.8,"discounted_cash":2933.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":5484.7,"discounted_cash":2193.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"USTEKINUMAB 90 MG/ML SC 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pharmacy | NDC EA = 0.98 ML"}]},{"description":"TESTOSTERONE CYPIONATE 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113533","type":"CDM"},{"code":"9034702","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":2.86,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.27,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM 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NDC EA = 1 ML"},{"gross_charge":5.2,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":13.58,"discounted_cash":5.43,"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":"9041701","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":14.3,"discounted_cash":5.72,"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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NDC EA = 1 ML"},{"gross_charge":11.0,"discounted_cash":4.4,"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":"574082701","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 ML"},{"gross_charge":2.29,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":13.06,"discounted_cash":5.22,"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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NDC EA = 5 ML"},{"gross_charge":7.39,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"113535","type":"CDM"},{"code":"591322126","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 = 5 ML"},{"gross_charge":4.78,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG/5ML PO 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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":"68382091506","type":"NDC"}],"standard_charges":[{"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":5.20,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.25,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ERLOTINIB HCL 150 MG PO 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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":65.01,"discounted_cash":26.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":10.58,"discounted_cash":4.23,"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":"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 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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":"SINCALIDE 5 MCG IJ 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EA = 1 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":"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 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| 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":2.28,"discounted_cash":0.91,"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"}]},{"description":"LAN-O-SOOTHE EX 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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":"60687083445","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":0.14,"discounted_cash":0.06,"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":"121059530","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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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114228","type":"CDM"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"},{"gross_charge":5.68,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"},{"gross_charge":7.61,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 400 ML"}]},{"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 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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":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"60687048711","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 = 1 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"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":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"60687048701","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 = 100 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"69584085410","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"59746021801","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":0.08,"discounted_cash":0.03,"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":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"51079098001","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 = 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"},{"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":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"51079098020","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"}]},{"description":"SPIRONOLACTONE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11425","type":"CDM"},{"code":"53489032901","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":0.07,"discounted_cash":0.03,"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":"SPIRONOLACTONE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11426","type":"CDM"},{"code":"59651042701","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BUDESONIDE 2 MG/ACT RE FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114375","type":"CDM"},{"code":"65649065102","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 33.4 G"},{"gross_charge":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 33.4 G"}]},{"description":"ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114379","type":"CDM"},{"code":"944500101","type":"NDC"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"121074710","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"52817084016","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"1210974106","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"60687073823","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"60687073842","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"66689079001","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.76,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"68094004159","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268074511","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268073212","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11441","type":"CDM"},{"code":"50268073211","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"59762040105","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"51079075320","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"60687069501","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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":0.20,"discounted_cash":0.08,"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":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"59762040101","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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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":"SUCRALFATE 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11442","type":"CDM"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"517102025","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":5.42,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"548970100","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":4.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":13.56,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"42023016401","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 = 1 ML"},{"gross_charge":17.99,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.31,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"517102001","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":9.04,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":10.13,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"55150037001","type":"NDC"}],"standard_charges":[{"gross_charge":7.66,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":11.21,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"114429","type":"CDM"},{"code":"55150037025","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":7.66,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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NDC EA = 100 EACH"}]},{"description":"TAMOXIFEN CITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11498","type":"CDM"},{"code":"54483413","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":"TAMOXIFEN CITRATE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"11498","type":"CDM"},{"code":"93078201","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NALOXEGOL OXALATE 12.5 MG PO 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| NDC EA = 30 EACH"},{"gross_charge":9.02,"discounted_cash":3.61,"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":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 = 1 EACH"},{"gross_charge":1.98,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115202","type":"CDM"},{"code":"378647016","type":"NDC"}],"standard_charges":[{"gross_charge":13.88,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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| NDC EA = 5 ML"},{"gross_charge":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATES 45 MMOLE/15ML IV SOLN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"115354","type":"CDM"},{"code":"409729511","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 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM PHOSPHATES 45 MMOLE/15ML IV SOLN 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ML"},{"gross_charge":33.36,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"TALIMOGENE LAHERPAREPVEC 100000000 UNIT/ML LS SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"117965","type":"CDM"},{"code":"55513007901","type":"NDC"}],"standard_charges":[{"gross_charge":6985.79,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3666.17,"discounted_cash":1466.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4254.48,"discounted_cash":1701.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MEPOLIZUMAB 100 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118000","type":"CDM"},{"code":"173088101","type":"NDC"}],"standard_charges":[{"gross_charge":2286.33,"discounted_cash":914.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3602.82,"discounted_cash":1441.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118002","type":"CDM"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"gross_charge":73.67,"discounted_cash":29.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":62.63,"discounted_cash":25.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":127.06,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-4 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118010","type":"CDM"},{"code":"338350841","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"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-4 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118010","type":"CDM"},{"code":"99920118010","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"COBIMETINIB FUMARATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118022","type":"CDM"},{"code":"50242071701","type":"NDC"}],"standard_charges":[{"gross_charge":82.05,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 63 EACH"},{"gross_charge":97.61,"discounted_cash":39.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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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Type: pharmacy | NDC EA = 20 ML"}]},{"description":"DARATUMUMAB 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118055","type":"CDM"},{"code":"57894050520","type":"NDC"}],"standard_charges":[{"gross_charge":87.74,"discounted_cash":35.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":155.12,"discounted_cash":62.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"PATIROMER SORBITEX CALCIUM 8.4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118251","type":"CDM"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"gross_charge":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":6.80,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":1.68,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118270","type":"CDM"},{"code":"45802057800","type":"NDC"}],"standard_charges":[{"gross_charge":16.10,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.2,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"118270","type":"CDM"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":12.20,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":24.74,"discounted_cash":9.90,"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":"68001064545","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 = 2 EACH"},{"gross_charge":16.10,"discounted_cash":6.44,"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":"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":"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":86.60,"discounted_cash":34.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":66.59,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"ELOTUZUMAB 300 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":2286.84,"discounted_cash":914.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3094.86,"discounted_cash":1237.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BENDAMUSTINE HCL 100 MG/4ML IV 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":278.47,"discounted_cash":111.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":59.66,"discounted_cash":23.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"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":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":"60505622800","type":"NDC"}],"standard_charges":[{"gross_charge":152.57,"discounted_cash":61.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":135.62,"discounted_cash":54.25,"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":1021.0,"discounted_cash":408.4,"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":783.06,"discounted_cash":313.23,"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":"6542312","type":"NDC"}],"standard_charges":[{"gross_charge":34.14,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 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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":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"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":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119082","type":"CDM"},{"code":"57664068331","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 = 300 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 ML"},{"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"}]},{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 ML"},{"gross_charge":0.02,"discounted_cash":0.0076,"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":"143953410","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 = 300 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119082","type":"CDM"},{"code":"143953401","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 = 300 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV 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pharmacy | NDC EA = 250 ML"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119095","type":"CDM"},{"code":"23155077131","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119097","type":"CDM"},{"code":"409428311","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 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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":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119098","type":"CDM"},{"code":"25021041510","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":0.07,"discounted_cash":0.03,"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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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 SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"119703","type":"CDM"},{"code":"5446154410","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"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV 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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"}]},{"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":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"},{"gross_charge":37.32,"discounted_cash":14.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"}]},{"description":"VENETOCLAX 100 MG PO 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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":"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":"51079042301","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MULTIVITAMIN+ PO 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Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"MORPHINE SULFATE-NACL 0.5-0.9 MG/ML-% IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120395","type":"CDM"},{"code":"61553011940","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL-BUPIVACAINE-NACL 0.2-0.1-0.9 MG/100ML-% EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120409","type":"CDM"},{"code":"99919120409","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 ML"}]},{"description":"FENTANYL-BUPIVACAINE-NACL 0.2-0.1-0.9 MG/100ML-% EP 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pharmacy | NDC EA = 10 ML"},{"gross_charge":16.47,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"120959","type":"CDM"},{"code":"517038101","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":18.5,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV 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| NDC EA = 100 EACH"}]},{"description":"VENLAFAXINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12203","type":"CDM"},{"code":"68084089695","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 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":"VENLAFAXINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12204","type":"CDM"},{"code":"68001015900","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 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Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VENLAFAXINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12204","type":"CDM"},{"code":"65162030609","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":"VENLAFAXINE HCL 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12206","type":"CDM"},{"code":"68084085611","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"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":"VENLAFAXINE HCL 75 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12206","type":"CDM"},{"code":"57237017501","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VENLAFAXINE HCL 37.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12207","type":"CDM"},{"code":"51079048020","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"VENLAFAXINE HCL 37.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12207","type":"CDM"},{"code":"57664039388","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":0.29,"discounted_cash":0.12,"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":"VENLAFAXINE HCL 37.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12207","type":"CDM"},{"code":"51079048001","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"}]},{"description":"VENLAFAXINE HCL 37.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12207","type":"CDM"},{"code":"68084084411","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 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"},{"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":"DORNASE ALFA 1 MG/ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12211","type":"CDM"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":48.38,"discounted_cash":19.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":7.77,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"DORNASE ALFA 1 MG/ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12211","type":"CDM"},{"code":"50242010039","type":"NDC"}],"standard_charges":[{"gross_charge":48.38,"discounted_cash":19.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLARATUMAB 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122131","type":"CDM"},{"code":"2892601","type":"NDC"}],"standard_charges":[{"gross_charge":37.68,"discounted_cash":15.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122158","type":"CDM"},{"code":"61553083448","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 ML"}]},{"description":"TIROFIBAN HCL 3.75 MG/15ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122160","type":"CDM"},{"code":"25208000104","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":3.54,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"COLESTIPOL HCL 5 GM OR 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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":"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":"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":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1223","type":"CDM"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"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":"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":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"},{"gross_charge":24.33,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FLAVOR SWEET-SF PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122505","type":"CDM"},{"code":"395009416","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"FLAVOR SWEET-SF PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122505","type":"CDM"},{"code":"574030216","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"BEZLOTOXUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122628","type":"CDM"},{"code":"6302500","type":"NDC"}],"standard_charges":[{"gross_charge":73.03,"discounted_cash":29.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"BEZLOTOXUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122628","type":"CDM"},{"code":"6302501","type":"NDC"}],"standard_charges":[{"gross_charge":73.03,"discounted_cash":29.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"},{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 ML"}]},{"description":"UREA 15 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122694","type":"CDM"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"PRENATABS FA 29-1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122740","type":"CDM"},{"code":"60258019001","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"NUSINERSEN 12 MG/5ML IT 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Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":468.94,"discounted_cash":187.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RANIBIZUMAB 0.5 MG/0.05ML IZ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"122982","type":"CDM"},{"code":"50242008003","type":"NDC"}],"standard_charges":[{"gross_charge":39000.0,"discounted_cash":15600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.05 ML"},{"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"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":2.60,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":0.70,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.28,"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":"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":"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":"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":"409330803","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123","type":"CDM"},{"code":"517760401","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":3.40,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"ROPIVACAINE HCL-NACL (PF) 0.2-0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123434","type":"CDM"},{"code":"61553049003","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123434","type":"CDM"},{"code":"99918123434","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"NOREPINEPHRINE-SODIUM CHLORIDE 16-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123447","type":"CDM"},{"code":"81298965803","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 = 250 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"60687075156","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123518","type":"CDM"},{"code":"121131411","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10.15 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"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 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NDC EA = 10 ML"},{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"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 = 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"},{"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":"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":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"},{"gross_charge":1.13,"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":"55150018301","type":"NDC"}],"standard_charges":[{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.44,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"55150018302","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 = 10 ML"},{"gross_charge":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12370","type":"CDM"},{"code":"517073501","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.83,"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"},{"gross_charge":1.98,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"BENZOCAINE 20 % MT AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123967","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":"BACLOFEN 10000 MCG/20ML IT SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123968","type":"CDM"},{"code":"45945015501","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"BACLOFEN 10000 MCG/20ML IT SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123968","type":"CDM"},{"code":"66794015501","type":"NDC"}],"standard_charges":[{"gross_charge":6.67,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":13.84,"discounted_cash":5.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":6.62,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"BACLOFEN 10000 MCG/20ML IT SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123968","type":"CDM"},{"code":"45945015502","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":10.75,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"BACLOFEN 40000 MCG/20ML IT SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123970","type":"CDM"},{"code":"45945015702","type":"NDC"}],"standard_charges":[{"gross_charge":26.41,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123972","type":"CDM"},{"code":"63323017005","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123972","type":"CDM"},{"code":"63323088401","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.51,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123972","type":"CDM"},{"code":"517340525","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 = 5 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"63323088101","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 = 15 ML"},{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"63323088116","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 = 15 ML"},{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"63323017015","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 = 15 ML"},{"gross_charge":1.25,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"409739182","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"409739172","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123973","type":"CDM"},{"code":"517731501","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 = 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":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":"PORACTANT ALFA 240 MG/3ML INTRATRACHEA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123983","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":138.62,"discounted_cash":55.45,"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"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123985","type":"CDM"},{"code":"64253040030","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.75,"discounted_cash":0.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123985","type":"CDM"},{"code":"76329334001","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 = 10 ML"},{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123985","type":"CDM"},{"code":"409163010","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.37,"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":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"123985","type":"CDM"},{"code":"409491111","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":668.86,"discounted_cash":267.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"THIOTEPA 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"124627","type":"CDM"},{"code":"143929201","type":"NDC"}],"standard_charges":[{"gross_charge":239.59,"discounted_cash":95.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"THIOTEPA 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"124627","type":"CDM"},{"code":"71288015710","type":"NDC"}],"standard_charges":[{"gross_charge":452.05,"discounted_cash":180.82,"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":"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":"ESTRADIOL 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12491","type":"CDM"},{"code":"378145205","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 = 500 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 12 GM IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":834.63,"discounted_cash":333.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":748.04,"discounted_cash":299.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SARILUMAB 150 MG/1.14ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"125301","type":"CDM"},{"code":"24590801","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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Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 600-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"125311","type":"CDM"},{"code":"338954960","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":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"125312","type":"CDM"},{"code":"338955350","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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NDC EA = 2 EACH"},{"gross_charge":111.09,"discounted_cash":44.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":95.01,"discounted_cash":38.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"DURVALUMAB 120 MG/2.4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"125334","type":"CDM"},{"code":"310450012","type":"NDC"}],"standard_charges":[{"gross_charge":429.47,"discounted_cash":171.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.4 ML"},{"gross_charge":276.07,"discounted_cash":110.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.4 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Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":17651.29,"discounted_cash":7060.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ADALIMUMAB 40 MG/0.4ML SC PNKT (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126881","type":"CDM"},{"code":"74055402","type":"NDC"}],"standard_charges":[{"gross_charge":563.29,"discounted_cash":225.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1220.84,"discounted_cash":488.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3129.38,"discounted_cash":1251.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TALC 4 G PL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126887","type":"CDM"},{"code":"62327044404","type":"NDC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TALC 4 G PL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126887","type":"CDM"},{"code":"62327044444","type":"NDC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TALC 3 G PL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126888","type":"CDM"},{"code":"62327033303","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RABIES IMMUNE GLOBULIN 300 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126928","type":"CDM"},{"code":"13533031810","type":"NDC"}],"standard_charges":[{"gross_charge":395.94,"discounted_cash":158.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":423.49,"discounted_cash":169.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":661.88,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES IMMUNE GLOBULIN 300 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126928","type":"CDM"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":423.49,"discounted_cash":169.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":395.94,"discounted_cash":158.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":661.88,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES IMMUNE GLOBULIN 1500 UNIT/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"126929","type":"CDM"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":661.92,"discounted_cash":264.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":423.49,"discounted_cash":169.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":395.93,"discounted_cash":158.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127017","type":"CDM"},{"code":"27808006502","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 = 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":"TERBINAFINE HCL 250 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":"TERBINAFINE HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12724","type":"CDM"},{"code":"67405050003","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TERBINAFINE HCL 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12724","type":"CDM"},{"code":"69097085907","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"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":"TRIAMTERENE-HCTZ 37.5-25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"12729","type":"CDM"},{"code":"51079093520","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"}]},{"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":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127317","type":"CDM"},{"code":"31722013801","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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1 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":0.30,"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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ 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NDC EA = 50 ML"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127321","type":"CDM"},{"code":"67157010151","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":4.83,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127330","type":"CDM"},{"code":"64950036204","type":"NDC"}],"standard_charges":[{"gross_charge":43.85,"discounted_cash":17.54,"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":"12735","type":"CDM"},{"code":"338519741","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":0.04,"discounted_cash":0.02,"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":"SARILUMAB 150 MG/1.14ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127350","type":"CDM"},{"code":"24592001","type":"NDC"}],"standard_charges":[{"gross_charge":1958.60,"discounted_cash":783.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"gross_charge":693.91,"discounted_cash":277.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"gross_charge":826.66,"discounted_cash":330.66,"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":1825.54,"discounted_cash":730.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"gross_charge":695.40,"discounted_cash":278.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.14 ML"},{"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"}]},{"description":"LIDOCAINE HCL 200 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127368","type":"CDM"},{"code":"70092115346","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"127434","type":"CDM"},{"code":"69130501","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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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":41.94,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":12.46,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":20.72,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ 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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 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EACH"},{"gross_charge":362.88,"discounted_cash":145.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"COPANLISIB HCL 60 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129466","type":"CDM"},{"code":"50419038501","type":"NDC"}],"standard_charges":[{"gross_charge":3410.17,"discounted_cash":1364.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"description":"RIBOFLAV5 & RIBOFLAV5-DEXTRAN 0.146 &0.146-20 % OP 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CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1298","type":"CDM"},{"code":"536379201","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ACETAMINOPHEN CHILDRENS 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129819","type":"CDM"},{"code":"904744520","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"ACETAMINOPHEN CHILDRENS 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129819","type":"CDM"},{"code":"46122021026","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 = 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":"46287002020","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.51,"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"},{"gross_charge":1.72,"discounted_cash":0.69,"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":"46287002004","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":1.47,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":3.26,"discounted_cash":1.30,"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":1.74,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"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":"46287002050","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.78,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"SPIRONOLACTONE 25 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129881","type":"CDM"},{"code":"69238202708","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":2.97,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"FLUTICASONE PROPIONATE 93 MCG/ACT NA EXHU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"129891","type":"CDM"},{"code":"71143037501","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"},{"gross_charge":13.31,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"},{"gross_charge":39.56,"discounted_cash":15.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1299","type":"CDM"},{"code":"121476605","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.03,"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":0.03,"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"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"}]},{"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":577.49,"discounted_cash":231.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":423.67,"discounted_cash":169.47,"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":"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":194.84,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":194.65,"discounted_cash":77.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CALCIUM CARBONATE 1250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1300","type":"CDM"},{"code":"54812025","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CALCIUM CARBONATE 1250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1300","type":"CDM"},{"code":"999170001300","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130008","type":"CDM"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"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"}]},{"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":405.54,"discounted_cash":162.22,"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"}]},{"description":"BORTEZOMIB 3.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130025","type":"CDM"},{"code":"63323072110","type":"NDC"}],"standard_charges":[{"gross_charge":402.22,"discounted_cash":160.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":225.15,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BENRALIZUMAB 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130047","type":"CDM"},{"code":"310173030","type":"NDC"}],"standard_charges":[{"gross_charge":5847.05,"discounted_cash":2338.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3655.19,"discounted_cash":1462.08,"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":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":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":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":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":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":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":"6307601","type":"NDC"}],"standard_charges":[{"gross_charge":184.08,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":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"}]},{"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":274.39,"discounted_cash":109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"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":184.08,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"},{"gross_charge":156.32,"discounted_cash":62.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 EACH"}]},{"description":"LETERMOVIR 480 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130321","type":"CDM"},{"code":"6500401","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":15.81,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"},{"gross_charge":9.08,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 ML"}]},{"description":"APREPITANT 130 MG/18ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130322","type":"CDM"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 18 ML"},{"gross_charge":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":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"},{"gross_charge":7.48,"discounted_cash":2.99,"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":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"},{"gross_charge":103.71,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1306","type":"CDM"},{"code":"517671001","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 = 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 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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":"68001034836","type":"NDC"}],"standard_charges":[{"gross_charge":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.01,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"GEMCITABINE HCL 1 GM/10ML IV 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Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"130987","type":"CDM"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"gross_charge":136.32,"discounted_cash":54.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":70.27,"discounted_cash":28.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":82.8,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO 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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":"VALACYCLOVIR HCL 1000 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13132","type":"CDM"},{"code":"378427677","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"VALACYCLOVIR HCL 500 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13133","type":"CDM"},{"code":"31722070490","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 = 90 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"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":"VALACYCLOVIR HCL 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13133","type":"CDM"},{"code":"378427593","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.14,"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"378427577","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":0.35,"discounted_cash":0.14,"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 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":43.1,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":27.13,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MAGNESIUM CHLORIDE 64 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"131376","type":"CDM"},{"code":"10006070013","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"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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pharmacy | NDC EA = 30 ML"}]},{"description":"POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"131385","type":"CDM"},{"code":"75834028030","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":10.02,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"131389","type":"CDM"},{"code":"70594002301","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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pharmacy | NDC EA = 5 ML"},{"gross_charge":6.28,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TAFAMIDIS MEGLUMINE (CARDIAC) 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133512","type":"CDM"},{"code":"69197512","type":"NDC"}],"standard_charges":[{"gross_charge":143.11,"discounted_cash":57.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 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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":2489.75,"discounted_cash":995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3837.48,"discounted_cash":1534.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"133845","type":"CDM"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":13871.63,"discounted_cash":5548.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":18611.41,"discounted_cash":7444.56,"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":0.76,"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"},{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 G"}]},{"description":"ACETAMINOPHEN 650 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13410","type":"CDM"},{"code":"46122062971","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134297","type":"CDM"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":72.16,"discounted_cash":28.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":29.32,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"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":826.28,"discounted_cash":330.51,"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"}]},{"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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.11,"discounted_cash":0.04,"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":0.12,"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":0.07,"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":3.86,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 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pharmacy | NDC EA = 1 ML"}]},{"description":"TRANEXAMIC ACID IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134831","type":"CDM"},{"code":"80830232902","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"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"TRANEXAMIC ACID IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134831","type":"CDM"},{"code":"51754010801","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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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134831","type":"CDM"},{"code":"25021041882","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"},{"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":"TRANEXAMIC ACID IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"134831","type":"CDM"},{"code":"80830232901","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"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"CAPSAICIN 0.025 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1350","type":"CDM"},{"code":"50268019560","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 G"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"CAPSAICIN 0.025 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1350","type":"CDM"},{"code":"536252525","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 G"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"DESMOPRESSIN ACETATE 1.5 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13506","type":"CDM"},{"code":"53687100","type":"NDC"}],"standard_charges":[{"gross_charge":189.18,"discounted_cash":75.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":291.11,"discounted_cash":116.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"BEVACIZUMAB-BVZR 100 MG/4ML IV 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NDC EA = 16 ML"},{"gross_charge":69.86,"discounted_cash":27.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"},{"gross_charge":146.61,"discounted_cash":58.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 16 ML"}]},{"description":"IMIPENEM-CILASTATIN-RELEBACTAM 1.25 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135075","type":"CDM"},{"code":"6385601","type":"NDC"}],"standard_charges":[{"gross_charge":285.82,"discounted_cash":114.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":198.03,"discounted_cash":79.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RITUXIMAB-PVVR 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135077","type":"CDM"},{"code":"69023801","type":"NDC"}],"standard_charges":[{"gross_charge":12.30,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":61.74,"discounted_cash":24.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":22.71,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB-PVVR 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135079","type":"CDM"},{"code":"69024901","type":"NDC"}],"standard_charges":[{"gross_charge":22.71,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":61.74,"discounted_cash":24.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":12.30,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"LUMATEPERONE TOSYLATE 42 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135094","type":"CDM"},{"code":"72060014201","type":"NDC"}],"standard_charges":[{"gross_charge":30.98,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":42.02,"discounted_cash":16.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":37.08,"discounted_cash":14.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEASLES, MUMPS & RUBELLA VAC SC INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135106","type":"CDM"},{"code":"6468101","type":"NDC"}],"standard_charges":[{"gross_charge":88.81,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":78.91,"discounted_cash":31.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEASLES, MUMPS & RUBELLA VAC SC INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135106","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":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135113","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":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135113","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 (PF) 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135113","type":"CDM"},{"code":"409230821","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 = 1 ML"},{"gross_charge":0.46,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM HCL (PF) 2 MG/2ML IJ 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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":"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":0.04,"discounted_cash":0.01,"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":0.26,"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":"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":"70954024010","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 = 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"}]},{"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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":0.28,"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":"68094000759","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 = 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":0.56,"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":"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":"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":"51672404709","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 = 450 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 450 ML"},{"gross_charge":0.06,"discounted_cash":0.02,"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":"60432012916","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 = 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":0.05,"discounted_cash":0.02,"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":2342.55,"discounted_cash":937.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":766.68,"discounted_cash":306.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":82.02,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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":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":22.58,"discounted_cash":9.03,"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"}]},{"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":258.58,"discounted_cash":103.43,"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"}]},{"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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"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":0.34,"discounted_cash":0.14,"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":"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":"68084044411","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1357","type":"CDM"},{"code":"904617261","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.76,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":862.64,"discounted_cash":345.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"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":"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":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"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":1.14,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"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":"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":1.90,"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"},{"gross_charge":1.03,"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":"68462010340","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":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"}]},{"description":"SULFADIAZINE POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13579","type":"CDM"},{"code":"38779055005","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"BROLUCIZUMAB-DBLL 6 MG/0.05ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135793","type":"CDM"},{"code":"78082761","type":"NDC"}],"standard_charges":[{"gross_charge":106378.4,"discounted_cash":42551.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.05 ML"}]},{"description":"BARICITINIB 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135806","type":"CDM"},{"code":"2473230","type":"NDC"}],"standard_charges":[{"gross_charge":58.50,"discounted_cash":23.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":53.00,"discounted_cash":21.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":83.4,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"DAKINS (FULL STRENGTH) 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135831","type":"CDM"},{"code":"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":1319.27,"discounted_cash":527.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":347.12,"discounted_cash":138.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1225.7,"discounted_cash":490.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PEGFILGRASTIM-BMEZ 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"135887","type":"CDM"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":6313.57,"discounted_cash":2525.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":1591.58,"discounted_cash":636.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"904322035","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1359","type":"CDM"},{"code":"46122055705","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":0.09,"discounted_cash":0.04,"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":"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":"904747835","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 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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":9134.59,"discounted_cash":3653.84,"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":10635.56,"discounted_cash":4254.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"METHOTREXATE SODIUM 2.5 MG OR 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pharmacy | NDC EA = 36 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"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":0.04,"discounted_cash":0.02,"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":"CRIZANLIZUMAB-TMCA 100 MG/10ML IV 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| NDC EA = 1 EACH"},{"gross_charge":32.03,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSINOH LANOLIN EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136234","type":"CDM"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7 G"}]},{"description":"INSULIN ASPART 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136239","type":"CDM"},{"code":"73070010315","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13654","type":"CDM"},{"code":"603016821","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":"ASPIRIN EC 325 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13654","type":"CDM"},{"code":"63739052301","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 = 750 EACH"},{"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":"TRASTUZUMAB-QYYP 420 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":2566.74,"discounted_cash":1026.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LASMIDITAN SUCCINATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136663","type":"CDM"},{"code":"2449108","type":"NDC"}],"standard_charges":[{"gross_charge":64.39,"discounted_cash":25.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":56.45,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"},{"gross_charge":83.73,"discounted_cash":33.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"CETIRIZINE HCL 10 MG/ML IV 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pharmacy | NDC EA = 1 ML"},{"gross_charge":328.01,"discounted_cash":131.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136665","type":"CDM"},{"code":"59630026601","type":"NDC"}],"standard_charges":[{"gross_charge":210.51,"discounted_cash":84.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":156.62,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":130.13,"discounted_cash":52.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"THEOPHYLLINE CR 100 MG OR 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TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13668","type":"CDM"},{"code":"50111048301","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":"EPTINEZUMAB-JJMR 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136849","type":"CDM"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":1147.76,"discounted_cash":459.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1393.31,"discounted_cash":557.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1940.07,"discounted_cash":776.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136863","type":"CDM"},{"code":"80830169101","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 = 15 ML"},{"gross_charge":0.71,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136863","type":"CDM"},{"code":"517210201","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 = 15 ML"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"136863","type":"CDM"},{"code":"517210225","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 = 15 ML"}]},{"description":"LEUPROLIDE ACETATE 3.75 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13691","type":"CDM"},{"code":"74364103","type":"NDC"}],"standard_charges":[{"gross_charge":1747.08,"discounted_cash":698.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.44,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.46,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":321.08,"discounted_cash":128.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"description":"SODIUM HYPOCHLORITE 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137439","type":"CDM"},{"code":"436067216","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":"TECHNET TC 99M SULFUR COLLOID CO KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137447","type":"CDM"},{"code":"45567003001","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TECHNET TC 99M SULFUR COLLOID CO KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137447","type":"CDM"},{"code":"51808022001","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CENOBAMATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137449","type":"CDM"},{"code":"71699005030","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":22.28,"discounted_cash":8.91,"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"}]},{"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":22.28,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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"}]},{"description":"CENOBAMATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137454","type":"CDM"},{"code":"71699020030","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":22.28,"discounted_cash":8.91,"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"}]},{"description":"RIMEGEPANT SULFATE 75 MG PO TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"137483","type":"CDM"},{"code":"72618300002","type":"NDC"}],"standard_charges":[{"gross_charge":32.68,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":116.29,"discounted_cash":46.52,"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":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"},{"gross_charge":98.38,"discounted_cash":39.35,"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 SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138034","type":"CDM"},{"code":"44206045621","type":"NDC"}],"standard_charges":[{"gross_charge":13.64,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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) 1 GM/5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138034","type":"CDM"},{"code":"44206045694","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 = 5 ML"},{"gross_charge":13.64,"discounted_cash":5.46,"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 SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138035","type":"CDM"},{"code":"44206045722","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"},{"gross_charge":11.52,"discounted_cash":4.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO (0.5 UNIT DIAL) 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138038","type":"CDM"},{"code":"2771401","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":0.76,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"REMDESIVIR 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138050","type":"CDM"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":488.81,"discounted_cash":195.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":650.72,"discounted_cash":260.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"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":13.59,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":11.54,"discounted_cash":4.62,"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":"44206045896","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":28.61,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"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":0.0084,"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"},{"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":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138077","type":"CDM"},{"code":"143963301","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 = 200 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138077","type":"CDM"},{"code":"143963310","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 = 200 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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":"24338023030","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":"24338026010","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 = 10 ML"},{"gross_charge":4.27,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NIMODIPINE 6 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138098","type":"CDM"},{"code":"24338026012","type":"NDC"}],"standard_charges":[{"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":10.68,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.27,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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":10.68,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":6.59,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"TUCATINIB 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138138","type":"CDM"},{"code":"51144000212","type":"NDC"}],"standard_charges":[{"gross_charge":219.98,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":119.05,"discounted_cash":47.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":136.18,"discounted_cash":54.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138147","type":"CDM"},{"code":"14789025007","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.34,"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":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138147","type":"CDM"},{"code":"42023024301","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 = 10 ML"},{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138152","type":"CDM"},{"code":"55135013201","type":"NDC"}],"standard_charges":[{"gross_charge":1884.62,"discounted_cash":753.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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"},{"gross_charge":2563.5,"discounted_cash":1025.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"68001053145","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"54162001709","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":0.07,"discounted_cash":0.03,"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":"51672207501","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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14.2 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"603044150","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"904880467","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":0.10,"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"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"904702367","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":0.08,"discounted_cash":0.03,"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":"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":"168001104","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 113.4 G"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13818","type":"CDM"},{"code":"168001116","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 453.6 G"}]},{"description":"INFLIXIMAB-AXXQ 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138342","type":"CDM"},{"code":"55513067001","type":"NDC"}],"standard_charges":[{"gross_charge":129.19,"discounted_cash":51.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":218.88,"discounted_cash":87.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138368","type":"CDM"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":704.79,"discounted_cash":281.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":465.82,"discounted_cash":186.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"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":"49281012065","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":"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":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":81.96,"discounted_cash":32.78,"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":"49281012265","type":"NDC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"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":"49281012388","type":"NDC"}],"standard_charges":[{"gross_charge":92.16,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 80 (2 X 40) MG UL SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138412","type":"CDM"},{"code":"72493010303","type":"NDC"}],"standard_charges":[{"gross_charge":18167.94,"discounted_cash":7267.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":23670.0,"discounted_cash":9468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"REMDESIVIR 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138416","type":"CDM"},{"code":"61958290201","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":19.99,"discounted_cash":8.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138418","type":"CDM"},{"code":"68094002959","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 7.5 ML"},{"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"}]},{"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":"904252820","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE 0.33-4 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13846","type":"CDM"},{"code":"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":"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 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"FLUOROESTRADIOL F 18 4-100 MCI/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138494","type":"CDM"},{"code":"72874000101","type":"NDC"}],"standard_charges":[{"gross_charge":4255.82,"discounted_cash":1702.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BRILLIANT BLUE G 0.025 % IO SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138633","type":"CDM"},{"code":"68803072225","type":"NDC"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"BRILLIANT BLUE G 0.025 % IO SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138633","type":"CDM"},{"code":"68803072205","type":"NDC"}],"standard_charges":[{"gross_charge":151.4,"discounted_cash":60.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"INEBILIZUMAB-CDON 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138758","type":"CDM"},{"code":"72677055103","type":"NDC"}],"standard_charges":[{"gross_charge":4366.67,"discounted_cash":1746.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3295.24,"discounted_cash":1318.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3355.99,"discounted_cash":1342.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"INEBILIZUMAB-CDON 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138758","type":"CDM"},{"code":"72677055101","type":"NDC"}],"standard_charges":[{"gross_charge":3295.24,"discounted_cash":1318.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3435.2,"discounted_cash":1374.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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 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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":"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":"ENLITE GLUCOSE SENSOR MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138790","type":"CDM"},{"code":"8627007701","type":"NDC"}],"standard_charges":[{"gross_charge":138.09,"discounted_cash":55.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":113.5,"discounted_cash":45.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DUPILUMAB 300 MG/2ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138818","type":"CDM"},{"code":"24591502","type":"NDC"}],"standard_charges":[{"gross_charge":532.09,"discounted_cash":212.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":570.19,"discounted_cash":228.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":902.6,"discounted_cash":361.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"DUPILUMAB 300 MG/2ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"138818","type":"CDM"},{"code":"24591500","type":"NDC"}],"standard_charges":[{"gross_charge":570.19,"discounted_cash":228.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":902.6,"discounted_cash":361.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"COLESTIPOL HCL 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13884","type":"CDM"},{"code":"59762045001","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 = 120 EACH"},{"gross_charge":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"COLESTIPOL HCL 1 GM OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13884","type":"CDM"},{"code":"115521116","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 = 120 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"},{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139021","type":"CDM"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":927.73,"discounted_cash":371.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"POLY-VI-SOL/IRON 11 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139065","type":"CDM"},{"code":"99917006378","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 ML"}]},{"description":"POLY-VI-SOL/IRON 11 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139065","type":"CDM"},{"code":"87040501","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 ML"}]},{"description":"TACROLIMUS ER 1 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139103","type":"CDM"},{"code":"68992301003","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":4.15,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TACROLIMUS ER 1 MG PO TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139103","type":"CDM"},{"code":"68992301001","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":3.4,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":6.65,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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":26.60,"discounted_cash":10.64,"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":26.60,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":13.21,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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pharmacy | NDC EA = 2.5 ML"},{"gross_charge":30.68,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":41.59,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG/2.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"139294","type":"CDM"},{"code":"55150027099","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":41.23,"discounted_cash":16.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV 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| NDC EA = 5 ML"},{"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":"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":"TAFASITAMAB-CXIX 200 MG IV 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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":"68084031911","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":0.07,"discounted_cash":0.03,"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":"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":0.0068,"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":"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":0.21,"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":"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":0.12,"discounted_cash":0.05,"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":"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13982","type":"CDM"},{"code":"51079049920","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":"LAMOTRIGINE 200 MG OR 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EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"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":"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":0.06,"discounted_cash":0.02,"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":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"69097015203","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"LAMOTRIGINE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13983","type":"CDM"},{"code":"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":"51079086601","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":0.08,"discounted_cash":0.03,"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":4.66,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":6.06,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":5.41,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"RAVULIZUMAB-CWVZ 300 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140031","type":"CDM"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":1628.85,"discounted_cash":651.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1627.27,"discounted_cash":650.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":870.94,"discounted_cash":348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"RAVULIZUMAB-CWVZ 1100 MG/11ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140032","type":"CDM"},{"code":"25682002801","type":"NDC"}],"standard_charges":[{"gross_charge":1629.71,"discounted_cash":651.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 ML"},{"gross_charge":870.94,"discounted_cash":348.38,"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 CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14005","type":"CDM"},{"code":"24385059523","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"},{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 72 EACH"}]},{"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":0.02,"discounted_cash":0.006,"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":0.17,"discounted_cash":0.07,"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":"536129497","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"67815203","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.12,"discounted_cash":0.05,"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":0.04,"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":0.0084,"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":"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":"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":0.04,"discounted_cash":0.01,"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"}]},{"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":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140093","type":"CDM"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 G"}]},{"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":0.06,"discounted_cash":0.03,"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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"MAGNESIUM CHLORIDE 70 MG PO 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pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140331","type":"CDM"},{"code":"69131101","type":"NDC"}],"standard_charges":[{"gross_charge":105.08,"discounted_cash":42.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":209.71,"discounted_cash":83.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 15 (10-5) GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14057","type":"CDM"},{"code":"55150011899","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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ML"},{"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"}]},{"description":"POTASSIUM CHLORIDE 10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140780","type":"CDM"},{"code":"81033022052","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"},{"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":"POTASSIUM CHLORIDE 10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140780","type":"CDM"},{"code":"81033041215","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 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":"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":25.84,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":69.53,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"140845","type":"CDM"},{"code":"55513032601","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 = 50 ML"},{"gross_charge":16.91,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":25.84,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"RELUGOLIX 120 MG PO 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(CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"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":"603233821","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":"ACETAMINOPHEN-CODEINE #3 300-30 MG OR TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"406048462","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":0.41,"discounted_cash":0.17,"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":"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":"ACETAMINOPHEN-CODEINE #3 300-30 MG OR TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14087","type":"CDM"},{"code":"406048423","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 = 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 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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":"63739052210","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ASPIRIN EC 81 MG OR TBEC (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14113","type":"CDM"},{"code":"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":"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":"517100401","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 ML"},{"gross_charge":9.11,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV 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10 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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"},{"gross_charge":0.06,"discounted_cash":0.03,"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":"713059204","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 = 120 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| 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 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Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":227.26,"discounted_cash":90.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":267.37,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"141828","type":"CDM"},{"code":"74527002201","type":"NDC"}],"standard_charges":[{"gross_charge":267.37,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":227.26,"discounted_cash":90.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":159.42,"discounted_cash":63.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14196","type":"CDM"},{"code":"46110711","type":"NDC"}],"standard_charges":[{"gross_charge":8.00,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"CONJ ESTROG-MEDROXYPROGEST ACE 0.625-5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14197","type":"CDM"},{"code":"46110811","type":"NDC"}],"standard_charges":[{"gross_charge":8.00,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"VINORELBINE TARTRATE 10 MG/ML IV 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pharmacy | NDC EA = 5 ML"},{"gross_charge":2.45,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"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":0.15,"discounted_cash":0.06,"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"}]},{"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":0.18,"discounted_cash":0.07,"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"}]},{"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":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14233","type":"CDM"},{"code":"70436022748","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 35 ML"}]},{"description":"ARTESUNATE 110 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142374","type":"CDM"},{"code":"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":"ARTESUNATE 110 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"142374","type":"CDM"},{"code":"73607001111","type":"NDC"}],"standard_charges":[{"gross_charge":3739.42,"discounted_cash":1495.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5378.5,"discounted_cash":2151.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":1203.03,"discounted_cash":481.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"PIFLUFOLASTAT F 18 9 MCI IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"143152","type":"CDM"},{"code":"71258002200","type":"NDC"}],"standard_charges":[{"gross_charge":4600.0,"discounted_cash":1840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DUPILUMAB 200 MG/1.14ML SC SOPN 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EACH"},{"gross_charge":152.64,"discounted_cash":61.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"143594","type":"CDM"},{"code":"5200010","type":"NDC"}],"standard_charges":[{"gross_charge":476.87,"discounted_cash":190.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":411.69,"discounted_cash":164.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":496.68,"discounted_cash":198.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"ANIFROLUMAB-FNIA 300 MG/2ML IV 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14369","type":"CDM"},{"code":"2714001","type":"NDC"}],"standard_charges":[{"gross_charge":64.66,"discounted_cash":25.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ABCIXIMAB 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14369","type":"CDM"},{"code":"57894020001","type":"NDC"}],"standard_charges":[{"gross_charge":81.19,"discounted_cash":32.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV 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NDC EA = 1 EACH"},{"gross_charge":21.59,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PRISMASOL BGK 0/2.5 32-2.5 MEQ/L EC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"144297","type":"CDM"},{"code":"24571010805","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 = 5000 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5000 ML"}]},{"description":"PRISMASOL BGK 4/2.5 32-4-2.5 MEQ/L EC 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= 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1445","type":"CDM"},{"code":"60505609301","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"}]},{"description":"CEFAZOLIN SODIUM 1 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1445","type":"CDM"},{"code":"781345170","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 = 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 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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":25.59,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":40.14,"discounted_cash":16.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"EFGARTIGIMOD ALFA-FCAB 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145085","type":"CDM"},{"code":"73475304105","type":"NDC"}],"standard_charges":[{"gross_charge":315.71,"discounted_cash":126.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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NDC EA = 10 ML"}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145230","type":"CDM"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":1459.08,"discounted_cash":583.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"},{"gross_charge":2287.18,"discounted_cash":914.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"}]},{"description":"TEBENTAFUSP-TEBN 100 MCG/0.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145442","type":"CDM"},{"code":"80446040101","type":"NDC"}],"standard_charges":[{"gross_charge":41980.0,"discounted_cash":16792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUTIMLIMAB-JOME 1100 MG/22ML IV 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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":"50268076411","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":0.47,"discounted_cash":0.19,"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":0.03,"discounted_cash":0.01,"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":0.02,"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":"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 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| NDC EA = 2 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145709","type":"CDM"},{"code":"9920111723","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 = 2 ML"},{"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":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145709","type":"CDM"},{"code":"67457043322","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 ML"}]},{"description":"FAMOTIDINE 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145709","type":"CDM"},{"code":"63323073912","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 = 2 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"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":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145710","type":"CDM"},{"code":"71288041080","type":"NDC"}],"standard_charges":[{"gross_charge":4.94,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":5.94,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":3.89,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145710","type":"CDM"},{"code":"63323056883","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":8.23,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":5.89,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"145710","type":"CDM"},{"code":"68001045743","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":8.29,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"},{"gross_charge":6.52,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.3 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ 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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":"69618000815","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 = 15 ML"}]},{"description":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148135","type":"CDM"},{"code":"904546052","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 = 60 EACH"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"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":"31722070090","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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"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":"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 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":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"65862020199","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 = 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":"LOSARTAN POTASSIUM 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14823","type":"CDM"},{"code":"68382013510","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":0.13,"discounted_cash":0.05,"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":"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":"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 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":"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":0.44,"discounted_cash":0.17,"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"}]},{"description":"LOSARTAN POTASSIUM 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14824","type":"CDM"},{"code":"31722070190","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.02,"discounted_cash":0.006,"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":0.02,"discounted_cash":0.0064,"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"},{"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":"65862020290","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":0.07,"discounted_cash":0.03,"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":"68084034701","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 = 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":0.19,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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: 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":13.78,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":51.54,"discounted_cash":20.62,"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":"456430001","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"456430008","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"discounted_cash":22.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":13.44,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14825","type":"CDM"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":44.3,"discounted_cash":17.72,"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":49.45,"discounted_cash":19.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":15.43,"discounted_cash":6.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148343","type":"CDM"},{"code":"310453530","type":"NDC"}],"standard_charges":[{"gross_charge":2050.79,"discounted_cash":820.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"gross_charge":2759.14,"discounted_cash":1103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"}]},{"description":"POSACONAZOLE 300 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148370","type":"CDM"},{"code":"85222401","type":"NDC"}],"standard_charges":[{"gross_charge":205.59,"discounted_cash":82.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":163.18,"discounted_cash":65.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PEGFILGRASTIM-PBBK 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148372","type":"CDM"},{"code":"70121162701","type":"NDC"}],"standard_charges":[{"gross_charge":866.82,"discounted_cash":346.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"},{"gross_charge":1373.37,"discounted_cash":549.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.6 ML"}]},{"description":"CULTURELLE BABY IMMUNE+DIGEST PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148377","type":"CDM"},{"code":"49100040053","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 ML"}]},{"description":"DOPAMINE IN D5W 0.8-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14844","type":"CDM"},{"code":"338100502","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 = 250 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14845","type":"CDM"},{"code":"409780911","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14845","type":"CDM"},{"code":"338100702","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"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"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":"DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14845","type":"CDM"},{"code":"409780922","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE IN D5W 3.2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14846","type":"CDM"},{"code":"338100902","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 = 250 ML"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14847","type":"CDM"},{"code":"41167000623","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 = 48 EACH"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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 SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148520","type":"CDM"},{"code":"43825020001","type":"NDC"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TECLISTAMAB-CQYV 30 MG/3ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148592","type":"CDM"},{"code":"57894044901","type":"NDC"}],"standard_charges":[{"gross_charge":682.84,"discounted_cash":273.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":472.19,"discounted_cash":188.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"TECLISTAMAB-CQYV 153 MG/1.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148593","type":"CDM"},{"code":"57894045001","type":"NDC"}],"standard_charges":[{"gross_charge":4341.6,"discounted_cash":1736.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.7 ML"},{"gross_charge":6145.62,"discounted_cash":2458.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.7 ML"}]},{"description":"EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148633","type":"CDM"},{"code":"65862049730","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"148637","type":"CDM"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 ML"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14868","type":"CDM"},{"code":"264959410","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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 ML"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14868","type":"CDM"},{"code":"338040903","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 ML"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14868","type":"CDM"},{"code":"264959420","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 = 250 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV 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NDC EA = 15 ML"}]},{"description":"CENTRUM OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149289","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 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":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149292","type":"CDM"},{"code":"17478051500","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.41,"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":"149304","type":"CDM"},{"code":"50242014201","type":"NDC"}],"standard_charges":[{"gross_charge":624.26,"discounted_cash":249.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":473.81,"discounted_cash":189.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"UBLITUXIMAB-XIIY 150 MG/6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149316","type":"CDM"},{"code":"73150015006","type":"NDC"}],"standard_charges":[{"gross_charge":1851.67,"discounted_cash":740.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"},{"gross_charge":1264.30,"discounted_cash":505.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 ML"}]},{"description":"TECHNETIUM TC 99M BICISATE IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149440","type":"CDM"},{"code":"11994000602","type":"NDC"}],"standard_charges":[{"gross_charge":53.21,"discounted_cash":21.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LECANEMAB-IRMB 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149521","type":"CDM"},{"code":"62856021201","type":"NDC"}],"standard_charges":[{"gross_charge":96.19,"discounted_cash":38.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":130.62,"discounted_cash":52.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"LECANEMAB-IRMB 500 MG/5ML IV 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"68462042121","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 = 210 ML"},{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 210 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"66993006272","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 = 210 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"66689006201","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 = 5 ML"},{"gross_charge":4.64,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"65162069388","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 = 210 ML"},{"gross_charge":1.60,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 210 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"65162069305","type":"NDC"}],"standard_charges":[{"gross_charge":1.60,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"31722062921","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 = 210 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NDC EA = 5 ML"}]},{"description":"ATOVAQUONE 750 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14953","type":"CDM"},{"code":"121101605","type":"NDC"}],"standard_charges":[{"gross_charge":2.90,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"LOSARTAN POTASSIUM-HCTZ 50-12.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"14958","type":"CDM"},{"code":"65862046890","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":0.08,"discounted_cash":0.03,"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":"TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"149687","type":"CDM"},{"code":"55513012301","type":"NDC"}],"standard_charges":[{"gross_charge":1447.68,"discounted_cash":579.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"},{"gross_charge":2447.73,"discounted_cash":979.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.91 ML"}]},{"description":"ROTAVIRUS VACCINE LIVE ORAL PO 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Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TIRZEPATIDE-WEIGHT MANAGEMENT 7.5 MG/0.5ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153139","type":"CDM"},{"code":"2248480","type":"NDC"}],"standard_charges":[{"gross_charge":377.80,"discounted_cash":151.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":526.89,"discounted_cash":210.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"TIRZEPATIDE-WEIGHT MANAGEMENT 10 MG/0.5ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153140","type":"CDM"},{"code":"2247180","type":"NDC"}],"standard_charges":[{"gross_charge":526.89,"discounted_cash":210.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 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SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153142","type":"CDM"},{"code":"2245701","type":"NDC"}],"standard_charges":[{"gross_charge":526.89,"discounted_cash":210.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":377.81,"discounted_cash":151.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR 4000 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153213","type":"CDM"},{"code":"53721201","type":"NDC"}],"standard_charges":[{"gross_charge":1946.36,"discounted_cash":778.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1220.13,"discounted_cash":488.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR 5000 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"153214","type":"CDM"},{"code":"53721301","type":"NDC"}],"standard_charges":[{"gross_charge":1512.6,"discounted_cash":605.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2398.24,"discounted_cash":959.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"SUMATRIPTAN SUCCINATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15327","type":"CDM"},{"code":"55111029109","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 = 9 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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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15328","type":"CDM"},{"code":"378563159","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"},{"gross_charge":0.55,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"},{"gross_charge":0.58,"discounted_cash":0.23,"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":"65862014736","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 = 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"},{"gross_charge":0.40,"discounted_cash":0.16,"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":"55111029209","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 = 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 EACH"},{"gross_charge":0.70,"discounted_cash":0.28,"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":"55111029236","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 = 36 EACH"},{"gross_charge":0.54,"discounted_cash":0.21,"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":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15330","type":"CDM"},{"code":"63323065130","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 ML"},{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV 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NDC EA = 30 ML"},{"gross_charge":0.49,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.93,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15330","type":"CDM"},{"code":"25021030730","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV 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TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15339","type":"CDM"},{"code":"16571020310","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":0.31,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICLOFENAC SODIUM 25 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15339","type":"CDM"},{"code":"68001027900","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.39,"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":0.56,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICLOFENAC SODIUM 50 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15340","type":"CDM"},{"code":"68001028000","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICLOFENAC SODIUM 75 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15341","type":"CDM"},{"code":"60687065811","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DICLOFENAC SODIUM 75 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15341","type":"CDM"},{"code":"68084033311","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":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DICLOFENAC SODIUM 75 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15341","type":"CDM"},{"code":"60687065801","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":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DICLOFENAC SODIUM 75 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15341","type":"CDM"},{"code":"68001028106","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IM 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"155590","type":"CDM"},{"code":"2940101","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 = 20 ML"},{"gross_charge":35.22,"discounted_cash":14.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ROFLUMILAST 0.15 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"155619","type":"CDM"},{"code":"80610011560","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":13.98,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"TISLELIZUMAB-JSGR 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"155910","type":"CDM"},{"code":"72579012101","type":"NDC"}],"standard_charges":[{"gross_charge":557.4,"discounted_cash":222.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"COVID-19MRNA VAC 6M-11Y MODERN 25 MCG/0.25ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156029","type":"CDM"},{"code":"80777029180","type":"NDC"}],"standard_charges":[{"gross_charge":355.52,"discounted_cash":142.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.25 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156146","type":"CDM"},{"code":"70748034001","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156148","type":"CDM"},{"code":"6483703","type":"NDC"}],"standard_charges":[{"gross_charge":211.71,"discounted_cash":84.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":211.03,"discounted_cash":84.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156162","type":"CDM"},{"code":"409318311","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 = 20 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"DULAGLUTIDE 0.75 MG/0.5ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156165","type":"CDM"},{"code":"2143301","type":"NDC"}],"standard_charges":[{"gross_charge":446.26,"discounted_cash":178.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":193.45,"discounted_cash":77.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DULAGLUTIDE 4.5 MG/0.5ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156168","type":"CDM"},{"code":"2318201","type":"NDC"}],"standard_charges":[{"gross_charge":333.78,"discounted_cash":133.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":446.26,"discounted_cash":178.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"DUPILUMAB 300 MG/2ML SC SOPN (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156184","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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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156295","type":"CDM"},{"code":"57894065002","type":"NDC"}],"standard_charges":[{"gross_charge":728.32,"discounted_cash":291.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":485.88,"discounted_cash":194.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"GUSELKUMAB 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156295","type":"CDM"},{"code":"57894065001","type":"NDC"}],"standard_charges":[{"gross_charge":485.88,"discounted_cash":194.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":728.32,"discounted_cash":291.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"OCRELIZUMAB-HYALURONIDASE-OCSQ 920-23000 MG-UT/23ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156301","type":"CDM"},{"code":"50242055401","type":"NDC"}],"standard_charges":[{"gross_charge":1300.97,"discounted_cash":520.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 23 ML"},{"gross_charge":1794.87,"discounted_cash":717.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 23 ML"}]},{"description":"ATEZOLIZUMAB-HYALURONIDAS-TQJS 1875-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156308","type":"CDM"},{"code":"50242093301","type":"NDC"}],"standard_charges":[{"gross_charge":772.62,"discounted_cash":309.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156356","type":"CDM"},{"code":"54643565002","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 = 100 ML"}]},{"description":"B-COMPLEX IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"156391","type":"CDM"},{"code":"67457014630","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":5.51,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"B-COMPLEX IJ 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pharmacy | NDC EA = 1 EACH"}]},{"description":"ALENDRONATE SODIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15661","type":"CDM"},{"code":"93514156","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"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15706","type":"CDM"},{"code":"121059516","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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML OR 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| 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":"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":"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":0.02,"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"},{"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":"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":"60505082306","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 = 3.7 ML"},{"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"}]},{"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":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":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":1.29,"discounted_cash":0.51,"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":"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":"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":"47335048588","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":0.32,"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"}]},{"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":"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":0.09,"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"}]},{"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":"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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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":"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 SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"15898","type":"CDM"},{"code":"703199501","type":"NDC"}],"standard_charges":[{"gross_charge":39.12,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":26.42,"discounted_cash":10.57,"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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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":"TELISOTUZUMAB VEDOTIN-TLLV 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"159112","type":"CDM"},{"code":"74104401","type":"NDC"}],"standard_charges":[{"gross_charge":2796.0,"discounted_cash":1118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2107.12,"discounted_cash":842.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TELISOTUZUMAB VEDOTIN-TLLV 100 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":11.37,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.09,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TRETINOIN (CHEMOTHERAPY) 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16005","type":"CDM"},{"code":"68084007521","type":"NDC"}],"standard_charges":[{"gross_charge":24.89,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":11.37,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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":"60505025701","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":0.66,"discounted_cash":0.27,"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":"DESMOPRESSIN ACETATE 0.1 MG OR 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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":"68001032500","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":0.38,"discounted_cash":0.15,"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":"DESMOPRESSIN ACETATE 0.1 MG OR 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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":"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":3.60,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.72,"discounted_cash":0.69,"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":1.55,"discounted_cash":0.62,"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":1.72,"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":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"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":0.22,"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":2.2,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 ML"},{"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"}]},{"description":"FAMCICLOVIR 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16081","type":"CDM"},{"code":"33342002507","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 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= 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":"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":0.13,"discounted_cash":0.05,"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":"RILUZOLE 50 MG OR 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Type: pharmacy | NDC EA = 60 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":0.27,"discounted_cash":0.11,"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":"ANASTROZOLE 1 MG OR 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= 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":"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":0.04,"discounted_cash":0.02,"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"}]},{"description":"CALCITRIOL 1 MCG/ML OR 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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":"CHLORDIAZEPOXIDE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1622","type":"CDM"},{"code":"51079037520","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CHLORDIAZEPOXIDE HCL 10 MG OR 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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 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NDC EA = 1 EACH"},{"gross_charge":7.22,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IJ SOLR CUSTOM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16371","type":"CDM"},{"code":"25021012250","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 EACH"},{"gross_charge":4.46,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.97,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IJ SOLR 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NDC EA = 1 EACH"},{"gross_charge":4.88,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IJ SOLR CUSTOM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"16371","type":"CDM"},{"code":"63323034020","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.35,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.88,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IJ SOLR 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NDC EA = 30 EACH"}]},{"description":"CLOMIPHENE CITRATE 50 MG OR 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":"68001023703","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 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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":"65219038302","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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":"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":"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":"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":"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":"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":"65219038304","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.39,"discounted_cash":0.16,"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":"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":1.16,"discounted_cash":0.47,"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":"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":"68001047547","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 = 28.4 G"},{"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":0.07,"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":"51672200202","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 G"},{"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"}]},{"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 CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1767","type":"CDM"},{"code":"45802043411","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.04,"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":"24385020503","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 = 28.4 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":0.11,"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":"24385020501","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":0.12,"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"}]},{"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":"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":0.04,"discounted_cash":0.01,"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"}]},{"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":0.37,"discounted_cash":0.15,"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":1.41,"discounted_cash":0.56,"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":0.76,"discounted_cash":0.31,"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"}]},{"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":1.31,"discounted_cash":0.52,"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"}]},{"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":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.44,"discounted_cash":0.18,"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":"70954003620","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 = 30 ML"},{"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":0.36,"discounted_cash":0.14,"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":"472022041","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"}]},{"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":0.06,"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"},{"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":"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":0.04,"discounted_cash":0.01,"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":0.10,"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":0.04,"discounted_cash":0.02,"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":0.08,"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":"68382037001","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 = 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":"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":0.11,"discounted_cash":0.05,"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":0.10,"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":"832046515","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.66,"discounted_cash":0.26,"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":0.99,"discounted_cash":0.40,"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":0.56,"discounted_cash":0.22,"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":0.81,"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"},{"gross_charge":0.35,"discounted_cash":0.14,"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":"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":"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":"173068224","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 = 8 G"},{"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"}]},{"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":"68180096301","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 = 8.5 G"},{"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":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":"85113201","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6.7 G"},{"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"}]},{"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":1.85,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"},{"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"}]},{"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":"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":"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":"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":"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":"24208041115","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 = 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"},{"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":"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":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"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":0.22,"discounted_cash":0.09,"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":"24208041105","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 = 5 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":2.62,"discounted_cash":1.05,"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":0.29,"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"}]},{"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":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 210 G"},{"gross_charge":0.56,"discounted_cash":0.23,"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":"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 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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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"}]},{"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":0.12,"discounted_cash":0.05,"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":"OLANZAPINE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17937","type":"CDM"},{"code":"904637661","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":0.02,"discounted_cash":0.0088,"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":"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":0.06,"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"},{"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":"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":0.39,"discounted_cash":0.16,"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"}]},{"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":0.21,"discounted_cash":0.08,"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 7.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17938","type":"CDM"},{"code":"62756055388","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":"DEXAMETHASONE 1 MG/ML OR CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17946","type":"CDM"},{"code":"54317644","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 = 30 ML"},{"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":0.68,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ZAFIRLUKAST 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17960","type":"CDM"},{"code":"68084005921","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 = 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"},{"gross_charge":1.21,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"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":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.34,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZAFIRLUKAST 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"17960","type":"CDM"},{"code":"55111062660","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 = 60 EACH"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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":"CODEINE SULFATE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1801","type":"CDM"},{"code":"54024324","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.31,"discounted_cash":0.12,"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":"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 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1802","type":"CDM"},{"code":"54024424","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":0.24,"discounted_cash":0.10,"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":"CODEINE SULFATE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1803","type":"CDM"},{"code":"527169901","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CODEINE SULFATE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1803","type":"CDM"},{"code":"54024525","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":1.22,"discounted_cash":0.49,"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":"DIMETHYL SULFOXIDE SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18072","type":"CDM"},{"code":"38779061405","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"SENNOSIDES 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"904652261","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":0.0096,"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":"904643480","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"SENNA 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"71399824503","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"}]},{"description":"SENNA 8.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18138","type":"CDM"},{"code":"69618006401","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"},{"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":"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":"SENNA 8.6 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1821","type":"CDM"},{"code":"31722089930","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 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"COLCHICINE 0.6 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"1821","type":"CDM"},{"code":"31722089901","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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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| NDC EA = 100 EACH"}]},{"description":"TORSEMIDE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18292","type":"CDM"},{"code":"31722053001","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":0.02,"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":"TORSEMIDE 10 MG OR 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= 100 EACH"}]},{"description":"TORSEMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18293","type":"CDM"},{"code":"68084053911","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":0.2,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TORSEMIDE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18294","type":"CDM"},{"code":"65862012801","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 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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":"RISPERIDONE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18310","type":"CDM"},{"code":"51079046520","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":"RISPERIDONE 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18310","type":"CDM"},{"code":"51079046501","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":"RISPERIDONE 4 MG OR 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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":"RISPERIDONE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18313","type":"CDM"},{"code":"904635961","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOBUTAMINE IN D5W 1 MG/ML IV 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NDC EA = 250 ML"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE IN D5W 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18314","type":"CDM"},{"code":"409234632","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":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE IN D5W 2 MG/ML IV 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| NDC EA = 100 EACH"}]},{"description":"BUPROPION SR (BID) 100 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18385","type":"CDM"},{"code":"70436005801","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":0.20,"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":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BUPROPION SR (BID) 100 MG OR 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| NDC EA = 100 EACH"}]},{"description":"BUPROPION SR (BID) 100 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18385","type":"CDM"},{"code":"50228017401","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":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"BUPROPION SR (BID) 100 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18385","type":"CDM"},{"code":"68084069711","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 = 1 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50 EACH"}]},{"description":"LEVOFLOXACIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18918","type":"CDM"},{"code":"65862053650","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 EACH"},{"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"LEVOFLOXACIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18918","type":"CDM"},{"code":"55111027950","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 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"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"LEVOFLOXACIN 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18918","type":"CDM"},{"code":"31722072150","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 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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":"LEVOFLOXACIN 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18919","type":"CDM"},{"code":"65862053750","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"TOPIRAMATE 25 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18920","type":"CDM"},{"code":"68084034211","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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18920","type":"CDM"},{"code":"68084034201","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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TOPIRAMATE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18921","type":"CDM"},{"code":"68084034521","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":0.51,"discounted_cash":0.21,"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":"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":"68084034411","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":0.13,"discounted_cash":0.05,"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":"TOPIRAMATE 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18922","type":"CDM"},{"code":"68462010960","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":0.0076,"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":"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":0.02,"discounted_cash":0.0076,"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":"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":"68084034401","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":0.13,"discounted_cash":0.05,"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":"LEVOFLOXACIN 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18925","type":"CDM"},{"code":"55150015730","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 ML"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML IV 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= 30 ML"},{"gross_charge":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18925","type":"CDM"},{"code":"25021013020","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 = 20 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"18925","type":"CDM"},{"code":"36000004501","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"}]},{"description":"LEVOFLOXACIN 25 MG/ML IV 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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 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":"NEEDLE (DISP) 25G X 1\" MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19001","type":"CDM"},{"code":"8290305125","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"}]},{"description":"SYRINGE 18G X 1-1/2\" 3 ML MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19074","type":"CDM"},{"code":"8290309580","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19146","type":"CDM"},{"code":"51079077601","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":"ATORVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19176","type":"CDM"},{"code":"68084009701","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"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":"ATORVASTATIN CALCIUM 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19176","type":"CDM"},{"code":"378395077","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":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 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":0.01,"discounted_cash":0.0056,"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":"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 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":0.21,"discounted_cash":0.08,"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":"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":0.29,"discounted_cash":0.12,"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":0.06,"discounted_cash":0.02,"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":"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":"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":"378395277","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":0.02,"discounted_cash":0.008,"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":"60505258009","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":0.22,"discounted_cash":0.09,"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":"68084009901","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":0.27,"discounted_cash":0.11,"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":"68084009911","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 = 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":"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":0.0088,"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":0.0076,"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":"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":0.66,"discounted_cash":0.26,"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"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA 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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":"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":"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":0.42,"discounted_cash":0.17,"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":0.65,"discounted_cash":0.26,"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":"59762100501","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 = 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":5.29,"discounted_cash":2.12,"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":"143972401","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 = 10 ML"},{"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":1.71,"discounted_cash":0.68,"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":"39822200001","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":1.34,"discounted_cash":0.54,"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":"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"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 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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":"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":0.90,"discounted_cash":0.36,"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":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO 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NDC EA = 3.5 G"},{"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"}]},{"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":0.84,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3.5 G"},{"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"}]},{"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":12.56,"discounted_cash":5.02,"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":"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":"54288012301","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":6.39,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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":7.57,"discounted_cash":3.03,"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":7.60,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":5.28,"discounted_cash":2.11,"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":1.18,"discounted_cash":0.47,"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":"17478020605","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":4.24,"discounted_cash":1.69,"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":"42702010305","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 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"},{"gross_charge":3.41,"discounted_cash":1.36,"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":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":6.60,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":"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 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 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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9.4 G"},{"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"}]},{"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 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":"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":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"},{"gross_charge":11.59,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"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":11.59,"discounted_cash":4.64,"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"}]},{"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":"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":"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":0.14,"discounted_cash":0.06,"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":3.8,"discounted_cash":1.52,"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 EA = 5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19714","type":"CDM"},{"code":"24208045705","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 = 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"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19714","type":"CDM"},{"code":"24208045725","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.53,"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":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19733","type":"CDM"},{"code":"23218105","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":49.80,"discounted_cash":19.92,"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":"60505100301","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 = 5 ML"},{"gross_charge":1.24,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19733","type":"CDM"},{"code":"61314012605","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 = 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":"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":5.62,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.84,"discounted_cash":0.34,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19733","type":"CDM"},{"code":"60505100302","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19736","type":"CDM"},{"code":"548540000","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 = 1 ML"},{"gross_charge":10.67,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":14.47,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"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":0.47,"discounted_cash":0.19,"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":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19741","type":"CDM"},{"code":"115147446","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 = 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":"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":"66993096245","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 = 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":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":0.12,"discounted_cash":0.05,"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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19746","type":"CDM"},{"code":"24208043405","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":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.15,"discounted_cash":1.26,"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":"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 ML"},{"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":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19746","type":"CDM"},{"code":"24208043410","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":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.51,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19746","type":"CDM"},{"code":"11980077905","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 = 5 ML"},{"gross_charge":22.43,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PRAMOXINE HCL 1 % RE FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19749","type":"CDM"},{"code":"51862018015","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.81,"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":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"}]},{"description":"PRAMOXINE HCL 1 % RE FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"19749","type":"CDM"},{"code":"37682315","type":"NDC"}],"standard_charges":[{"gross_charge":7.07,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":3.13,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":2.63,"discounted_cash":1.05,"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 56 G"},{"gross_charge":0.03,"discounted_cash":0.01,"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":"65064435","type":"NDC"}],"standard_charges":[{"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"},{"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":"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":"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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 85 G"}]},{"description":"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":0.51,"discounted_cash":0.21,"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":"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":"72819023416","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":"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 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":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"},{"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":1.43,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.74,"discounted_cash":0.69,"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":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":"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":"60687023101","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.13,"discounted_cash":0.05,"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":"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":"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":"68180035103","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":0.02,"discounted_cash":0.008,"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"}]},{"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.01,"discounted_cash":0.004,"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":"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":"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":0.42,"discounted_cash":0.17,"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":1.36,"discounted_cash":0.55,"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":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":1.61,"discounted_cash":0.64,"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":"70069000501","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 = 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"},{"gross_charge":1.44,"discounted_cash":0.58,"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":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":0.98,"discounted_cash":0.39,"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":0.88,"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"},{"gross_charge":0.89,"discounted_cash":0.35,"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":2.88,"discounted_cash":1.15,"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":0.01,"discounted_cash":0.0056,"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":"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":"69680011225","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 = 1 ML"},{"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"}]},{"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":"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":67.81,"discounted_cash":27.12,"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":32.55,"discounted_cash":13.02,"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":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 454 G"},{"gross_charge":0.02,"discounted_cash":0.0076,"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":"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":"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":0.94,"discounted_cash":0.38,"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"}]},{"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":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.58,"discounted_cash":0.23,"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":"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":0.04,"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":"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":0.13,"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":0.05,"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":"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":"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":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"},{"gross_charge":1.68,"discounted_cash":0.67,"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":0.22,"discounted_cash":0.09,"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":5.33,"discounted_cash":2.13,"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":"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 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NDC EA = 15 ML"}]},{"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":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"},{"gross_charge":11.74,"discounted_cash":4.70,"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":"8373982600","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":15.73,"discounted_cash":6.29,"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":"70710111001","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":0.008,"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":"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":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"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":0.05,"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":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"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":"172524160","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 = 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":"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 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":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"},{"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":"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":"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":"409669512","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"},{"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":0.20,"discounted_cash":0.08,"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 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"65219044501","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 ML"}]},{"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":"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":"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":"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":0.18,"discounted_cash":0.07,"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":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"20472","type":"CDM"},{"code":"72266014601","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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| 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":"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":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 EACH"}]},{"description":"MELOXICAM 7.5 MG OR 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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 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 15 MG OR 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SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2090","type":"CDM"},{"code":"63323012700","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"}]},{"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 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= 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"},{"gross_charge":1.26,"discounted_cash":0.51,"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":"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":"781808926","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 = 6 EACH"},{"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":0.20,"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":"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":"AZITHROMYCIN 250 MG OR 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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":"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 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= 1 EACH"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21063","type":"CDM"},{"code":"55150017410","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 = 1 EACH"},{"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":1.96,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AZITHROMYCIN 500 MG IV 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= 1 EACH"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21063","type":"CDM"},{"code":"67457086050","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 = 1 EACH"}]},{"description":"FLUOXETINE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"21086","type":"CDM"},{"code":"93719801","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DAKINS (FULL STRENGTH) 0.5 % EX 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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":"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 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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":"904663861","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":0.26,"discounted_cash":0.10,"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":"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 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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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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":"67877024601","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":"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":"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":"IRBESARTAN 150 MG OR 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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":"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":65.21,"discounted_cash":26.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":179.91,"discounted_cash":71.96,"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":57.17,"discounted_cash":22.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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"}]},{"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":0.85,"discounted_cash":0.34,"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":6.27,"discounted_cash":2.51,"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":"85128801","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 17 G"},{"gross_charge":0.08,"discounted_cash":0.03,"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":"58160096412","type":"NDC"}],"standard_charges":[{"gross_charge":293.12,"discounted_cash":117.25,"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":276.53,"discounted_cash":110.61,"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":"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":"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":"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":0.17,"discounted_cash":0.07,"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":"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":0.04,"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":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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":0.06,"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":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 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":0.59,"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"},{"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":"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":"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":"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":0.05,"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"},{"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":"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":"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":250.39,"discounted_cash":100.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"},{"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"}]},{"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":3.65,"discounted_cash":1.46,"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":"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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":116.58,"discounted_cash":46.63,"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":"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":"68462049833","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.81,"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":0.29,"discounted_cash":0.12,"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":"60687073179","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 = 5 ML"},{"gross_charge":2.14,"discounted_cash":0.85,"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":"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 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CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"50268057411","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":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"50268057415","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 = 50 EACH"},{"gross_charge":0.56,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"},{"gross_charge":0.47,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"57237021330","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 = 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"},{"gross_charge":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"31722072830","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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"603465402","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 = 90 EACH"},{"gross_charge":0.78,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"29300022210","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 = 1000 EACH"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 EACH"}]},{"description":"MONTELUKAST SODIUM 5 MG OR CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22510","type":"CDM"},{"code":"93742598","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 = 90 EACH"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML OR 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Type: pharmacy | NDC EA = 473 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22560","type":"CDM"},{"code":"70954025810","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 = 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":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22560","type":"CDM"},{"code":"99912574980","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22584","type":"CDM"},{"code":"169008181","type":"NDC"}],"standard_charges":[{"gross_charge":5.80,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"REPAGLINIDE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22586","type":"CDM"},{"code":"57664074588","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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"REPAGLINIDE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22586","type":"CDM"},{"code":"574024101","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":0.18,"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"}]},{"description":"REPAGLINIDE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22586","type":"CDM"},{"code":"378312201","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"REPAGLINIDE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22586","type":"CDM"},{"code":"65862067101","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":0.11,"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":"LOSARTAN POTASSIUM 100 MG OR 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":0.02,"discounted_cash":0.0072,"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":0.04,"discounted_cash":0.01,"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 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Charge Type: pharmacy | NDC EA = 15 ML"}]},{"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":0.72,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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"}]},{"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":1.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.81,"discounted_cash":0.32,"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":"58914078510","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.27,"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":"60687052721","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 = 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"},{"gross_charge":1.71,"discounted_cash":0.68,"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":"49884041201","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 = 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":"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":"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":"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":12.01,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":10.43,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"22661","type":"CDM"},{"code":"703523311","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":30.21,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"},{"gross_charge":12.01,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 ML"}]},{"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":2.15,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.88,"discounted_cash":1.15,"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":"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":"82260029905","type":"NDC"}],"standard_charges":[{"gross_charge":25.26,"discounted_cash":10.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.18,"discounted_cash":1.27,"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":2.81,"discounted_cash":1.13,"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":"22719","type":"CDM"},{"code":"13668009390","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":0.02,"discounted_cash":0.0064,"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":"29300023916","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.36,"discounted_cash":0.14,"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":"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":"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 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":1.22,"discounted_cash":0.49,"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":"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":0.02,"discounted_cash":0.0064,"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":0.24,"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":"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 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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":"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":0.05,"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":0.01,"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"}]},{"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":0.37,"discounted_cash":0.15,"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":0.12,"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":"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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":0.29,"discounted_cash":0.12,"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":"51672128003","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 = 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":0.13,"discounted_cash":0.05,"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":"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":1.59,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":26.02,"discounted_cash":10.41,"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":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.74,"discounted_cash":0.29,"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":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"},{"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":"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":3.12,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"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":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":"82584060510","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":21.90,"discounted_cash":8.76,"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":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":0.40,"discounted_cash":0.16,"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":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.81,"discounted_cash":0.72,"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":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.53,"discounted_cash":0.21,"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":"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":"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":"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":"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 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 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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":"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":0.54,"discounted_cash":0.22,"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":0.22,"discounted_cash":0.09,"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":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.53,"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":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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":0.68,"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":"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":"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 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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":"65219062202","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 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pharmacy | NDC EA = 100 EACH"}]},{"description":"CLINIMIX E/DEXTROSE (2.75/5) 2.75 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23160","type":"CDM"},{"code":"338114203","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 ML"},{"gross_charge":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 ML"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXAMETHASONE 0.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2319","type":"CDM"},{"code":"64980050924","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 = 237 ML"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"}]},{"description":"DEXAMETHASONE 0.5 MG/5ML OR ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2319","type":"CDM"},{"code":"64980050905","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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2320","type":"CDM"},{"code":"54317763","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":"DEXAMETHASONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2322","type":"CDM"},{"code":"54817925","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":0.16,"discounted_cash":0.06,"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":"DEXAMETHASONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2322","type":"CDM"},{"code":"54417925","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":0.10,"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":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXAMETHASONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2322","type":"CDM"},{"code":"60505624901","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":"DEXAMETHASONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2322","type":"CDM"},{"code":"48102004501","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":"CANDESARTAN CILEXETIL 4 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23229","type":"CDM"},{"code":"186000431","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 = 30 EACH"}]},{"description":"CANDESARTAN CILEXETIL 16 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23231","type":"CDM"},{"code":"186001631","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"}]},{"description":"MAFENIDE ACETATE 5 % EX PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23233","type":"CDM"},{"code":"49884090252","type":"NDC"}],"standard_charges":[{"gross_charge":50.73,"discounted_cash":20.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MAFENIDE ACETATE 5 % EX PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23233","type":"CDM"},{"code":"51079062485","type":"NDC"}],"standard_charges":[{"gross_charge":110.23,"discounted_cash":44.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":133.74,"discounted_cash":53.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"MAFENIDE ACETATE 5 % EX PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23233","type":"CDM"},{"code":"50742031050","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":86.49,"discounted_cash":34.59,"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"}]},{"description":"DEXAMETHASONE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2324","type":"CDM"},{"code":"60505625101","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXAMETHASONE 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2324","type":"CDM"},{"code":"54817425","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DEXAMETHASONE 1 MG OR 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| NDC EA = 18 EACH"},{"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":0.47,"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 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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":"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 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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":"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":"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":"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":0.06,"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":0.15,"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":0.11,"discounted_cash":0.04,"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 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":"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 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 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":"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":"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":0.01,"discounted_cash":0.0048,"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":"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":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 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EACH"},{"gross_charge":55.62,"discounted_cash":22.25,"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":"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":"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":0.01,"discounted_cash":0.0056,"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":"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 ML"},{"gross_charge":0.01,"discounted_cash":0.0056,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"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 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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 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"76329330101","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"69374095350","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 = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409751766","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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"76329330201","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 = 50 ML"},{"gross_charge":0.36,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409751716","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 = 50 ML"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409664816","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 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":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409490234","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 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":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409490264","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"},{"gross_charge":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2365","type":"CDM"},{"code":"409664802","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 70 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2367","type":"CDM"},{"code":"338071906","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 = 2000 ML"}]},{"description":"INFLIXIMAB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23796","type":"CDM"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":101.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":186.4,"discounted_cash":74.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1055.83,"discounted_cash":422.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLIXIMAB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23796","type":"CDM"},{"code":"57894016001","type":"NDC"}],"standard_charges":[{"gross_charge":260.54,"discounted_cash":104.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":186.4,"discounted_cash":74.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":429.45,"discounted_cash":171.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ATOVAQUONE-PROGUANIL HCL 250-100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23814","type":"CDM"},{"code":"173067502","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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":"70710115703","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 = 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":"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"23872","type":"CDM"},{"code":"60505250201","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.41,"discounted_cash":0.96,"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":"70710115803","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.61,"discounted_cash":0.25,"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":"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":0.66,"discounted_cash":0.27,"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"}]},{"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 = 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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":"MYCOPHENOLATE MOFETIL HCL 500 MG IV 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pharmacy | NDC EA = 1 EACH"},{"gross_charge":22.60,"discounted_cash":9.04,"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":12.88,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":22.60,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 5 MG/ML IJ 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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":0.04,"discounted_cash":0.02,"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":"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":"54162001101","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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SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24176","type":"CDM"},{"code":"54356699","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 = 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"},{"gross_charge":0.20,"discounted_cash":0.08,"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":"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 = 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NDC EA = 5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"60687036911","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":0.42,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2418","type":"CDM"},{"code":"591079401","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":0.02,"discounted_cash":0.006,"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":"59651071901","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":0.14,"discounted_cash":0.06,"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":"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 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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":0.22,"discounted_cash":0.09,"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 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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":0.02,"discounted_cash":0.008,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 ML"},{"gross_charge":0.04,"discounted_cash":0.01,"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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24335","type":"CDM"},{"code":"597004037","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 = 30 EACH"},{"gross_charge":4.25,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TELMISARTAN 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24336","type":"CDM"},{"code":"68382047378","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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TELMISARTAN 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24336","type":"CDM"},{"code":"68382047330","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":0.26,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TELMISARTAN 80 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24336","type":"CDM"},{"code":"597004137","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 = 30 EACH"},{"gross_charge":4.21,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":504.14,"discounted_cash":201.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":57.13,"discounted_cash":22.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":39.62,"discounted_cash":15.85,"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":"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":"LEUPROLIDE ACETATE 1 MG/0.2ML IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24362","type":"CDM"},{"code":"55150047801","type":"NDC"}],"standard_charges":[{"gross_charge":21.11,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":397.25,"discounted_cash":158.9,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24385","type":"CDM"},{"code":"50383090110","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.99,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.56,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1-2 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24385","type":"CDM"},{"code":"51672300701","type":"NDC"}],"standard_charges":[{"gross_charge":7.81,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"70010006505","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 = 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":"METFORMIN HCL 1000 MG OR 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pharmacy | NDC EA = 1 EACH"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24409","type":"CDM"},{"code":"58468003002","type":"NDC"}],"standard_charges":[{"gross_charge":198.35,"discounted_cash":79.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2123.23,"discounted_cash":849.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":265.98,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LAMIVUDINE 100 MG OR 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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":"ISOSORBIDE MONONITRATE CR 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24521","type":"CDM"},{"code":"68084059101","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"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":"ISOSORBIDE MONONITRATE CR 30 MG OR 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pharmacy | NDC EA = 100 EACH"}]},{"description":"ISOSORBIDE MONONITRATE CR 30 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24521","type":"CDM"},{"code":"60687078311","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":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CHOLECALCIFEROL 400 UNIT OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24559","type":"CDM"},{"code":"77333094810","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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24559","type":"CDM"},{"code":"904582360","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 400 UNIT OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24559","type":"CDM"},{"code":"77333094825","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":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV 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EA = 30 EACH"},{"gross_charge":5.76,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.84,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CETAPHIL EX LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24674","type":"CDM"},{"code":"299392716","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":"COENZYME Q10 100 MG OR 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NDC EA = 500 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 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":"DILTIAZEM HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2475","type":"CDM"},{"code":"50228048105","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 = 500 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100 EACH"}]},{"description":"DILTIAZEM HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2475","type":"CDM"},{"code":"51079074520","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"}]},{"description":"DILTIAZEM HCL 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2476","type":"CDM"},{"code":"93031901","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DILTIAZEM HCL 60 MG OR 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= 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":"TACROLIMUS 0.5 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"24914","type":"CDM"},{"code":"16729004101","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":0.10,"discounted_cash":0.04,"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":"TACROLIMUS 0.5 MG OR 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NDC EA = 3 ML"},{"gross_charge":0.09,"discounted_cash":0.04,"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":"378827031","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 = 3 ML"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML OR 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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":"CIPROFLOXACIN HCL 500 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25119","type":"CDM"},{"code":"60687086011","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":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CIPROFLOXACIN HCL 500 MG OR 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EA = 30 EACH"}]},{"description":"DISULFIRAM 250 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2540","type":"CDM"},{"code":"64980017101","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":"ALLOPURINOL SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25408","type":"CDM"},{"code":"67457018750","type":"NDC"}],"standard_charges":[{"gross_charge":1121.09,"discounted_cash":448.44,"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":"POLYETHYLENE GLYCOL 3350 OR 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EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25424","type":"CDM"},{"code":"60687043192","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 = 100 EACH"},{"gross_charge":0.81,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.45,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25424","type":"CDM"},{"code":"99917025424","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 = 8.5 G"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.5 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25424","type":"CDM"},{"code":"11523726808","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":1.24,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25424","type":"CDM"},{"code":"11523723401","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 = 1 EACH"},{"gross_charge":1.36,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25424","type":"CDM"},{"code":"41100080676","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 = 10 EACH"}]},{"description":"DIVALPROEX DR 125 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2551","type":"CDM"},{"code":"29300013801","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 = 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":"DIVALPROEX DR 125 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2551","type":"CDM"},{"code":"57237004601","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":"DIVALPROEX DR 125 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2551","type":"CDM"},{"code":"62756079688","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"},{"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":"DIVALPROEX DR 125 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2551","type":"CDM"},{"code":"68001047200","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":"DIVALPROEX DR 125 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2551","type":"CDM"},{"code":"245018001","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CHLORAMPHENICOL SOD SUCCINATE 1 GM IV 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EA = 1 EACH"}]},{"description":"RISPERIDONE 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25519","type":"CDM"},{"code":"51079046020","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":"RISPERIDONE 0.25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25519","type":"CDM"},{"code":"51079046001","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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"RISPERIDONE 0.25 MG OR 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TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"60687086811","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":"DIVALPROEX DR 250 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"832712389","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"68001047300","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":0.03,"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":"DIVALPROEX DR 250 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"62756079788","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":0.11,"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"}]},{"description":"DIVALPROEX DR 250 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"62756079713","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":0.03,"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":0.0076,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"DIVALPROEX DR 250 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"74621413","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 = 100 EACH"}]},{"description":"DIVALPROEX DR 250 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2552","type":"CDM"},{"code":"29300013901","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":0.0096,"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":"RISPERIDONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25520","type":"CDM"},{"code":"50458030201","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.91,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"RISPERIDONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25520","type":"CDM"},{"code":"43547034006","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":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"RISPERIDONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25520","type":"CDM"},{"code":"50458059110","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":"RISPERIDONE 0.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25520","type":"CDM"},{"code":"68084027111","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"PIOGLITAZONE HCL 15 MG OR 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NDC EA = 30 EACH"},{"gross_charge":1.29,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PIOGLITAZONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25528","type":"CDM"},{"code":"68084087801","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 = 100 EACH"}]},{"description":"PIOGLITAZONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25528","type":"CDM"},{"code":"33342005407","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"PIOGLITAZONE HCL 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25528","type":"CDM"},{"code":"16729002015","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PIOGLITAZONE HCL 15 MG OR 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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"}]},{"description":"PIOGLITAZONE HCL 30 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25529","type":"CDM"},{"code":"33342005510","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 = 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"},{"gross_charge":0.02,"discounted_cash":0.0092,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PIOGLITAZONE HCL 30 MG OR 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= 1 EACH"}]},{"description":"DIVALPROEX DR 500 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2553","type":"CDM"},{"code":"904686161","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIVALPROEX DR 500 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2553","type":"CDM"},{"code":"60687087911","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 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NDC EA = 100 EACH"}]},{"description":"DIVALPROEX DR 500 MG OR TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2553","type":"CDM"},{"code":"68084078261","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"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"PIOGLITAZONE HCL 45 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25530","type":"CDM"},{"code":"64764045124","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 100 EACH"}]},{"description":"DOCUSATE SODIUM 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2566","type":"CDM"},{"code":"57896040110","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 = 1000 EACH"},{"gross_charge":0.01,"discounted_cash":0.0048,"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":"DOCUSATE SODIUM 100 MG OR 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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":"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":"904728180","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 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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":"904699960","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":0.03,"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":"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 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":"DOCUSATE SODIUM 250 MG OR 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":"50268026811","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":"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 250 MG OR 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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":"121187010","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":0.17,"discounted_cash":0.07,"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":"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":"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":"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":"121187000","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":0.17,"discounted_cash":0.07,"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":"121054410","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":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"ALCOHOL 98 % IJ 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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":"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":2.03,"discounted_cash":0.81,"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"}]},{"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":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"},{"gross_charge":3.23,"discounted_cash":1.29,"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":"68001041103","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 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":0.07,"discounted_cash":0.03,"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":"51224002160","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"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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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":0.19,"discounted_cash":0.08,"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":"60687050711","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":0.19,"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"}]},{"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":"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 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":0.08,"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":0.0092,"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":"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":975.38,"discounted_cash":390.15,"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"}]},{"description":"TEMOZOLOMIDE 5 MG OR 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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":0.34,"discounted_cash":0.14,"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":"67877053714","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 = 14 EACH"},{"gross_charge":0.89,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"TEMOZOLOMIDE 20 MG OR 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EACH"},{"gross_charge":76.82,"discounted_cash":30.73,"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":"16571081751","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 = 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":"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 CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25893","type":"CDM"},{"code":"51862008414","type":"NDC"}],"standard_charges":[{"gross_charge":26.99,"discounted_cash":10.80,"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":"47335089174","type":"NDC"}],"standard_charges":[{"gross_charge":1.60,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":4.76,"discounted_cash":1.90,"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":"47335089160","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.69,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25894","type":"CDM"},{"code":"47335089274","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":4.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":2.17,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25894","type":"CDM"},{"code":"16571081841","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":22.59,"discounted_cash":9.04,"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":"47335089260","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.17,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.38,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25894","type":"CDM"},{"code":"16729005053","type":"NDC"}],"standard_charges":[{"gross_charge":22.59,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":2.10,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":5.08,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG OR 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NDC EA = 14 EACH"},{"gross_charge":18.95,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 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":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"},{"gross_charge":141.79,"discounted_cash":56.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25895","type":"CDM"},{"code":"16729005153","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":9.51,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":46.24,"discounted_cash":18.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25895","type":"CDM"},{"code":"16571082151","type":"NDC"}],"standard_charges":[{"gross_charge":46.24,"discounted_cash":18.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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EACH"},{"gross_charge":40.24,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"TEMOZOLOMIDE 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25895","type":"CDM"},{"code":"85141701","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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":1.07,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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":"409910420","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":0.51,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2595","type":"CDM"},{"code":"409582001","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":0.43,"discounted_cash":0.17,"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":"143925401","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":0.44,"discounted_cash":0.17,"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":"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":0.04,"discounted_cash":0.02,"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 Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ZALEPLON 10 MG OR 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EA = 20 ML"},{"gross_charge":1.83,"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":1.82,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":2.40,"discounted_cash":0.96,"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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100 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":0.50,"discounted_cash":0.20,"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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOXEPIN HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2611","type":"CDM"},{"code":"51079043720","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":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOXEPIN HCL 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2611","type":"CDM"},{"code":"51079043701","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 EACH"},{"gross_charge":0.29,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"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":0.42,"discounted_cash":0.17,"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":0.86,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DOXEPIN HCL 10 MG/ML OR 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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"},{"gross_charge":0.48,"discounted_cash":0.19,"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 SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"25021020751","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 = 100 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"69027702","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"69303220","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 = 25 ML"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"63323088330","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 = 25 ML"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"70860020825","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 = 25 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"69303420","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 = 100 ML"},{"gross_charge":0.26,"discounted_cash":0.10,"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":"69303320","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 = 75 ML"},{"gross_charge":0.44,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 75 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"69035820","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 = 5 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"69303120","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":0.26,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2616","type":"CDM"},{"code":"25021020725","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 = 25 ML"},{"gross_charge":0.57,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 25 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2654","type":"CDM"},{"code":"517970225","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 = 2 ML"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":4.32,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"47781047013","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 EACH"},{"gross_charge":2.68,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":2.27,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"72205004411","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 = 10 EACH"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":1.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"70710101002","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 = 10 EACH"},{"gross_charge":1.11,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"69238126601","type":"NDC"}],"standard_charges":[{"gross_charge":7.89,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":1.70,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":2.87,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"64380079901","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 = 10 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"4080085","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 = 10 EACH"},{"gross_charge":4.26,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":13.67,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"31722063231","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 = 10 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26546","type":"CDM"},{"code":"68180067711","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 EACH"},{"gross_charge":2.11,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"65862065401","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"781557801","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":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.30,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"47335000788","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"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"51079027301","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 = 1 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"51079027303","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 = 30 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"60687018811","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 EACH"},{"gross_charge":2.01,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ENTACAPONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26547","type":"CDM"},{"code":"64679078102","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":"PROGESTERONE 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26550","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":"EXEMESTANE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26551","type":"CDM"},{"code":"832059530","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":0.36,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.05,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"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":1.43,"discounted_cash":0.57,"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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EXEMESTANE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26551","type":"CDM"},{"code":"54008013","type":"NDC"}],"standard_charges":[{"gross_charge":9.82,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.61,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"RENA-VITE OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"26687","type":"CDM"},{"code":"60258016001","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":0.05,"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":"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":0.83,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":3.30,"discounted_cash":1.32,"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":1.57,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":1.52,"discounted_cash":0.61,"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":"72485010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"},{"gross_charge":2.36,"discounted_cash":0.95,"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":"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":"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":"31722053712","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":0.10,"discounted_cash":0.04,"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"}]},{"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":0.18,"discounted_cash":0.07,"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"}]},{"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":0.04,"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"},{"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":"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":"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":"68084087011","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":0.03,"discounted_cash":0.01,"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":"31722053705","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":0.02,"discounted_cash":0.008,"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":"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":"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":"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":"904712461","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":0.19,"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":"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":0.42,"discounted_cash":0.17,"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":0.18,"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":"904605261","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":0.12,"discounted_cash":0.05,"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":0.09,"discounted_cash":0.04,"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 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":"50474059640","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 = 120 EACH"},{"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"}]},{"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":0.11,"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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.40,"discounted_cash":0.56,"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":2.66,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.28,"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"}]},{"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":"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":0.17,"discounted_cash":0.07,"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":"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":"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":"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":"59651011860","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":0.19,"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"}]},{"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":"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":"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 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":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"},{"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":"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":"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 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":0.16,"discounted_cash":0.06,"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 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":10.97,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"},{"gross_charge":0.22,"discounted_cash":0.09,"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":"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":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.43 ML"},{"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"}]},{"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":"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":"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":82.27,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":71.86,"discounted_cash":28.74,"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 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":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"},{"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 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":"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":"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":0.20,"discounted_cash":0.08,"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"},{"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":"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":0.26,"discounted_cash":0.10,"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":"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":0.05,"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"},{"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":0.18,"discounted_cash":0.07,"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":"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":"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":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":41.01,"discounted_cash":16.40,"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":"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":"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":"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":"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":"28595055049","type":"NDC"}],"standard_charges":[{"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"},{"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":0.09,"discounted_cash":0.03,"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":"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":"574052104","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":0.1,"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":"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":"66689020204","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 ML"},{"gross_charge":0.09,"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":"574052174","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 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"},{"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":"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 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pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"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":3.09,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":3.71,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"NIACIN (ANTIHYPERLIPIDEMIC) 1000 MG OR 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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":"CEFTAZIDIME 2 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27291","type":"CDM"},{"code":"409508411","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.46,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 2 GM IV 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NDC EA = 1 EACH"}]},{"description":"CEFUROXIME SODIUM 1.5 GM IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27299","type":"CDM"},{"code":"143997790","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 = 1 EACH"},{"gross_charge":2.75,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.15,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IV 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1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27311","type":"CDM"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":5.48,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":2.16,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 2 GM IJ SOLR 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PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27507","type":"CDM"},{"code":"555101116","type":"NDC"}],"standard_charges":[{"gross_charge":57.43,"discounted_cash":22.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":14.91,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"ALPROSTADIL (VASODILATOR) 250 MCG UR PLLT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27509","type":"CDM"},{"code":"37812006","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 = 6 EACH"},{"gross_charge":6.56,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"},{"gross_charge":61.36,"discounted_cash":24.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27629","type":"CDM"},{"code":"378370159","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27630","type":"CDM"},{"code":"378370259","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 9 EACH"}]},{"description":"DIVALPROEX SPRINKLES 125 MG OR CPSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27631","type":"CDM"},{"code":"27241011501","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"},{"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":"DIVALPROEX SPRINKLES 125 MG OR CPSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27631","type":"CDM"},{"code":"68084031301","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":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DIVALPROEX SPRINKLES 125 MG OR CPSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27631","type":"CDM"},{"code":"68084031311","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27632","type":"CDM"},{"code":"29033002012","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 = 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"},{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27632","type":"CDM"},{"code":"60505280607","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 = 120 EACH"},{"gross_charge":1.34,"discounted_cash":0.54,"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":"CARBAMAZEPINE 200 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27632","type":"CDM"},{"code":"66993040832","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 = 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"},{"gross_charge":1.47,"discounted_cash":0.59,"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":1.48,"discounted_cash":0.59,"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"},{"gross_charge":0.37,"discounted_cash":0.15,"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":"66993040932","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 = 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":0.41,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":0.05,"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 TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27634","type":"CDM"},{"code":"781801601","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":0.15,"discounted_cash":0.06,"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":"78051005","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"}]},{"description":"CARBAMAZEPINE 100 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27634","type":"CDM"},{"code":"51672412301","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":0.07,"discounted_cash":0.03,"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":"59746078901","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":0.23,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27635","type":"CDM"},{"code":"60687058311","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":"51672412401","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":0.40,"discounted_cash":0.16,"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":"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":1.17,"discounted_cash":0.47,"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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27635","type":"CDM"},{"code":"68084056121","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 = 30 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"CARBAMAZEPINE 200 MG OR TB12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27635","type":"CDM"},{"code":"68084056111","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 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"},{"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":"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 CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27644","type":"CDM"},{"code":"597000160","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 = 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":"ASPIRIN-DIPYRIDAMOLE 25-200 MG OR CP12","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27644","type":"CDM"},{"code":"93304006","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 = 60 EACH"}]},{"description":"NIFEDIPINE CR OSMOTIC 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27659","type":"CDM"},{"code":"62175026137","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 = 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":"NIFEDIPINE CR OSMOTIC 60 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27659","type":"CDM"},{"code":"50742026101","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":"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":"59762669208","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"}]},{"description":"NIFEDIPINE CR OSMOTIC 90 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27660","type":"CDM"},{"code":"50742026201","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":0.08,"discounted_cash":0.03,"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":"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":"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":6.01,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":6.00,"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 STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27663","type":"CDM"},{"code":"17478040401","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27663","type":"CDM"},{"code":"83851010030","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 = 300 EACH"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27663","type":"CDM"},{"code":"17238090011","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"}]},{"description":"LANSOPRAZOLE 15 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27691","type":"CDM"},{"code":"68001011104","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":0.28,"discounted_cash":0.11,"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":"LANSOPRAZOLE 30 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27692","type":"CDM"},{"code":"68001011203","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 = 500 EACH"},{"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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 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":0.09,"discounted_cash":0.03,"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":"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":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.80,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"OMEPRAZOLE 10 MG OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27693","type":"CDM"},{"code":"62175011432","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 EACH"}]},{"description":"OMEPRAZOLE 20 MG OR 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= 100 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27838","type":"CDM"},{"code":"81826000112","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 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27838","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":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27838","type":"CDM"},{"code":"264780020","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 = 250 ML"}]},{"description":"WHITE PETROLATUM GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27849","type":"CDM"},{"code":"8884433200","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 G"}]},{"description":"WHITE PETROLATUM GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27849","type":"CDM"},{"code":"521231100","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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EA = 1 EACH"}]},{"description":"VENLAFAXINE HCL 37.5 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27857","type":"CDM"},{"code":"65862052730","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VENLAFAXINE HCL 37.5 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27857","type":"CDM"},{"code":"65862052790","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 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CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27858","type":"CDM"},{"code":"65862052890","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.11,"discounted_cash":0.04,"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":"93738598","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 = 90 EACH"},{"gross_charge":0.25,"discounted_cash":0.1,"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":"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":"904624761","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":"VENLAFAXINE HCL 150 MG OR 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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"},{"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":"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":0.05,"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":0.01,"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":"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 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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":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"gross_charge":0.80,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"}]},{"description":"NICOTINE 14 MG/24HR TD 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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":1.55,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 14 EACH"},{"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"}]},{"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":0.71,"discounted_cash":0.28,"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"},{"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":1.23,"discounted_cash":0.49,"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":"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":0.77,"discounted_cash":0.31,"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":"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":0.05,"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":0.04,"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"},{"gross_charge":0.09,"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":"50383077515","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":0.05,"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"}]},{"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":"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":"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":"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":"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":"54350015","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":0.01,"discounted_cash":0.0056,"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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27898","type":"CDM"},{"code":"62135071242","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 = 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":"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":"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":"406912576","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":5.28,"discounted_cash":2.11,"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":"406902576","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 = 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 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EACH"},{"gross_charge":1.66,"discounted_cash":0.66,"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":"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 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 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1 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 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27907","type":"CDM"},{"code":"378912398","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":18.1,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":3.47,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27907","type":"CDM"},{"code":"406907576","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 = 5 EACH"},{"gross_charge":7.24,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":1.30,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL 75 MCG/HR TD 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Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.19,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":3.44,"discounted_cash":1.38,"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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EACH"},{"gross_charge":24.91,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27908","type":"CDM"},{"code":"60505700900","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27908","type":"CDM"},{"code":"406900076","type":"NDC"}],"standard_charges":[{"gross_charge":7.67,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":3.42,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"},{"gross_charge":3.7,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 EACH"}]},{"description":"FENTANYL CITRATE 400 MCG BU LPOP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27914","type":"CDM"},{"code":"93786619","type":"NDC"}],"standard_charges":[{"gross_charge":2.70,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FENTANYL CITRATE 1200 MCG BU LPOP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27917","type":"CDM"},{"code":"406921230","type":"NDC"}],"standard_charges":[{"gross_charge":6.80,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EMPTY STERILIZED MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2795","type":"CDM"},{"code":"63323000130","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 = 25 EACH"}]},{"description":"OYSTER SHELL CALCIUM/VITAMIN D 250-125 MG-UNIT PO 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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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15 ML"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27994","type":"CDM"},{"code":"904501735","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":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27994","type":"CDM"},{"code":"536108494","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":"POLYVINYL ALCOHOL 1.4 % OP 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NDC EA = 454 G"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27999","type":"CDM"},{"code":"574200302","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 ML"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML OR SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"27999","type":"CDM"},{"code":"574200202","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 = 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":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML CO 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960 ML"}]},{"description":"SILVER NITRATE 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28001","type":"CDM"},{"code":"64950037896","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 = 960 ML"}]},{"description":"SERTRALINE HCL 20 MG/ML OR CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28011","type":"CDM"},{"code":"59762494001","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"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % EX 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TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28160","type":"CDM"},{"code":"49884032152","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":0.88,"discounted_cash":0.35,"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"}]},{"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":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28161","type":"CDM"},{"code":"55111026479","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":1.33,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":0.29,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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"}]},{"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":0.50,"discounted_cash":0.20,"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":0.22,"discounted_cash":0.09,"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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EA = 1 EACH"}]},{"description":"OLANZAPINE ODT 20 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"49884032352","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 = 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":"OLANZAPINE ODT 20 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"49884032355","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 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TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"55111026579","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 = 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":"OLANZAPINE ODT 20 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"60505327803","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 = 30 EACH"},{"gross_charge":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC 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TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"64380017502","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":"OLANZAPINE ODT 20 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28162","type":"CDM"},{"code":"60505327800","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 = 100 EACH"},{"gross_charge":0.31,"discounted_cash":0.13,"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":"CHLORHEXIDINE GLUCONATE 4 % EX LIQD (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28188","type":"CDM"},{"code":"16571011112","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 = 118 ML"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX LIQD (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28188","type":"CDM"},{"code":"52380127204","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":0.02,"discounted_cash":0.0064,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX LIQD (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28188","type":"CDM"},{"code":"67618020004","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 = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX LIQD 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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 PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"82347050504","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 = 1 EACH"}]},{"description":"LIDOCAINE 5 % EX 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PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28203","type":"CDM"},{"code":"603188016","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 = 30 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.12,"discounted_cash":0.85,"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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28224","type":"CDM"},{"code":"9513503","type":"NDC"}],"standard_charges":[{"gross_charge":102.55,"discounted_cash":41.02,"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":"904655304","type":"NDC"}],"standard_charges":[{"gross_charge":5.60,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.87,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.00,"discounted_cash":0.80,"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":"31722074920","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 = 20 EACH"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":2.71,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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":"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":"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 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 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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":"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":"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":"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":0.22,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBIDOPA-LEVODOPA CR 25-100 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28264","type":"CDM"},{"code":"51079097820","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":0.10,"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":"CARBIDOPA-LEVODOPA CR 25-100 MG OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28264","type":"CDM"},{"code":"68001017100","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":0.13,"discounted_cash":0.05,"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":"CARBIDOPA-LEVODOPA CR 25-100 MG OR 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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":"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 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":0.12,"discounted_cash":0.05,"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 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28279","type":"CDM"},{"code":"51991079406","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 = 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":"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":2.18,"discounted_cash":0.87,"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: 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NDC EA = 4 EACH"}]},{"description":"ESTRADIOL 0.1 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28409","type":"CDM"},{"code":"378335299","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":16.78,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":4.72,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"ESTRADIOL 0.1 MG/24HR TD 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NDC EA = 2 ML"},{"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":"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":"WHITE PETROLATUM GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28809","type":"CDM"},{"code":"9991827849","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 = 5 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SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28810","type":"CDM"},{"code":"64980044801","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.33,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.71,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28810","type":"CDM"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.15,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":0.91,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"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":1.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"},{"gross_charge":2.15,"discounted_cash":0.86,"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":1.67,"discounted_cash":0.67,"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":"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":0.22,"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"},{"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":"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":0.17,"discounted_cash":0.07,"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"}]},{"description":"DIVALPROEX ER (DAILY) 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28812","type":"CDM"},{"code":"68084041511","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 = 1 EACH"},{"gross_charge":0.77,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.83,"discounted_cash":0.73,"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":"68084041593","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.34,"discounted_cash":0.54,"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":"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 ML"}]},{"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":"HYDROCORTISONE 2.5 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28824","type":"CDM"},{"code":"10631040701","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"},{"gross_charge":2.05,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE 2.5 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28824","type":"CDM"},{"code":"62559043130","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 G"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.97,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % RE CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28824","type":"CDM"},{"code":"64980030130","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 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"},{"gross_charge":0.01,"discounted_cash":0.0048,"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":"60687042976","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":0.04,"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":0.04,"discounted_cash":0.01,"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":"12843036305","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 = 355 ML"},{"gross_charge":0.01,"discounted_cash":0.0044,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 355 ML"}]},{"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 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"78024615","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 = 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"},{"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":"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":2.66,"discounted_cash":1.06,"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"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28842","type":"CDM"},{"code":"74310832","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":1.66,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"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 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28843","type":"CDM"},{"code":"78024815","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 = 30 EACH"},{"gross_charge":10.63,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":4.96,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":"74647932","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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 CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28843","type":"CDM"},{"code":"78024861","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 = 1 EACH"},{"gross_charge":10.63,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":4.96,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28844","type":"CDM"},{"code":"78027422","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 = 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":4.74,"discounted_cash":1.90,"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":0.88,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"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"}]},{"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":3.77,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"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":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":6.73,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 G"},{"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"}]},{"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":"574402450","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 G"},{"gross_charge":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 G"},{"gross_charge":1.14,"discounted_cash":0.45,"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":"17478007031","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 = 1 G"},{"gross_charge":1.02,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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 OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2888","type":"CDM"},{"code":"24208091019","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 = 1 G"},{"gross_charge":0.25,"discounted_cash":0.1,"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":"28947","type":"CDM"},{"code":"63323052603","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":39.92,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":115.96,"discounted_cash":46.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28947","type":"CDM"},{"code":"7440701","type":"NDC"}],"standard_charges":[{"gross_charge":486.99,"discounted_cash":194.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":162.10,"discounted_cash":64.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28947","type":"CDM"},{"code":"143967401","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 = 2.5 ML"},{"gross_charge":47.02,"discounted_cash":18.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":16.11,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28947","type":"CDM"},{"code":"7440754","type":"NDC"}],"standard_charges":[{"gross_charge":100.67,"discounted_cash":40.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28947","type":"CDM"},{"code":"409114001","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":19.89,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":57.32,"discounted_cash":22.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28947","type":"CDM"},{"code":"42023018201","type":"NDC"}],"standard_charges":[{"gross_charge":37.13,"discounted_cash":14.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":43.4,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"},{"gross_charge":57.56,"discounted_cash":23.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 ML"}]},{"description":"SIROLIMUS 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28958","type":"CDM"},{"code":"68462068301","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.19,"discounted_cash":0.88,"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":"SIROLIMUS 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28958","type":"CDM"},{"code":"55111065301","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 = 100 EACH"},{"gross_charge":3.99,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":1.76,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIROLIMUS 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28958","type":"CDM"},{"code":"8104110","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIROLIMUS 1 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28958","type":"CDM"},{"code":"50268071811","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.27,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOFLOXACIN 750 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28964","type":"CDM"},{"code":"31722072320","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 = 20 EACH"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 EACH"}]},{"description":"SAMARIUM SM 153 LEXIDRONAM 1850 MBQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28965","type":"CDM"},{"code":"57902086001","type":"NDC"}],"standard_charges":[{"gross_charge":29.82,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BECLOMETHASONE DIPROPIONATE 40 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28970","type":"CDM"},{"code":"59310020212","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.7 G"}]},{"description":"BECLOMETHASONE DIPROPIONATE 80 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28971","type":"CDM"},{"code":"59310020412","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8.7 G"}]},{"description":"MIFEPRISTONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28975","type":"CDM"},{"code":"64875000101","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MIFEPRISTONE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28975","type":"CDM"},{"code":"64875000103","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 EACH"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2899","type":"CDM"},{"code":"62559063001","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.37,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":1.16,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2899","type":"CDM"},{"code":"62559044001","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"},{"gross_charge":0.63,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2899","type":"CDM"},{"code":"52536013213","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 = 100 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Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML OR SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2899","type":"CDM"},{"code":"24338013610","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 = 200 ML"},{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"},{"gross_charge":2.98,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 200 ML"}]},{"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":0.01,"discounted_cash":0.0048,"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":0.03,"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 TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28995","type":"CDM"},{"code":"50268053115","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 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"METFORMIN HCL 500 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"28995","type":"CDM"},{"code":"67877015905","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 = 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":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2903","type":"CDM"},{"code":"409648201","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":95.32,"discounted_cash":38.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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":0.10,"discounted_cash":0.04,"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"}]},{"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":"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":"54879002710","type":"NDC"}],"standard_charges":[{"gross_charge":8.56,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":3.62,"discounted_cash":1.45,"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":"70121148301","type":"NDC"}],"standard_charges":[{"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":2.34,"discounted_cash":0.94,"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":45.20,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.34,"discounted_cash":0.54,"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":"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":"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":"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":4.70,"discounted_cash":1.88,"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"},{"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"}]},{"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":"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":"76329920205","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":10.57,"discounted_cash":4.23,"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":"67457063900","type":"NDC"}],"standard_charges":[{"gross_charge":5.80,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":4.13,"discounted_cash":1.65,"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":"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":"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":"517234010","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 = 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":4.51,"discounted_cash":1.80,"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":"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":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":4.51,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.5 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":13.13,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"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"}]},{"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":7.45,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":7.44,"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":"65162069890","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":0.21,"discounted_cash":0.08,"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":"121213406","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 = 6 ML"},{"gross_charge":0.46,"discounted_cash":0.18,"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":"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":"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":"42192060816","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 470 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"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":"42192060840","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 = 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"},{"gross_charge":0.07,"discounted_cash":0.03,"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":0.13,"discounted_cash":0.05,"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":"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":"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":"AMPHETAMINE-DEXTROAMPHETAMINE 15 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29188","type":"CDM"},{"code":"555077702","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":0.73,"discounted_cash":0.29,"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":"68001018300","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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"QUETIAPINE FUMARATE 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29267","type":"CDM"},{"code":"68084053411","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 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":"QUETIAPINE FUMARATE 300 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29267","type":"CDM"},{"code":"68084053401","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":0.62,"discounted_cash":0.25,"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":0.53,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29267","type":"CDM"},{"code":"60687037101","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":0.53,"discounted_cash":0.21,"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":"TYPHOID VACCINE OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29268","type":"CDM"},{"code":"69401000002","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"TYPHOID VACCINE OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29268","type":"CDM"},{"code":"58337000301","type":"NDC"}],"standard_charges":[{"gross_charge":9.90,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"TYPHOID VACCINE OR CPDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29268","type":"CDM"},{"code":"69401000001","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"DILTIAZEM HCL ER BEADS 120 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29269","type":"CDM"},{"code":"68084005211","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":0.16,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"DILTIAZEM HCL COATED BEADS 120 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29270","type":"CDM"},{"code":"10370082909","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 = 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":0.7,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"DILTIAZEM HCL COATED BEADS 120 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29270","type":"CDM"},{"code":"60687019511","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"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":"DILTIAZEM HCL COATED BEADS 120 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29270","type":"CDM"},{"code":"68084005201","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"}]},{"description":"DILTIAZEM HCL ER BEADS 180 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29271","type":"CDM"},{"code":"68084005311","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 = 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":"DILTIAZEM HCL COATED BEADS 180 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29272","type":"CDM"},{"code":"60687020611","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.24,"discounted_cash":0.10,"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":"DILTIAZEM HCL COATED BEADS 180 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29272","type":"CDM"},{"code":"63739028410","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"}]},{"description":"DILTIAZEM HCL COATED BEADS 180 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29272","type":"CDM"},{"code":"68084005301","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"DILTIAZEM HCL COATED BEADS 240 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29274","type":"CDM"},{"code":"62037059990","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 = 90 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| NDC EA = 280 EACH"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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":3.33,"discounted_cash":1.33,"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":24.00,"discounted_cash":9.60,"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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pharmacy | NDC EA = 237 ML"},{"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":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29302","type":"CDM"},{"code":"42799081501","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 = 237 ML"},{"gross_charge":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 237 ML"}]},{"description":"ESTRADIOL VALERATE 20 MG/ML IM 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5 ML"},{"gross_charge":40.99,"discounted_cash":16.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ESTRADIOL VALERATE 40 MG/ML IM OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2932","type":"CDM"},{"code":"42023011201","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 = 5 ML"},{"gross_charge":4.44,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":55.88,"discounted_cash":22.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"PROPRANOLOL HCL 1 MG/ML IV 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Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29396","type":"CDM"},{"code":"781315895","type":"NDC"}],"standard_charges":[{"gross_charge":16.49,"discounted_cash":6.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":67.81,"discounted_cash":27.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":26.93,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29396","type":"CDM"},{"code":"71288042710","type":"NDC"}],"standard_charges":[{"gross_charge":37.07,"discounted_cash":14.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":30.17,"discounted_cash":12.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29424","type":"CDM"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"51079019703","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"9519004","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"93716356","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":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"51079019701","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"93716398","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 = 90 EACH"},{"gross_charge":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"27241019130","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 = 30 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"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":"TOLTERODINE TARTRATE 2 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29434","type":"CDM"},{"code":"43975032203","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"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":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"13668019090","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 = 90 EACH"},{"gross_charge":0.81,"discounted_cash":0.32,"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":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"51079019801","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"59762004802","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | 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 CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"904659304","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.66,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":5.83,"discounted_cash":2.33,"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":"13668019030","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":0.81,"discounted_cash":0.32,"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":"93716405","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"93716456","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"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":"93716498","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"93204998","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 = 90 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"93204956","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 = 30 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"93204905","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 = 500 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"378340493","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 EACH"}]},{"description":"TOLTERODINE TARTRATE 4 MG OR CP24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29435","type":"CDM"},{"code":"378340405","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 = 500 EACH"}]},{"description":"NATEGLINIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29437","type":"CDM"},{"code":"68382072116","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"},{"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":0.45,"discounted_cash":0.18,"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 TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29437","type":"CDM"},{"code":"68084045811","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 EACH"},{"gross_charge":1.20,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"NATEGLINIDE 60 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29437","type":"CDM"},{"code":"49884098401","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":0.31,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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":"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":0.32,"discounted_cash":0.13,"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":0.64,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29443","type":"CDM"},{"code":"168041660","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 = 60 G"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"},{"gross_charge":1.17,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29443","type":"CDM"},{"code":"168041630","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 = 30 G"},{"gross_charge":1.17,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":3.62,"discounted_cash":1.45,"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":"45802070000","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":0.80,"discounted_cash":0.32,"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":"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":2.76,"discounted_cash":1.11,"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"}]},{"description":"BOTULINUM TOXIN TYPE B 5000 UNIT/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29449","type":"CDM"},{"code":"10454071010","type":"NDC"}],"standard_charges":[{"gross_charge":420.16,"discounted_cash":168.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":472.48,"discounted_cash":188.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":635.08,"discounted_cash":254.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 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":635.08,"discounted_cash":254.03,"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 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":"10454071110","type":"NDC"}],"standard_charges":[{"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":419.17,"discounted_cash":167.67,"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":"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":0.46,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.88,"discounted_cash":0.75,"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":"641602010","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 = 10 ML"},{"gross_charge":2.62,"discounted_cash":1.05,"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":"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":"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 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":0.38,"discounted_cash":0.15,"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"},{"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":"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":0.46,"discounted_cash":0.18,"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":"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":303.94,"discounted_cash":121.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"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":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 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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":0.64,"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":2.19,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.51,"discounted_cash":0.20,"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":"904627208","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 = 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":1.69,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 40 EACH"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 10-0.59 MG/ML-% IV 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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":"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 TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"29858","type":"CDM"},{"code":"527260037","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"METOPROLOL SUCCINATE 25 MG OR 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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":0.23,"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":"68001035600","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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NDC EA = 100 EACH"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"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":"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":0.22,"discounted_cash":0.09,"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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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":"60687041301","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":0.24,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.5,"discounted_cash":0.2,"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":"68001050200","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":0.21,"discounted_cash":0.08,"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":"METOPROLOL SUCCINATE 100 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30071","type":"CDM"},{"code":"904632461","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":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":"FACTOR IX COMPLEX 500 UNIT IV 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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":9.58,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.24,"discounted_cash":3.30,"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":"68084096595","type":"NDC"}],"standard_charges":[{"gross_charge":8.71,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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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":"68084096525","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":34.47,"discounted_cash":13.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VALGANCICLOVIR HCL 450 MG OR 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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":85.75,"discounted_cash":34.3,"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":3.61,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":8.81,"discounted_cash":3.53,"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":0.01,"discounted_cash":0.004,"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":0.0068,"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 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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":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30510","type":"CDM"},{"code":"378967131","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 = 3 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30510","type":"CDM"},{"code":"76204060060","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"},{"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":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30510","type":"CDM"},{"code":"76204060030","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 = 3 ML"},{"gross_charge":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"30510","type":"CDM"},{"code":"60687040583","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"},{"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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"FERRIC SUBSULFATE 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OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3189","type":"CDM"},{"code":"93026430","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 = 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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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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NDC EA = 1 EACH"},{"gross_charge":17.18,"discounted_cash":6.87,"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":"42023022101","type":"NDC"}],"standard_charges":[{"gross_charge":9.90,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.78,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":34.81,"discounted_cash":13.92,"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 = 1 EACH"},{"gross_charge":59.81,"discounted_cash":23.92,"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":"43598090111","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":18.08,"discounted_cash":7.23,"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 = 1 EACH"},{"gross_charge":29.92,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":9.95,"discounted_cash":3.98,"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":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"},{"gross_charge":48.66,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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NDC EA = 5 ML"},{"gross_charge":10.95,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":5.83,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3215","type":"CDM"},{"code":"25021083805","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":5.24,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ 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NDC EA = 100 EACH"}]},{"description":"FLUPHENAZINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3220","type":"CDM"},{"code":"527178901","type":"NDC"}],"standard_charges":[{"gross_charge":2.10,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUPHENAZINE HCL 2.5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3220","type":"CDM"},{"code":"378600901","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":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"FLUPHENAZINE HCL 5 MG OR 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pharmacy | NDC EA = 0.5 ML"},{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"},{"gross_charge":18.12,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 ML"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32215","type":"CDM"},{"code":"55111067810","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 = 0.5 ML"},{"gross_charge":9.11,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 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= 30 EACH"},{"gross_charge":2.41,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.40,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"TRIMETHOBENZAMIDE HCL 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32311","type":"CDM"},{"code":"53489037601","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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":"TRIMETHOBENZAMIDE HCL 300 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"32311","type":"CDM"},{"code":"62135077330","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":12.54,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3232","type":"CDM"},{"code":"63323018410","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 = 10 ML"},{"gross_charge":1.54,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":5.78,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3232","type":"CDM"},{"code":"39822110001","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 = 10 ML"},{"gross_charge":1.72,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"},{"gross_charge":1.96,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 1 % EX 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| 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 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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":"409610204","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 = 4 ML"},{"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":0.44,"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 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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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"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"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"36000006301","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 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409610210","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 = 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 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 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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":"36000028325","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":0.25,"discounted_cash":0.1,"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":"3291","type":"CDM"},{"code":"55150032401","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 = 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 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3291","type":"CDM"},{"code":"409610218","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 = 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"},{"gross_charge":0.14,"discounted_cash":0.06,"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":"63323028003","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 = 4 ML"},{"gross_charge":0.16,"discounted_cash":0.06,"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":"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 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 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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":"55150032301","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 = 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":0.21,"discounted_cash":0.08,"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":0.21,"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":"71288020304","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":"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":"409610219","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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"},{"gross_charge":1.46,"discounted_cash":0.59,"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 OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3292","type":"CDM"},{"code":"54329446","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":0.04,"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"}]},{"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":0.03,"discounted_cash":0.01,"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":"FUROSEMIDE 10 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3292","type":"CDM"},{"code":"54329450","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 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"},{"gross_charge":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 120 ML"}]},{"description":"FUROSEMIDE 8 MG/ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3293","type":"CDM"},{"code":"68094086759","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 = 5 ML"},{"gross_charge":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"FUROSEMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3294","type":"CDM"},{"code":"54829725","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"}]},{"description":"FUROSEMIDE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3294","type":"CDM"},{"code":"904579661","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":"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 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3294","type":"CDM"},{"code":"64980056201","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":"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":"904717861","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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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":"69315011710","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":0.0044,"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":"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 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":0.02,"discounted_cash":0.0088,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 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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) 1000 UNIT IV 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Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":6.44,"discounted_cash":2.58,"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":"51079016401","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":7.69,"discounted_cash":3.08,"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":"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 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":0.32,"discounted_cash":0.13,"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"}]},{"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":"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 200 MG OR 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EA = 30 EACH"},{"gross_charge":17.47,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":2.86,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"VORICONAZOLE 200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"33009","type":"CDM"},{"code":"27241006303","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":1.55,"discounted_cash":0.62,"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 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= 100 EACH"}]},{"description":"METAXALONE 800 MG OR 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":"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":245.55,"discounted_cash":98.22,"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":"34089","type":"CDM"},{"code":"31722013130","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":0.06,"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"}]},{"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":0.13,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA 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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":"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":0.12,"discounted_cash":0.05,"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":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EZETIMIBE 10 MG OR 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= 100 EACH"},{"gross_charge":0.02,"discounted_cash":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"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":0.28,"discounted_cash":0.11,"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":0.03,"discounted_cash":0.01,"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":0.1,"discounted_cash":0.04,"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":0.18,"discounted_cash":0.07,"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":"67877049090","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"},{"gross_charge":0.26,"discounted_cash":0.11,"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":"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":0.45,"discounted_cash":0.18,"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":"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 CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3423","type":"CDM"},{"code":"45802005635","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 G"},{"gross_charge":2.38,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 15 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":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 15 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":2.38,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"},{"gross_charge":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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 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| 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":"63323017301","type":"NDC"}],"standard_charges":[{"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":0.95,"discounted_cash":0.38,"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":0.60,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 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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 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":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"}]},{"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":1.50,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"},{"gross_charge":0.50,"discounted_cash":0.20,"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":"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":"63323001002","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":0.51,"discounted_cash":0.21,"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 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":"61314063305","type":"NDC"}],"standard_charges":[{"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"},{"gross_charge":0.46,"discounted_cash":0.18,"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":"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":0.79,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":0.21,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"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":"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":"62332009930","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":0.09,"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":"60505267403","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 = 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"},{"gross_charge":0.46,"discounted_cash":0.19,"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":"43598055630","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":1.38,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"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":0.06,"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":"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 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":0.01,"discounted_cash":0.0056,"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":"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":0.07,"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"}]},{"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":0.09,"discounted_cash":0.04,"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":0.01,"discounted_cash":0.0056,"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 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":24.88,"discounted_cash":9.95,"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"}]},{"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":24.88,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":12.85,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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":16.5,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":13.57,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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":26.35,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.66,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.59,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"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":"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":"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":"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":0.39,"discounted_cash":0.16,"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":"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":"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":11.99,"discounted_cash":4.80,"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":0.49,"discounted_cash":0.20,"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":"2323830","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":11.92,"discounted_cash":4.77,"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":0.26,"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 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":"68462026630","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATOMOXETINE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34447","type":"CDM"},{"code":"2322930","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 = 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"},{"gross_charge":13.03,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATOMOXETINE HCL 40 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34447","type":"CDM"},{"code":"55111052130","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 EACH"},{"gross_charge":1.57,"discounted_cash":0.63,"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":"GUAIFENESIN-CODEINE 100-10 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34463","type":"CDM"},{"code":"121077516","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 = 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"},{"gross_charge":0.02,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34463","type":"CDM"},{"code":"121177505","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 = 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":"GUAIFENESIN-CODEINE 100-10 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34463","type":"CDM"},{"code":"603107556","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 = 236 ML"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML OR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34463","type":"CDM"},{"code":"603107554","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 = 118 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG OR 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pharmacy | NDC EA = 0.5 ML"},{"gross_charge":188.09,"discounted_cash":75.23,"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":"64764054311","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":12.51,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"LANSOPRAZOLE 15 MG PO 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EACH"},{"gross_charge":0.32,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"68084075311","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":0.28,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"93342001","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":"CYCLOBENZAPRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"603307821","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":"CYCLOBENZAPRINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35184","type":"CDM"},{"code":"10702000601","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 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":0.0048,"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: 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":"CYCLOBENZAPRINE HCL 5 MG OR 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":"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":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 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NDC EA = 120 ML"}]},{"description":"SIROLIMUS 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35262","type":"CDM"},{"code":"59762100301","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 = 100 EACH"},{"gross_charge":4.62,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":11.63,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIROLIMUS 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35262","type":"CDM"},{"code":"55111065401","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 = 100 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":6.64,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"SIROLIMUS 2 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35262","type":"CDM"},{"code":"8103205","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 = 100 EACH"}]},{"description":"THALIDOMIDE 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35263","type":"CDM"},{"code":"59572021095","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":"THALIDOMIDE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35264","type":"CDM"},{"code":"59572022096","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"THALIDOMIDE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35264","type":"CDM"},{"code":"59572022016","type":"NDC"}],"standard_charges":[{"gross_charge":17.29,"discounted_cash":6.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":315.84,"discounted_cash":126.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"},{"gross_charge":30.49,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 EACH"}]},{"description":"APREPITANT 80 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35488","type":"CDM"},{"code":"6046102","type":"NDC"}],"standard_charges":[{"gross_charge":77.62,"discounted_cash":31.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":57.58,"discounted_cash":23.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"},{"gross_charge":197.79,"discounted_cash":79.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 EACH"}]},{"description":"APREPITANT 80 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35488","type":"CDM"},{"code":"6046101","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"APREPITANT 125 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35489","type":"CDM"},{"code":"6046201","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"APREPITANT 125 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35489","type":"CDM"},{"code":"6046206","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 6 EACH"}]},{"description":"OXYBUTYNIN 3.9 MG/24HR TD PTTW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35495","type":"CDM"},{"code":"52544092008","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 8 EACH"}]},{"description":"HYDROCODONE-IBUPROFEN 7.5-200 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35613","type":"CDM"},{"code":"53746014501","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":0.39,"discounted_cash":0.16,"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":"CLONAZEPAM ODT 0.5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35627","type":"CDM"},{"code":"93929219","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONAZEPAM ODT 0.5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35627","type":"CDM"},{"code":"49884030802","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"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":"CLONAZEPAM ODT 0.5 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35627","type":"CDM"},{"code":"49884030852","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":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONAZEPAM ODT 1 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35628","type":"CDM"},{"code":"62332036706","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CLONAZEPAM ODT 1 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35628","type":"CDM"},{"code":"49884030952","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":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONAZEPAM ODT 1 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35628","type":"CDM"},{"code":"49884030902","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 = 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":0.95,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CLONAZEPAM ODT 1 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35628","type":"CDM"},{"code":"93929319","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":0.54,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONAZEPAM ODT 2 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35629","type":"CDM"},{"code":"93929419","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.53,"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":"CLONAZEPAM ODT 2 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35629","type":"CDM"},{"code":"49884031002","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"},{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"CLONAZEPAM ODT 2 MG OR TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35629","type":"CDM"},{"code":"49884031052","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.54,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35640","type":"CDM"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.88,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":3.57,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35640","type":"CDM"},{"code":"54288010001","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"},{"gross_charge":1.9,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35640","type":"CDM"},{"code":"55150026605","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 = 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":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35640","type":"CDM"},{"code":"16729024231","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":7.96,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 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100 EACH"},{"gross_charge":0.52,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HALOPERIDOL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3583","type":"CDM"},{"code":"781139613","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":"HALOPERIDOL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3583","type":"CDM"},{"code":"781139601","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"}]},{"description":"HALOPERIDOL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3583","type":"CDM"},{"code":"904592561","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"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3584","type":"CDM"},{"code":"67457042600","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 ML"},{"gross_charge":0.58,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ 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| NDC EA = 100 EACH"},{"gross_charge":0.65,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"68001023500","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":0.15,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"68001044503","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 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":0.18,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"68001056700","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"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"68084036009","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 = 80 EACH"},{"gross_charge":0.43,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 80 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR 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pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"245531901","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"68084036011","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 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TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"99917035943","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"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"66758019006","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"}]},{"description":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR 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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":"POTASSIUM CHLORIDE CRYS CR 20 MEQ OR TBCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35943","type":"CDM"},{"code":"60687075611","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":0.39,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE BUTYR LIPO BASE 0.1 % EX 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| 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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 45 G"}]},{"description":"HYDROCORTISONE BUTYR LIPO BASE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35944","type":"CDM"},{"code":"68462046465","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 = 60 G"},{"gross_charge":6.02,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 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CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35944","type":"CDM"},{"code":"16781038460","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 = 60 G"}]},{"description":"HYDROCORTISONE BUTYR LIPO BASE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"35944","type":"CDM"},{"code":"16781038445","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 = 45 G"}]},{"description":"IMATINIB MESYLATE 400 MG OR 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NDC EA = 30 EACH"}]},{"description":"IMATINIB MESYLATE 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36092","type":"CDM"},{"code":"78064930","type":"NDC"}],"standard_charges":[{"gross_charge":46.99,"discounted_cash":18.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":28.38,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":327.29,"discounted_cash":130.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"IMATINIB MESYLATE 400 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36092","type":"CDM"},{"code":"47335047583","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 = 30 EACH"},{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ATAZANAVIR SULFATE 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36149","type":"CDM"},{"code":"65862071160","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":2.68,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ATAZANAVIR SULFATE 150 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36149","type":"CDM"},{"code":"93552606","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":0.96,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ATAZANAVIR SULFATE 150 MG OR 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NDC EA = 60 EACH"}]},{"description":"ATAZANAVIR SULFATE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36150","type":"CDM"},{"code":"59762040906","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ATAZANAVIR SULFATE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36150","type":"CDM"},{"code":"93552706","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"ATAZANAVIR SULFATE 200 MG OR 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NDC EA = 30 EACH"},{"gross_charge":13.27,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"EMTRICITABINE 200 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36252","type":"CDM"},{"code":"61958060101","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":7.14,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":16.17,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ESTRADIOL 0.0375 MG/24HR TD 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PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36268","type":"CDM"},{"code":"378336199","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":5.14,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"},{"gross_charge":5.33,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 4 EACH"}]},{"description":"HEPATAMINE 8 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3629","type":"CDM"},{"code":"264937155","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 = 500 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CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"364","type":"CDM"},{"code":"68084061111","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"AMANTADINE HCL 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"364","type":"CDM"},{"code":"60687042211","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 = 1 EACH"},{"gross_charge":1.12,"discounted_cash":0.45,"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":"AMANTADINE HCL 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"364","type":"CDM"},{"code":"51079024701","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 = 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":"AMANTADINE HCL 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"364","type":"CDM"},{"code":"832101500","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":0.45,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.73,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"AMANTADINE HCL 100 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"364","type":"CDM"},{"code":"591493001","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":"AMANTADINE HCL 100 MG OR 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TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36438","type":"CDM"},{"code":"50268008811","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"}]},{"description":"ARIPIPRAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36438","type":"CDM"},{"code":"59148000735","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":4.22,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARIPIPRAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36438","type":"CDM"},{"code":"60505267303","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":1.35,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"},{"gross_charge":0.48,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"ARIPIPRAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36438","type":"CDM"},{"code":"62332009830","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"}]},{"description":"ARIPIPRAZOLE 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36438","type":"CDM"},{"code":"62332009831","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":0.05,"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":0.0084,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"ARIPIPRAZOLE 5 MG OR 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pharmacy | NDC EA = 90 EACH"}]},{"description":"BUPROPION XL (DAILY) 150 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36775","type":"CDM"},{"code":"68001051905","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"},{"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":"BUPROPION XL (DAILY) 150 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36775","type":"CDM"},{"code":"51079004701","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"}]},{"description":"BUPROPION XL (DAILY) 300 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36776","type":"CDM"},{"code":"68001061405","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":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"LEVONORGEST-ETH ESTRAD 91-DAY 0.15-0.03 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36857","type":"CDM"},{"code":"68180084313","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 = 91 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 91 EACH"},{"gross_charge":0.41,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 91 EACH"}]},{"description":"A & D ZINC OXIDE EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36891","type":"CDM"},{"code":"85141002","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 = 113 G"},{"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":"PHENYLEPHRINE HCL 0.125 % NA 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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":"AMIODARONE HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36959","type":"CDM"},{"code":"51862024030","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 EACH"},{"gross_charge":2.54,"discounted_cash":1.01,"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":"AMIODARONE HCL 100 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36959","type":"CDM"},{"code":"68382029706","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 = 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":"DOCUSATE SODIUM 150 MG/15ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36962","type":"CDM"},{"code":"536130485","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 = 473 ML"},{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 473 ML"}]},{"description":"DOCUSATE SODIUM 50 MG/5ML OR LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36962","type":"CDM"},{"code":"904727972","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":"36962","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 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60 EACH"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3697","type":"CDM"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":15.40,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":4.65,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"},{"gross_charge":3.83,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ 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ML"},{"gross_charge":15.40,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3697","type":"CDM"},{"code":"17478093401","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":15.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3697","type":"CDM"},{"code":"517090101","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 = 1 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TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36973","type":"CDM"},{"code":"42858070101","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.25,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.94,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"THEOPHYLLINE 400 MG OR TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36973","type":"CDM"},{"code":"68462038001","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":1.21,"discounted_cash":0.48,"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":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36976","type":"CDM"},{"code":"78112069480","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 = 20 ML"}]},{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36976","type":"CDM"},{"code":"904630521","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 = 177 ML"}]},{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36976","type":"CDM"},{"code":"536122858","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 = 177 ML"}]},{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"36976","type":"CDM"},{"code":"536242558","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 = 177 ML"}]},{"description":"HYDRALAZINE HCL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3698","type":"CDM"},{"code":"68084044711","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":0.14,"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":"HYDRALAZINE HCL 10 MG OR 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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":"HYDRALAZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3700","type":"CDM"},{"code":"51079007501","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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDRALAZINE HCL 25 MG OR 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NDC EA = 100 EACH"}]},{"description":"HYDRALAZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3700","type":"CDM"},{"code":"60687082211","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":"HYDRALAZINE HCL 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3700","type":"CDM"},{"code":"31722052001","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":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"51079007620","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 = 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":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"51079007601","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":0.25,"discounted_cash":0.1,"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":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"60687083301","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"60687083311","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":0.17,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"62584073401","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":0.10,"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":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"62584073411","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":0.09,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"31722052101","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 = 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":0.01,"discounted_cash":0.0052,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDRALAZINE HCL 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3701","type":"CDM"},{"code":"904644261","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"60687017311","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":0.16,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"33342029709","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"31722080760","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 = 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":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"904650561","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 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":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"591387045","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":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":0.05,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"MEMANTINE HCL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37170","type":"CDM"},{"code":"456320511","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"FOSAMPRENAVIR CALCIUM 700 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37182","type":"CDM"},{"code":"49702020718","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":8.58,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":17.38,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"FOSAMPRENAVIR CALCIUM 700 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37182","type":"CDM"},{"code":"378352091","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":6.32,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"},{"gross_charge":15.07,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 60 EACH"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3720","type":"CDM"},{"code":"63739012810","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":"HYDROCHLOROTHIAZIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3720","type":"CDM"},{"code":"68084008611","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":"HYDROCHLOROTHIAZIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3720","type":"CDM"},{"code":"16729018301","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":"HYDROCHLOROTHIAZIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3720","type":"CDM"},{"code":"29300012801","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"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3720","type":"CDM"},{"code":"172208360","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":"HYDROCHLOROTHIAZIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3721","type":"CDM"},{"code":"172208960","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":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCHLOROTHIAZIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3721","type":"CDM"},{"code":"16729018401","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"}]},{"description":"HYDROCHLOROTHIAZIDE 50 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3721","type":"CDM"},{"code":"29300012901","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":"HYDROCORTISONE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3725","type":"CDM"},{"code":"24385019003","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 = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"45802043803","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 = 28 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"904762331","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 = 28 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"51672201302","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 = 28.4 G"},{"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"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"536140795","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":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"53329009101","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 = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"16784011372","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 = 0.9 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"536127780","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":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"168001516","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 = 453.6 G"},{"gross_charge":0.11,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 453.6 G"},{"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":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"168015408","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 = 1.5 G"},{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3726","type":"CDM"},{"code":"168015431","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 = 28.35 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"168008031","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":0.10,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"51672300302","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 = 28.35 G"},{"gross_charge":0.08,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"472033730","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 G"},{"gross_charge":0.20,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"316019330","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 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"45802000403","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 G"},{"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":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3727","type":"CDM"},{"code":"168008016","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 = 453.6 G"},{"gross_charge":0.12,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 453.6 G"}]},{"description":"HYDROCORTISONE 1 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3728","type":"CDM"},{"code":"71399012001","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 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":"HYDROCORTISONE 1 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3728","type":"CDM"},{"code":"63736033942","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 = 118 ML"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 118 ML"}]},{"description":"HYDROCORTISONE 1 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3728","type":"CDM"},{"code":"96073204","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 = 120 ML"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3731","type":"CDM"},{"code":"24385027603","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 = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3731","type":"CDM"},{"code":"45802027603","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 = 28 G"},{"gross_charge":0.03,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3731","type":"CDM"},{"code":"168002031","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 = 28.35 G"},{"gross_charge":0.14,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"},{"gross_charge":0.07,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE 2.5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3732","type":"CDM"},{"code":"168014630","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 = 28.35 G"},{"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"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"68084046911","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":0.74,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"60687058211","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 = 1 EACH"},{"gross_charge":0.94,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"68084046901","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 = 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":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"115169701","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":0.08,"discounted_cash":0.03,"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 Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"42543097106","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 = 100 EACH"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"59651041401","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"},{"gross_charge":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"59762007401","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":0.25,"discounted_cash":0.10,"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":"HYDROCORTISONE 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3733","type":"CDM"},{"code":"64380097106","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":0.24,"discounted_cash":0.10,"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":"HYDROCORTISONE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3734","type":"CDM"},{"code":"59762007501","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":0.33,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCORTISONE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3734","type":"CDM"},{"code":"54505033310","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":0.66,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 EACH"}]},{"description":"HYDROCORTISONE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3734","type":"CDM"},{"code":"143125401","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":"HYDROCORTISONE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3734","type":"CDM"},{"code":"64380097206","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":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":"HYDROCORTISONE 20 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3734","type":"CDM"},{"code":"9004401","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"}]},{"description":"SACCHAROMYCES BOULARDII 250 MG OR CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37343","type":"CDM"},{"code":"4142000007","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 = 50 EACH"},{"gross_charge":0.51,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 EACH"}]},{"description":"L-METHYLFOLATE-B12-B6-B2 5.635-1-50-5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37372","type":"CDM"},{"code":"525050390","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"},{"gross_charge":5.34,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 90 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"69367024312","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 = 12 EACH"},{"gross_charge":0.38,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":1.85,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"574709012","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":10.43,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"713050306","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"713050312","type":"NDC"}],"standard_charges":[{"gross_charge":5.30,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"},{"gross_charge":0.99,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"713050324","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"},{"gross_charge":1.31,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 24 EACH"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3738","type":"CDM"},{"code":"42494034112","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 12 EACH"}]},{"description":"TADALAFIL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37400","type":"CDM"},{"code":"27241011205","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 = 500 EACH"},{"gross_charge":0.02,"discounted_cash":0.0068,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 EACH"}]},{"description":"TADALAFIL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37400","type":"CDM"},{"code":"50268073813","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"}]},{"description":"TADALAFIL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37400","type":"CDM"},{"code":"50268073811","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 = 1 EACH"}]},{"description":"TADALAFIL 5 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37400","type":"CDM"},{"code":"31722064430","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":"TADALAFIL 10 MG OR TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37401","type":"CDM"},{"code":"43547005003","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":0.06,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 EACH"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3743","type":"CDM"},{"code":"9082501","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":17.23,"discounted_cash":6.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3743","type":"CDM"},{"code":"9001103","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":21.68,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3743","type":"CDM"},{"code":"9001104","type":"NDC"}],"standard_charges":[{"gross_charge":21.35,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3744","type":"CDM"},{"code":"9000501","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3745","type":"CDM"},{"code":"9001305","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.004,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"},{"gross_charge":40.19,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3746","type":"CDM"},{"code":"9001612","type":"NDC"}],"standard_charges":[{"gross_charge":78.95,"discounted_cash":31.58,"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":"CHOLESTYRAMINE LIGHT 4 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37482","type":"CDM"},{"code":"245003642","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 = 42 EACH"},{"gross_charge":0.30,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 42 EACH"},{"gross_charge":1.86,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 42 EACH"}]},{"description":"CHOLESTYRAMINE LIGHT 4 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37482","type":"CDM"},{"code":"49884079265","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.74,"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"}]},{"description":"CHOLESTYRAMINE LIGHT 4 GM OR PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"37482","type":"CDM"},{"code":"42806027095","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 = 60 EACH"},{"gross_charge":0.90,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy 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