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80 MG/0.8ML IJ SOSY [148492]","drug_information":{"unit":"42.4","type":"ML"},"code_information":[{"code":"0075-0622-01","type":"NDC"}],"standard_charges":[{"gross_charge":564.35,"discounted_cash":338.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY [148493]","drug_information":{"unit":"34.435","type":"ML"},"code_information":[{"code":"0075-0623-03","type":"NDC"}],"standard_charges":[{"gross_charge":543.18,"discounted_cash":325.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY [148489]","drug_information":{"unit":"23.7","type":"ML"},"code_information":[{"code":"0075-0624-30","type":"NDC"}],"standard_charges":[{"gross_charge":611.75,"discounted_cash":367.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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| NDC EA = 7 NULL"}]},{"description":"POLYSPORIN 500-10000 UNIT/GM EX OINT [6396]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0081-0798-88","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 71 NULL"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOLN [28282]","drug_information":{"unit":"638.16","type":"UN"},"code_information":[{"code":"0088-2220-33","type":"NDC"}],"standard_charges":[{"gross_charge":247.29,"discounted_cash":148.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONAZEPAM 0.5 MG PO TABS 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65 TABLET"}]},{"description":"CILOSTAZOL 50 MG PO TABS [24473]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0093-2065-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS [5005]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0093-2203-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 TABLET"}]},{"description":"METOCLOPRAMIDE HCL 5 MG PO TABS [5006]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0093-2204-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 106 TABLET"}]},{"description":"CEPHALEXIN 250 MG PO CAPS [9499]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0093-3145-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0093-3426-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 TABLET"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS 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PHOSPHATE IN D5W 900 MG/50ML IV SOLN [9627]","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"0338-4114-50","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"0338-6045-37","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN [27838]","drug_information":{"unit":"596200","type":"ML"},"code_information":[{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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[136223]","drug_information":{"unit":"350","type":"ML"},"code_information":[{"code":"0338-9553-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN [136223]","drug_information":{"unit":"2500","type":"ML"},"code_information":[{"code":"0338-9553-50","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN [117058]","drug_information":{"unit":"42800","type":"ML"},"code_information":[{"code":"0338-9557-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.96,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 122 TABLET"}]},{"description":"ALLOPURINOL 150 MG PO TABS [300008]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-0181-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"HALOPERIDOL 1 MG PO TABS [3579]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-0257-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DIAZEPAM 2 MG PO TABS [2404]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-0271-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 74 TABLET"}]},{"description":"DIAZEPAM 5 MG PO TABS [2405]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-0345-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ATENOLOL 100 MG PO TABS 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Pharmacy"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TD PT24 [27471]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-9102-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 PATCH"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TD PT24 [27471]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-9102-93","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TD PT24 [27474]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-9112-93","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":10.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 PATCH"}]},{"description":"FENTANYL 12 MCG/HR TD PT72 [41382]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-9119-16","type":"NDC"}],"standard_charges":[{"gross_charge":109.05,"discounted_cash":65.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72 [27905]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0378-9121-16","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"discounted_cash":47.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 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[41228]","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"0395-0089-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORA-PLUS PO LIQD [5851]","drug_information":{"unit":"24","type":"ML"},"code_information":[{"code":"0395-0091-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMPLE SYRUP PO SYRP [7242]","drug_information":{"unit":"81.375","type":"ML"},"code_information":[{"code":"0395-2661-16","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0123-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1968 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0123-23","type":"NDC"}],"standard_charges":[{"gross_charge":9.00,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 687 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [34544]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0124-23","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 592 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [34544]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0124-62","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS [28384]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0125-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 306 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS [28384]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0125-23","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 377 TABLET"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS [8949]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0484-23","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 460 TABLET"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS [8949]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-0484-62","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 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[300135]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-3243-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0406-3243-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 TABLET"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC [15996]","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"0406-4123-03","type":"NDC"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE HCL 5 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167.5 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 175 MCG PO TABS [10406]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0527-3289-46","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"PROPRANOLOL HCL ER 60 MG PO CAP-SR-24HR [38224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0527-4116-37","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33 CAPSULE"}]},{"description":"PROPRANOLOL HCL ER 80 MG PO CAP-SR-24HR 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Pharmacy"}]},{"description":"CAPSAICIN 0.025 % EX CREA [1350]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0536-2525-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 960 NULL"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM [10717]","drug_information":{"unit":"3","type":"EA"},"code_information":[{"code":"0536-3029-34","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET ENEMA 7-19 GM/118ML RE ENEM [3123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0536-7415-51","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4655 ENEMA"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT [38304]","drug_information":{"unit":"9","type":"ME"},"code_information":[{"code":"0548-5850-00","type":"NDC"}],"standard_charges":[{"gross_charge":1739.55,"discounted_cash":1043.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COSYNTROPIN 0.25 MG IJ SOLR [9686]","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"0548-5900-00","type":"NDC"}],"standard_charges":[{"gross_charge":684.05,"discounted_cash":410.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT [38304]","drug_information":{"unit":"11","type":"ME"},"code_information":[{"code":"0548-5905-00","type":"NDC"}],"standard_charges":[{"gross_charge":1729.91,"discounted_cash":1037.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]","drug_information":{"unit":"190","type":"ML"},"code_information":[{"code":"0548-9502-00","type":"NDC"}],"standard_charges":[{"gross_charge":250.53,"discounted_cash":150.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG PO CAPS [1624]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0158-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.60,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 CAPSULE"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG PO CAPS [1623]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0159-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 CAPSULE"}]},{"description":"MEGESTROL ACETATE 40 MG PO TABS [4871]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0607-02","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 TABLET"}]},{"description":"MEGESTROL ACETATE 20 MG PO TABS [4870]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0607-56","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"ESTRADIOL 1 MG PO TABS [9967]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0886-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 63 TABLET"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0555-0997-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.1,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BROMOCRIPTINE MESYLATE 2.5 MG PO TABS 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TABLET"}]},{"description":"CHARCOAL ACTIVATED PO LIQD [27099]","drug_information":{"unit":"600","type":"ML"},"code_information":[{"code":"0574-0521-76","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"0574-0805-30","type":"NDC"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":23.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT [2888]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0574-4024-35","type":"NDC"}],"standard_charges":[{"gross_charge":35.1,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290.5 NULL"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT [2888]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0574-4024-50","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":42.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 NULL"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP [11567]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0574-4031-05","type":"NDC"}],"standard_charges":[{"gross_charge":98.93,"discounted_cash":59.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 NULL"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT 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TABLET"}]},{"description":"VITAMIN C 125 MG PO TABS [300211]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-0522-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ASCORBIC ACID 500 MG PO TABS [664]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-0523-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 TABLET"}]},{"description":"ASCORBIC ACID 500 MG PO TABS [664]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-0523-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 376 TABLET"}]},{"description":"OYSTER SHELL CALCIUM 500 MG PO TABS [5955]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-1883-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 257 TABLET"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG PO CAPS [2510]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-2056-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 66 CAPSULE"}]},{"description":"CALAMINE 8-8 % EX LOTN [78983]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-2533-21","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354 NULL"}]},{"description":"MULTIVITAMIN-MINERALS PO TABS [143122]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-2641-72","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 297 TABLET"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS [11599]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-2725-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 437 TABLET"}]},{"description":"CARBAMAZEPINE 100 MG PO CHEW [1355]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-3854-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.33,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 TABLET"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN [7030]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-3865-75","type":"NDC"}],"standard_charges":[{"gross_charge":1.00,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1056.1 NULL"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-4040-73","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 326 TABLET"}]},{"description":"FISH OIL 1000 MG PO CAPS [3113]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-4043-60","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 CAPSULE"}]},{"description":"LACTASE 3000 UNITS PO TABS [22469]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5224-52","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 51 TABLET"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS [2509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5306-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 CAPSULE"}]},{"description":"PRENATAL 27-0.8 MG PO TABS [43010]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5313-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 TABLET"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA [16299]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5354-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 280 NULL"}]},{"description":"PENTOXIFYLLINE ER 400 MG PO TAB-CONT-REL [21300]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5448-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS [151461]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5460-52","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS [151461]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5460-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 244 TABLET"}]},{"description":"MULTIVITAMIN-MINERALS PO TABS [143122]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5492-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1296 TABLET"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS [9895]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5523-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 TABLET"}]},{"description":"DOXAZOSIN MESYLATE 4 MG PO TABS [9896]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5524-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"PAROXETINE HCL 20 MG PO TABS [10855]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5677-61","type":"NDC"}],"standard_charges":[{"gross_charge":19.01,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 TABLET"}]},{"description":"FLUOXETINE HCL 10 MG PO CAPS [10069]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5784-61","type":"NDC"}],"standard_charges":[{"gross_charge":18.35,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 CAPSULE"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS [10070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5785-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 379.5 CAPSULE"}]},{"description":"ACYCLOVIR 200 MG PO CAPS [8969]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5789-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.85,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 CAPSULE"}]},{"description":"VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5823-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 215 TABLET"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5853-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 413 TABLET"}]},{"description":"IBUPROFEN 600 MG PO TABS [3844]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5854-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 594 TABLET"}]},{"description":"IBUPROFEN 800 MG PO TABS [3845]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5855-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 245 TABLET"}]},{"description":"SIMETHICONE 40 MG/0.6ML PO SUSP [7228]","drug_information":{"unit":"750","type":"ML"},"code_information":[{"code":"0904-5894-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN HCL 150 MG PO CAPS [1740]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-5959-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.8,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 CAPSULE"}]},{"description":"LORAZEPAM 0.25 MG PO TABS [300005]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 TABLET"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6008-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 313 TABLET"}]},{"description":"LORAZEPAM 2 MG PO TABS [4574]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6009-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 137 TABLET"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6082-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 272 TABLET"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG PO TABS [30264]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6084-61","type":"NDC"}],"standard_charges":[{"gross_charge":18.4,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 79 TABLET"}]},{"description":"CITALOPRAM HYDROBROMIDE 5 MG PO TABS [300568]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6084-61","type":"NDC"}],"standard_charges":[{"gross_charge":15.96,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"CITALOPRAM HYDROBROMIDE 20 MG PO TABS [21062]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6085-61","type":"NDC"}],"standard_charges":[{"gross_charge":18.60,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 394 TABLET"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS [1357]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6172-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.32,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 219 TABLET"}]},{"description":"BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG [89728]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6255-49","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 LOZENGE"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6292-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.54,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2043 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6292-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6293-04","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6294-61","type":"NDC"}],"standard_charges":[{"gross_charge":28.16,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2415 TABLET"}]},{"description":"CARVEDILOL 1.5625 MG PO TABS [300125]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6300-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARVEDILOL 3.125 MG PO TABS [18551]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6300-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1023 TABLET"}]},{"description":"CARVEDILOL 6.25 MG PO TABS [15747]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6301-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 98 TABLET"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6302-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.66,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1352 TABLET"}]},{"description":"CARVEDILOL 25 MG PO TABS [15748]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6303-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1099 TABLET"}]},{"description":"PHENOL 1.4 % MT LIQD [36976]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6305-21","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4607 NULL"}]},{"description":"FLEET ENEMA 7-19 GM/118ML RE ENEM [3123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6320-78","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 798 ENEMA"}]},{"description":"LEVOFLOXACIN 250 MG PO TABS [18918]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6351-61","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":48.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LEVOFLOXACIN 500 MG PO TABS [18919]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6352-61","type":"NDC"}],"standard_charges":[{"gross_charge":91.4,"discounted_cash":54.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 TABLET"}]},{"description":"LEVOFLOXACIN 750 MG PO TABS [28964]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6353-61","type":"NDC"}],"standard_charges":[{"gross_charge":130.9,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"RISPERIDONE 0.5 MG PO TABS [25520]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6358-61","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37 TABLET"}]},{"description":"RISPERIDONE 2 MG PO TABS [18311]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6360-61","type":"NDC"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 199.5 TABLET"}]},{"description":"AMLODIPINE BESYLATE 5 MG PO TABS [9071]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6370-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 993 TABLET"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6371-61","type":"NDC"}],"standard_charges":[{"gross_charge":17.50,"discounted_cash":10.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1430.5 TABLET"}]},{"description":"OLANZAPINE 10 MG PO TABS [17937]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6376-61","type":"NDC"}],"standard_charges":[{"gross_charge":72.29,"discounted_cash":43.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 93.5 TABLET"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS [97959]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6401-61","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":15.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 258 CAPSULE"}]},{"description":"BISACODYL 5 MG PO TBEC [1079]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6407-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 137 TABLET"}]},{"description":"CALCIUM CARBONATE ANTACID 500 MG PO CHEW [9385]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6412-92","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2574 TABLET"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS [14793]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6418-61","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"ESCITALOPRAM OXALATE 10 MG PO TABS [33512]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6426-61","type":"NDC"}],"standard_charges":[{"gross_charge":26.45,"discounted_cash":15.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 554 TABLET"}]},{"description":"HYDRALAZINE HCL 10 MG PO TABS [3698]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6440-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.94,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39.5 TABLET"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS [3700]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6441-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 191 TABLET"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS [3701]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6442-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.20,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 241 TABLET"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG PO TAB-SR-24HR [24521]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6449-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":8.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"PROMETHAZINE HCL 12.5 MG PO TABS [6621]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6461-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6461-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [85123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6467-07","type":"NDC"}],"standard_charges":[{"gross_charge":103.8,"discounted_cash":62.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BACLOFEN 10 MG PO TABS [860]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6475-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 131 TABLET"}]},{"description":"DONEPEZIL HCL 2.5 MG PO TABS [300196]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6477-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS [18786]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6477-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 TABLET"}]},{"description":"LUBRIFRESH P.M. OP OINT [21064]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6488-38","type":"NDC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 NULL"}]},{"description":"FLUCONAZOLE 200 MG PO TABS [10045]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6501-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6519-61","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 TABLET"}]},{"description":"SENNOSIDES 8.6 MG PO TABS [11349]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6522-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6550-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TAB-SR-12HR [18386]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6585-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR [129900]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6615-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS [3774]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6617-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.30,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 906 TABLET"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN [1359]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6627-35","type":"NDC"}],"standard_charges":[{"gross_charge":2.80,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 NULL"}]},{"description":"QUETIAPINE FUMARATE 12.5 MG PO TABS [300154]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6638-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 TABLET"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6638-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 740 TABLET"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6640-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.73,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 464 TABLET"}]},{"description":"QUETIAPINE FUMARATE 200 MG PO TABS [21825]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6641-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 475.375 TABLET"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6665-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 663 CAPSULE"}]},{"description":"GABAPENTIN 300 MG PO CAPS [18308]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6666-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4576.9999 CAPSULE"}]},{"description":"GABAPENTIN 400 MG PO CAPS [18307]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6667-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 546.75 CAPSULE"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS [6657]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6705-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.20,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 TABLET"}]},{"description":"CETIRIZINE HCL 10 MG PO TABS [9506]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6717-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 131 TABLET"}]},{"description":"GUAIFENESIN ER 600 MG PO TAB-SR-12HR [37651]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6718-39","type":"NDC"}],"standard_charges":[{"gross_charge":11.20,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1869 TABLET"}]},{"description":"PSEUDOEPHEDRINE HCL 30 MG PO TABS [6714]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6727-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 TABLET"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":"900","type":"EA"},"code_information":[{"code":"0904-6761-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.50,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS [101]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6773-61","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10025.9231 TABLET"}]},{"description":"ASPIRIN 81 MG PO TBEC [688]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6783-70","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 277 TABLET"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6794-89","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3627 TABLET"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6797-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 202 TABLET"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6798-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.12,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 489 TABLET"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6799-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.67,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1118.5 TABLET"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6808-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52 TABLET"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6808-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6824-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2251 TABLET"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO LIQD [42219]","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"0904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN [140859]","drug_information":{"unit":"90","type":"ML"},"code_information":[{"code":"0904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX SODIUM 500 MG PO TBEC [2553]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6861-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 293 TABLET"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6868-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 552 TABLET"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6923-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 94.5 TABLET"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS [300060]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6927-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 339 TABLET"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6927-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 810 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6949-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.63,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS [4421]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6950-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.90,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 386 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6953-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 372.5 TABLET"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":"142.5","type":"ML"},"code_information":[{"code":"0904-6985-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS [9066]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6993-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 188 TABLET"}]},{"description":"DOCUSATE SODIUM 100 MG PO CAPS [2566]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-6998-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":"1395","type":"ML"},"code_information":[{"code":"0904-7035-88","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7036-04","type":"NDC"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 86 TABLET"}]},{"description":"ALLOPURINOL 100 MG PO TABS [310]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7041-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 306 TABLET"}]},{"description":"ALLOPURINOL 50 MG PO TABS [300101]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7041-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 TABLET"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR [27858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7077-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7093-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7095-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62 TABLET"}]},{"description":"LABETALOL HCL 200 MG PO TABS [10374]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7110-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 73 TABLET"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7121-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237.5 TABLET"}]},{"description":"BUSPIRONE HCL 2.5 MG PO TABS [300397]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7122-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 TABLET"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS [9324]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7122-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 163 TABLET"}]},{"description":"LEVETIRACETAM 500 MG PO TABS [26817]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7124-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 639 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Type: Pharmacy | NDC EA = 848 CAPSULE"}]},{"description":"THIAMINE HCL 100 MG PO TABS [7877]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7191-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 335 TABLET"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"0904-7193-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 591 TABLET"}]},{"description":"FOLIC ACID 1 MG PO TABS 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GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN [102251]","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"0944-2700-07","type":"NDC"}],"standard_charges":[{"gross_charge":98.79,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 30 GM/300ML IJ SOLN [106463]","drug_information":{"unit":"900","type":"ML"},"code_information":[{"code":"0944-2700-07","type":"NDC"}],"standard_charges":[{"gross_charge":98.79,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN [102251]","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"0944-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.39,"discounted_cash":60.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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CAPSULE"}]},{"description":"CLOMIPRAMINE HCL 25 MG PO CAPS [9635]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27241-210-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.54,"discounted_cash":35.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 CAPSULE"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML PO SYRP [6627]","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"27808-065-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCOD POLI-CHLORPHE POLI ER 10-8 MG/5ML PO SUER [152681]","drug_information":{"unit":"665","type":"ML"},"code_information":[{"code":"27808-086-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 5 MG PO TABS [36612]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27808-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.45,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 TABLET"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27808-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":30.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 238 TABLET"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS [35135]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27808-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.66,"discounted_cash":29.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 425 TABLET"}]},{"description":"PALIPERIDONE ER 3 MG PO TAB-SR-24HR [78160]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27808-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.14,"discounted_cash":94.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG PO TABS [2625]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"27808-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.10,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 288 TABLET"}]},{"description":"LAMOTRIGINE 100 MG PO TABS [13982]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LAMOTRIGINE 150 MG PO TABS [14266]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-113-16","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 TABLET"}]},{"description":"BISOPROLOL FUMARATE 2.5 MG PO TABS [300460]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG PO TABS [18290]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.2,"discounted_cash":14.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.50,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 202.5 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 2.5 MG PO TABS [300278]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-413-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS [35184]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-413-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 338 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS [2017]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 98 TABLET"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS [432]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"AMITRIPTYLINE HCL 5 MG PO TABS [300525]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"GUANFACINE HCL 1 MG PO TABS [10149]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"29300-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"ITRACONAZOLE 10 MG/ML PO SOLN [19928]","drug_information":{"unit":"160","type":"ML"},"code_information":[{"code":"31722-006-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL 10 MG PO TABS [4986]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-174-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS [3701]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-521-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.54,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 TABLET"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-531-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 96 TABLET"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [81249]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-630-31","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-632-31","type":"NDC"}],"standard_charges":[{"gross_charge":84.45,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"LOSARTAN POTASSIUM 12.5 MG PO TABS 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TABLET"}]},{"description":"VALACYCLOVIR HCL 500 MG PO TABS [13133]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-704-90","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 126 TABLET"}]},{"description":"VALACYCLOVIR HCL 1 G PO TABS [13132]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-705-30","type":"NDC"}],"standard_charges":[{"gross_charge":70.2,"discounted_cash":42.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG PO TBEC [26224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-712-90","type":"NDC"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":19.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 TABLET"}]},{"description":"MONTELUKAST SODIUM 4 MG PO CHEW [27234]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-727-30","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":20.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"MONTELUKAST SODIUM 5 MG PO CHEW [22510]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-728-30","type":"NDC"}],"standard_charges":[{"gross_charge":32.73,"discounted_cash":19.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 TABLET"}]},{"description":"LACOSAMIDE 50 MG PO TABS [92316]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-812-60","type":"NDC"}],"standard_charges":[{"gross_charge":60.11,"discounted_cash":36.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 516 TABLET"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"31722-832-60","type":"NDC"}],"standard_charges":[{"gross_charge":329.65,"discounted_cash":197.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 TABLET"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN 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TABS [37170]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"33342-297-09","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 TABLET"}]},{"description":"MEMANTINE HCL 10 MG PO TABS [36966]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"33342-298-09","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"35573-428-51","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 433 TABLET"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN [87474]","drug_information":{"unit":"1609.5","type":"ML"},"code_information":[{"code":"36000-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN [103332]","drug_information":{"unit":"10350","type":"ML"},"code_information":[{"code":"36000-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.30,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"36000-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":15.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]","drug_information":{"unit":"230","type":"ML"},"code_information":[{"code":"36000-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.58,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"36000-282-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":"337","type":"ML"},"code_information":[{"code":"36000-283-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":6.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [102515]","drug_information":{"unit":"9139","type":"ML"},"code_information":[{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":0.93,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN [10372]","drug_information":{"unit":"414","type":"ML"},"code_information":[{"code":"36000-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN [10372]","drug_information":{"unit":"116","type":"ML"},"code_information":[{"code":"36000-322-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA [23461]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"39328-024-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 NULL"}]},{"description":"SODIUM HYPOCHLORITE 0.5 % EX SOLN [139937]","drug_information":{"unit":"12250","type":"ML"},"code_information":[{"code":"39328-062-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"K PHOS MONO-SOD PHOS DI & MONO 155-852-130 MG PO TABS [10365]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"39328-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 516 TABLET"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR [114]","drug_information":{"unit":"9","type":"ME"},"code_information":[{"code":"39822-0190-1","type":"NDC"}],"standard_charges":[{"gross_charge":239.03,"discounted_cash":143.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN SULFATE 500 MG PO TABS [5472]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"39822-0310-5","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN [3232]","drug_information":{"unit":"5.2","type":"ML"},"code_information":[{"code":"39822-1100-1","type":"NDC"}],"standard_charges":[{"gross_charge":218.25,"discounted_cash":130.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CADEXOMER IODINE 0.9 % EX GEL [12858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"40565-12249","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":6.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1280 NULL"}]},{"description":"MULTIVITAMIN-MINERALS PO TABS [143122]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"40985-22368","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1175 TABLET"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":"90","type":"EA"},"code_information":[{"code":"41100-81125","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENGAY GREASELESS 10-15 % EX CREA [15146]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"41167-06006","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 170 NULL"}]},{"description":"GNP MUSCLE RUB 10-15 % EX CREA 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8.8 MG/5ML PO SYRP [15168]","drug_information":{"unit":"640","type":"ML"},"code_information":[{"code":"48433-219-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARENICLINE TARTRATE 1 MG PO TABS [76445]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"49884-156-76","type":"NDC"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":30.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TOLVAPTAN 15 MG PO TABS [93253]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"49884-768-52","type":"NDC"}],"standard_charges":[{"gross_charge":2855.45,"discounted_cash":1713.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 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[10070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50111-648-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.49,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 135 CAPSULE"}]},{"description":"CARISOPRODOL 350 MG PO TABS [1395]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50228-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"NABUMETONE 500 MG PO TABS [10676]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50228-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"TENECTEPLASE 50 MG IV KIT [28530]","drug_information":{"unit":"105.94","type":"ME"},"code_information":[{"code":"50242-037-06","type":"NDC"}],"standard_charges":[{"gross_charge":1993.10,"discounted_cash":1195.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMALIZUMAB 150 MG SC SOLR [36151]","drug_information":{"unit":"666","type":"ME"},"code_information":[{"code":"50242-040-62","type":"NDC"}],"standard_charges":[{"gross_charge":877.19,"discounted_cash":526.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 2 MG IJ SOLR [31310]","drug_information":{"unit":"175.5","type":"ME"},"code_information":[{"code":"50242-041-64","type":"NDC"}],"standard_charges":[{"gross_charge":983.15,"discounted_cash":589.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 50 MG IV SOLR [9003]","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"50242-044-13","type":"NDC"}],"standard_charges":[{"gross_charge":536.33,"discounted_cash":321.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORNASE ALFA 2.5 MG/2.5ML IN SOLN [12211]","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"50242-100-39","type":"NDC"}],"standard_charges":[{"gross_charge":310.42,"discounted_cash":186.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORNASE ALFA 2.5 MG/2.5ML IN SOLN [12211]","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"50242-100-40","type":"NDC"}],"standard_charges":[{"gross_charge":308.2,"discounted_cash":184.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENECTEPLASE 50 MG IV KIT [28530]","drug_information":{"unit":"66.12","type":"ME"},"code_information":[{"code":"50242-120-47","type":"NDC"}],"standard_charges":[{"gross_charge":1646.28,"discounted_cash":987.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCRELIZUMAB 300 MG/10ML IV SOLN [135321]","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"50242-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":11715.04,"discounted_cash":7029.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 400 MG PO TABS [8971]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-061-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 TABLET"}]},{"description":"AZITHROMYCIN 250 MG PO TABS [20943]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-074-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.28,"discounted_cash":5.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 241 TABLET"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS [36438]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-088-11","type":"NDC"}],"standard_charges":[{"gross_charge":157.81,"discounted_cash":94.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1513 TABLET"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS [36438]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-088-15","type":"NDC"}],"standard_charges":[{"gross_charge":157.85,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"BACLOFEN 10 MG PO TABS [860]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-106-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 197 TABLET"}]},{"description":"BUPROPION HCL 75 MG PO TABS [9322]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-142-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 132 CAPSULE"}]},{"description":"CARBAMAZEPINE ER 100 MG PO CAP-SR-12HR [37567]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-170-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.95,"discounted_cash":14.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 51 CAPSULE"}]},{"description":"CARBAMAZEPINE ER 200 MG PO CAP-SR-12HR [27632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-171-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.05,"discounted_cash":15.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 CAPSULE"}]},{"description":"CILOSTAZOL 50 MG PO TABS [24473]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-176-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [85123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":101.10,"discounted_cash":60.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 86 TABLET"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-187-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.6,"discounted_cash":25.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS [2017]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-191-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TAB-SR-24HR [34418]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-259-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49 TABLET"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TAB-SR-24HR [77001]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-260-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.37,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 94 TABLET"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-299-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 342 TABLET"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-330-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 91 TABLET"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SYRP [3071]","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"50268-336-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [157688]","drug_information":{"unit":"405","type":"ML"},"code_information":[{"code":"50268-336-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 200 MG PO TABS [10045]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-339-11","type":"NDC"}],"standard_charges":[{"gross_charge":87.02,"discounted_cash":52.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 2.5-162.5 MG PO TABS [300369]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":6.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2427 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS [28384]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 TABLET"}]},{"description":"INDOMETHACIN 25 MG PO CAPS [3897]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"LOSARTAN POTASSIUM 12.5 MG PO TABS [300325]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-504-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS [14823]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-504-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-505-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 448 TABLET"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-523-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 53 TABLET"}]},{"description":"MELATONIN 3 MG PO TABS [16830]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-524-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 146 TABLET"}]},{"description":"MELOXICAM 7.5 MG PO TABS [20566]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.07,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 TABLET"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-535-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR [300296]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-540-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG PO TAB-SR-24HR [29858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-540-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 243 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TAB-SR-24HR [30070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-541-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 TABLET"}]},{"description":"NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TAB-CONT-REL [27181]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-584-11","type":"NDC"}],"standard_charges":[{"gross_charge":35.15,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-630-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.95,"discounted_cash":13.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 TABLET"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS [6583]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-684-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS [97959]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-740-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.29,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 206 CAPSULE"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":"2390","type":"ML"},"code_information":[{"code":"50268-745-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-756-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 210 TABLET"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS [14793]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-760-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"B-12 250 MCG PO TABS [86457]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CYANOCOBALAMIN 250 MCG PO TABS [2010]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"VITAMIN B-12 250 MCG PO TABS [8655]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 295 TABLET"}]},{"description":"VITAMIN B-12 250 MCG PO TABS [8655]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-854-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 TABLET"}]},{"description":"VITAMIN B-12 1000 MCG PO TABS [8654]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-855-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 349 TABLET"}]},{"description":"VITAMIN B-12 1000 MCG PO TABS [8654]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-855-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"VITAMIN B-6 50 MG PO TABS [8667]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-858-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ASCORBIC ACID 250 MG PO TABS [663]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-860-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 TABLET"}]},{"description":"VITAMIN C 125 MG PO TABS [300211]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-860-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"VITAMIN C 250 MG PO TABS [8679]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-860-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.34,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 TABLET"}]},{"description":"VITAMIN D3 125 MCG (5000 UT) PO TABS [104254]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50268-866-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290.8 TABLET"}]},{"description":"WITCH HAZEL-GLYCERIN EX PADS [11678]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50289-3250-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 NULL"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50383-700-16","type":"NDC"}],"standard_charges":[{"gross_charge":28.72,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 96 NULL"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN [38245]","drug_information":{"unit":"90","type":"ML"},"code_information":[{"code":"50383-779-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY [10006798]","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"50458-563-01","type":"NDC"}],"standard_charges":[{"gross_charge":13772.44,"discounted_cash":8263.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY [10006799]","drug_information":{"unit":"31.5","type":"ML"},"code_information":[{"code":"50458-564-01","type":"NDC"}],"standard_charges":[{"gross_charge":13709.82,"discounted_cash":8225.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 2.5 MG PO TABS [10005042]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-577-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.95,"discounted_cash":36.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"RIVAROXABAN 2.5 MG PO TABS [10005042]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-577-60","type":"NDC"}],"standard_charges":[{"gross_charge":60.72,"discounted_cash":36.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 175 TABLET"}]},{"description":"RIVAROXABAN 15 MG PO TABS [107671]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-578-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.4,"discounted_cash":60.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 336 TABLET"}]},{"description":"RIVAROXABAN 20 MG PO TABS [107672]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.4,"discounted_cash":60.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 373 TABLET"}]},{"description":"RIVAROXABAN 10 MG PO TABS [105868]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-580-10","type":"NDC"}],"standard_charges":[{"gross_charge":110.84,"discounted_cash":66.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 TABLET"}]},{"description":"RIVAROXABAN 10 MG PO TABS [105868]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50458-580-30","type":"NDC"}],"standard_charges":[{"gross_charge":121.65,"discounted_cash":72.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"RISPERIDONE 1 MG/ML PO SOLN [17377]","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"50458-596-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.1,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLLAGENASE 250 UNIT/GM EX OINT [9682]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50484-010-30","type":"NDC"}],"standard_charges":[{"gross_charge":59.48,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 NULL"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS [101]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50580-458-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15053.5 TABLET"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":"82.5","type":"ML"},"code_information":[{"code":"50580-534-04","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE, PCEC IM SUSR [22120]","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"50632-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":2462.54,"discounted_cash":1477.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE, PCEC IM SUSR [22120]","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"50632-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":2477.08,"discounted_cash":1486.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHENAMINE HIPPURATE 1 G PO TABS [10549]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ISOSORBIDE MONONITRATE ER 15 MG PO TAB-SR-24HR [300035]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG PO TAB-SR-24HR [24521]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.86,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 401 TABLET"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TAB-SR-24HR [24268]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.26,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 TABLET"}]},{"description":"MEXILETINE HCL 150 MG PO CAPS [10595]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-239-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 CAPSULE"}]},{"description":"NIFEDIPINE ER 30 MG PO TAB-SR-24HR [10719]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TAB-SR-24HR [28643]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.23,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 107 TABLET"}]},{"description":"NIFEDIPINE ER 60 MG PO TAB-SR-24HR [10720]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150.5 TABLET"}]},{"description":"NIFEDIPINE ER 90 MG PO TAB-SR-24HR [37662]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"50742-622-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.45,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.80,"discounted_cash":19.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1564.5 TABLET"}]},{"description":"CHLORTHALIDONE 12.5 MG PO TABS [300090]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"FUROSEMIDE 10 MG PO TABS [300034]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-072-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"FUROSEMIDE 20 MG PO TABS [3294]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-072-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 269 TABLET"}]},{"description":"FUROSEMIDE 20 MG PO TABS [3294]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-072-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"FUROSEMIDE 20 MG PO TABS [3294]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-072-56","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FUROSEMIDE 40 MG PO TABS [3295]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-073-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 535.5 TABLET"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-086-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.98,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 127 TABLET"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 496 TABLET"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS [300060]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-103-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 114 TABLET"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG PO CAPS [1623]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.39,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 126 CAPSULE"}]},{"description":"ALLOPURINOL 100 MG PO TABS [310]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 TABLET"}]},{"description":"ALLOPURINOL 50 MG PO TABS [300101]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-209-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 297 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-209-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-210-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.73,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 979 TABLET"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO TABS [300041]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"DIAZEPAM 2.5 MG PO TABS [300367]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIAZEPAM 5 MG PO TABS [2405]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.41,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 276 TABLET"}]},{"description":"DIAZEPAM 10 MG PO TABS [2403]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-286-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS [1357]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-385-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS [4421]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-440-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 98 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 75 MCG PO TABS [4422]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-441-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 103 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-444-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300.48 TABLET"}]},{"description":"MIDODRINE HCL 5 MG PO TABS [10610]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.00,"discounted_cash":10.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 101 TABLET"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS [11111]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.65,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 TABLET"}]},{"description":"FUROSEMIDE 80 MG PO TABS [3296]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-527-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 TABLET"}]},{"description":"CETIRIZINE HCL 5 MG PO TABS [15349]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-597-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ATENOLOL 50 MG PO TABS [718]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-684-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 91 TABLET"}]},{"description":"ATENOLOL 100 MG PO TABS [716]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-685-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS [4560]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-690-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.34,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 341 CAPSULE"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS [4560]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-690-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 CAPSULE"}]},{"description":"HALOPERIDOL 5 MG PO TABS [3583]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-736-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-753-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 259 TABLET"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-753-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"ATENOLOL 25 MG PO TABS [717]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-759-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 38 TABLET"}]},{"description":"ATENOLOL 12.5 MG PO TABS [300012]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51079-759-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TAB-SR-24HR 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NDC EA = 18 CAPSULE"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG PO CAPS [11050]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51991-203-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 CAPSULE"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"51991-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.18,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 TABLET"}]},{"description":"ALPRAZOLAM 0.5 MG PO TABS 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ALFA 10000 UNIT/ML IJ SOLN [9938]","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"59676-310-01","type":"NDC"}],"standard_charges":[{"gross_charge":1661.95,"discounted_cash":997.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNIT/ML IJ SOLN [24513]","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"59676-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":6541.75,"discounted_cash":3925.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNIT/ML IJ SOLN [24513]","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"59676-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":6577.1,"discounted_cash":3946.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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[6583]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-113-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37 TABLET"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-115-06","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-175-09","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS [300060]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-216-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"OLANZAPINE 5 MG PO TAB-DISPERSE [28159]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-306-12","type":"NDC"}],"standard_charges":[{"gross_charge":78.45,"discounted_cash":47.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"OLANZAPINE 10 MG PO TAB-DISPERSE [28160]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-307-12","type":"NDC"}],"standard_charges":[{"gross_charge":112.45,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"TERAZOSIN HCL 1 MG PO CAPS [14550]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-383-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 CAPSULE"}]},{"description":"TERAZOSIN HCL 2 MG PO CAPS [14551]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-384-06","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 CAPSULE"}]},{"description":"TERAZOSIN HCL 5 MG PO CAPS [14553]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59746-385-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 CAPSULE"}]},{"description":"MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS [4855]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0055-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 TABLET"}]},{"description":"MEDROXYPROGESTERONE ACETATE 10 MG PO TABS [4854]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0056-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":5.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"HYDROCORTISONE 2.5 MG PO TABS [300189]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0073-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"HYDROCORTISONE 5 MG PO TABS [10209]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0073-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"HYDROCORTISONE 10 MG PO TABS [3733]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0074-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 TABLET"}]},{"description":"SULFASALAZINE 500 MG PO TBEC [7563]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-0104-5","type":"NDC"}],"standard_charges":[{"gross_charge":5.11,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 38 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Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CELECOXIB 200 MG PO CAPS [24501]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-1517-1","type":"NDC"}],"standard_charges":[{"gross_charge":44.55,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"SULFASALAZINE 500 MG PO TABS [7562]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"59762-5000-5","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 183 TABLET"}]},{"description":"MISOPROSTOL 25 MCG PO TABS 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[146722]","drug_information":{"unit":"2469.8","type":"ML"},"code_information":[{"code":"60267-705-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 200 MG PO CAPS [8969]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0042-6","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"DOXAZOSIN MESYLATE 1 MG PO TABS [9894]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0093-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS [9895]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0094-0","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 TABLET"}]},{"description":"DOXAZOSIN MESYLATE 4 MG PO TABS [9896]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0095-0","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 TABLET"}]},{"description":"GLIPIZIDE 2.5 MG PO TABS [300134]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0141-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 HALF TABLET"}]},{"description":"GLIPIZIDE 5 MG PO TABS [10117]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0141-0","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 245 TABLET"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS [1357]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0183-0","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"TIZANIDINE HCL 2 MG PO TABS [14792]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0251-3","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 TABLET"}]},{"description":"OFLOXACIN 0.3 % OT SOLN [22257]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0363-1","type":"NDC"}],"standard_charges":[{"gross_charge":162.85,"discounted_cash":97.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 NULL"}]},{"description":"PAROXETINE HCL 10 MG/5ML PO SUSP [22959]","drug_information":{"unit":"585","type":"ML"},"code_information":[{"code":"60505-0402-5","type":"NDC"}],"standard_charges":[{"gross_charge":10.01,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN [19746]","drug_information":{"unit":"2720","type":"ML"},"code_information":[{"code":"60505-0560-1","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":14.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0582-4","type":"NDC"}],"standard_charges":[{"gross_charge":295.57,"discounted_cash":177.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 103 NULL"}]},{"description":"DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN [21135]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0815-0","type":"NDC"}],"standard_charges":[{"gross_charge":256.15,"discounted_cash":153.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 NULL"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN [15738]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0823-6","type":"NDC"}],"standard_charges":[{"gross_charge":171.08,"discounted_cash":102.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 NULL"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-0829-1","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3552.0028 NULL"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":"119.9","type":"ML"},"code_information":[{"code":"60505-1003-1","type":"NDC"}],"standard_charges":[{"gross_charge":180.52,"discounted_cash":108.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"60505-1003-2","type":"NDC"}],"standard_charges":[{"gross_charge":133.38,"discounted_cash":80.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDODRINE HCL 5 MG PO TABS [10610]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-1321-1","type":"NDC"}],"standard_charges":[{"gross_charge":15.81,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 489 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2579-9","type":"NDC"}],"standard_charges":[{"gross_charge":35.35,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2580-9","type":"NDC"}],"standard_charges":[{"gross_charge":35.21,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 TABLET"}]},{"description":"TRIAMTERENE-HCTZ 18.75-12.5 MG PO TABS [300626]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2656-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"TRIAMTERENE-HCTZ 37.5-25 MG PO TABS [8132]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2656-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2671-9","type":"NDC"}],"standard_charges":[{"gross_charge":35.35,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1310 TABLET"}]},{"description":"CARBAMAZEPINE ER 100 MG PO CAP-SR-12HR [37567]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-2805-7","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"OLANZAPINE 5 MG PO TABS [17936]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-3111-0","type":"NDC"}],"standard_charges":[{"gross_charge":71.83,"discounted_cash":43.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 373 TABLET"}]},{"description":"OLANZAPINE 10 MG PO TABS [17937]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-3113-0","type":"NDC"}],"standard_charges":[{"gross_charge":106.06,"discounted_cash":63.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 182 TABLET"}]},{"description":"OLANZAPINE 5 MG PO TAB-DISPERSE [28159]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-3275-3","type":"NDC"}],"standard_charges":[{"gross_charge":77.59,"discounted_cash":46.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 TABLET"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS [28842]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-4630-3","type":"NDC"}],"standard_charges":[{"gross_charge":9.18,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 CAPSULE"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS [28843]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-4632-3","type":"NDC"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 CAPSULE"}]},{"description":"PRASUGREL HCL 10 MG PO TABS [93952]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-4643-3","type":"NDC"}],"standard_charges":[{"gross_charge":87.19,"discounted_cash":52.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 TABLET"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [89683]","drug_information":{"unit":"5411","type":"ML"},"code_information":[{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":21.46,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [89683]","drug_information":{"unit":"2905","type":"ML"},"code_information":[{"code":"60505-6130-5","type":"NDC"}],"standard_charges":[{"gross_charge":21.47,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR [1445]","drug_information":{"unit":"1001525.1","type":"ME"},"code_information":[{"code":"60505-6142-0","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR [1445]","drug_information":{"unit":"270162","type":"ME"},"code_information":[{"code":"60505-6142-5","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/115ML-% IV SOLN [301004]","drug_information":{"unit":"7015","type":"ML"},"code_information":[{"code":"60505-6143-4","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR [16369]","drug_information":{"unit":"646","type":"GM"},"code_information":[{"code":"60505-6146-0","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":83.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR [27311]","drug_information":{"unit":"531","type":"GM"},"code_information":[{"code":"60505-6147-0","type":"NDC"}],"standard_charges":[{"gross_charge":240.05,"discounted_cash":144.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]","drug_information":{"unit":"1036.05","type":"GM"},"code_information":[{"code":"60505-6148-0","type":"NDC"}],"standard_charges":[{"gross_charge":268.60,"discounted_cash":161.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]","drug_information":{"unit":"22.25","type":"GM"},"code_information":[{"code":"60505-6148-4","type":"NDC"}],"standard_charges":[{"gross_charge":268.00,"discounted_cash":160.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"60505-6152-1","type":"NDC"}],"standard_charges":[{"gross_charge":171.55,"discounted_cash":102.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]","drug_information":{"unit":"56","type":"ME"},"code_information":[{"code":"60505-6152-4","type":"NDC"}],"standard_charges":[{"gross_charge":177.35,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]","drug_information":{"unit":"2332.75","type":"GM"},"code_information":[{"code":"60505-6157-0","type":"NDC"}],"standard_charges":[{"gross_charge":122.25,"discounted_cash":73.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]","drug_information":{"unit":"134.75","type":"GM"},"code_information":[{"code":"60505-6157-4","type":"NDC"}],"standard_charges":[{"gross_charge":83.64,"discounted_cash":50.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":"1497.8889","type":"GM"},"code_information":[{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":145.73,"discounted_cash":87.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4-0.5 G IV SOLR [149351]","drug_information":{"unit":"3","type":"GM"},"code_information":[{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":145.7,"discounted_cash":87.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":"29.2778","type":"GM"},"code_information":[{"code":"60505-6159-4","type":"NDC"}],"standard_charges":[{"gross_charge":146.44,"discounted_cash":87.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-6226-0","type":"NDC"}],"standard_charges":[{"gross_charge":131.2,"discounted_cash":78.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 NULL"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-6226-1","type":"NDC"}],"standard_charges":[{"gross_charge":62.61,"discounted_cash":37.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 NULL"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR [1445]","drug_information":{"unit":"148","type":"ME"},"code_information":[{"code":"60505-6243-0","type":"NDC"}],"standard_charges":[{"gross_charge":30.84,"discounted_cash":18.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE 7 MG/24HR TD PT24 [27860]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-7061-0","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76 PATCH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24 [27862]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-7062-0","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 245 PATCH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24 [27863]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60505-7063-0","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":11.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1215 PATCH"}]},{"description":"CLONIDINE HCL 0.05 MG PO TABS [300639]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 TABLET"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS [1755]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-113-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.80,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 TABLET"}]},{"description":"ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-121-95","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":10.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-122-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 29 TABLET"}]},{"description":"CLONIDINE HCL 0.2 MG PO TABS [1756]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-124-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.89,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 157.5 TABLET"}]},{"description":"DOCUSATE SODIUM 100 MG PO CAPS [2566]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 CAPSULE"}]},{"description":"DOCUSATE SODIUM 100 MG PO CAPS [2566]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-129-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 CAPSULE"}]},{"description":"METFORMIN HCL 850 MG PO TABS [14719]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-143-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37 TABLET"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-145-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1283.5 TABLET"}]},{"description":"CEPHALEXIN 250 MG PO CAPS [9499]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 67 CAPSULE"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 TABLET"}]},{"description":"METFORMIN HCL 250 MG PO TABS [300127]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 TABLET"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1730 TABLET"}]},{"description":"HALOPERIDOL 5 MG PO TABS [3583]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-161-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 451 TABLET"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-163-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 CAPSULE"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-163-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":7.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1259 CAPSULE"}]},{"description":"PRAVASTATIN SODIUM 10 MG PO TABS [11110]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-169-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.3,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 41 TABLET"}]},{"description":"MEMANTINE HCL 5 MG PO TABS [37170]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-173-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"MEMANTINE HCL 10 MG PO TABS [36966]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 TABLET"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CAP-SR-24HR [29270]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-195-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CAP-SR-24HR [29270]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-195-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.03,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 273 CAPSULE"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CAP-SR-24HR [29272]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-206-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.10,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 218 CAPSULE"}]},{"description":"SIMVASTATIN 40 MG PO TABS [11366]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-210-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"SIMVASTATIN 40 MG PO TABS [11366]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-210-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.31,"discounted_cash":18.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 279 TABLET"}]},{"description":"GEMFIBROZIL 600 MG PO TABS [3378]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-224-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 TABLET"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS [4560]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 CAPSULE"}]},{"description":"SERTRALINE HCL 12.5 MG PO TABS [300136]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-231-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 164 TABLET"}]},{"description":"SERTRALINE HCL 50 MG PO TABS [11351]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-242-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.07,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 TABLET"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-245-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.14,"discounted_cash":25.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76 TABLET"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN [36590]","drug_information":{"unit":"177.5","type":"ML"},"code_information":[{"code":"60687-249-40","type":"NDC"}],"standard_charges":[{"gross_charge":7.76,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN [18877]","drug_information":{"unit":"140.56","type":"ML"},"code_information":[{"code":"60687-252-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.30,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SERTRALINE HCL 100 MG PO TABS [11350]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-253-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 342.5 TABLET"}]},{"description":"AZITHROMYCIN 250 MG PO TABS [20943]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.58,"discounted_cash":14.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 TABLET"}]},{"description":"DONEPEZIL HCL 2.5 MG PO TABS [300196]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-292-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS [18786]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-292-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.36,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 114 TABLET"}]},{"description":"ITRACONAZOLE 100 MG PO CAPS [10364]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-299-95","type":"NDC"}],"standard_charges":[{"gross_charge":23.32,"discounted_cash":14.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 CAPSULE"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-302-95","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 38 TABLET"}]},{"description":"DONEPEZIL HCL 10 MG PO TABS [18787]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-303-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 161 TABLET"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-325-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-325-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 TABLET"}]},{"description":"QUETIAPINE FUMARATE 12.5 MG PO TABS [300154]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 TABLET"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 189 TABLET"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-333-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354.5 TABLET"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS [9350]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-345-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-349-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.92,"discounted_cash":23.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 217 TABLET"}]},{"description":"QUETIAPINE FUMARATE 200 MG PO TABS [21825]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-360-11","type":"NDC"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":39.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 252.5 TABLET"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS [999]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-368-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37 TABLET"}]},{"description":"DICYCLOMINE HCL 10 MG PO CAPS [2418]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-369-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.91,"discounted_cash":5.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 137 CAPSULE"}]},{"description":"QUETIAPINE FUMARATE 300 MG PO TABS [29267]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-371-11","type":"NDC"}],"standard_charges":[{"gross_charge":86.27,"discounted_cash":51.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 175.0833 TABLET"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-375-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 79 CAPSULE"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS [10609]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-387-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 41 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR [300296]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-390-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 211 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG PO TAB-SR-24HR [29858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-390-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 681 TABLET"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]","drug_information":{"unit":"1307.5","type":"ML"},"code_information":[{"code":"60687-394-79","type":"NDC"}],"standard_charges":[{"gross_charge":2.60,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":"4525.5","type":"ML"},"code_information":[{"code":"60687-395-79","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 2.5-162.5 MG PO TABS [300369]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.93,"discounted_cash":4.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1801 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TAB-SR-24HR [30070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":6.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 756.5 TABLET"}]},{"description":"CLOZAPINE 25 MG PO TABS [9648]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-404-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.61,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 TABLET"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [30510]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-405-79","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 972 VIAL"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [34544]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-407-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 202 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG PO TAB-SR-24HR [30071]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.20,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 327 TABLET"}]},{"description":"CLOZAPINE 100 MG PO TABS [9647]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-415-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":12.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 192.75 TABLET"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-416-11","type":"NDC"}],"standard_charges":[{"gross_charge":108.65,"discounted_cash":65.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 29 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN [37848]","drug_information":{"unit":"176.9","type":"ML"},"code_information":[{"code":"60687-417-44","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS [28384]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-418-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"FINASTERIDE 5 MG PO TABS [10037]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-428-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 TABLET"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK [25424]","drug_information":{"unit":"43","type":"GM"},"code_information":[{"code":"60687-431-98","type":"NDC"}],"standard_charges":[{"gross_charge":20.06,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK [25424]","drug_information":{"unit":"1424","type":"GM"},"code_information":[{"code":"60687-431-99","type":"NDC"}],"standard_charges":[{"gross_charge":20.17,"discounted_cash":12.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE HCL 25 MG PO TABS [435]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-433-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 TABLET"}]},{"description":"AMIODARONE HCL 200 MG PO TABS [9066]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.15,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"AMIODARONE HCL 200 MG PO TABS [9066]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-437-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.37,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 841 TABLET"}]},{"description":"LABETALOL HCL 100 MG PO TABS [10373]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-439-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"TRAZODONE HCL 25 MG PO TABS [300808]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-443-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 TABLET"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-443-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1060 TABLET"}]},{"description":"AMITRIPTYLINE HCL 50 MG PO TABS [436]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-444-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 61 TABLET"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-446-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 TABLET"}]},{"description":"LABETALOL HCL 200 MG PO TABS [10374]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-453-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 102 TABLET"}]},{"description":"TRAZODONE HCL 100 MG PO TABS [8083]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-454-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2097.5 TABLET"}]},{"description":"IBUPROFEN 600 MG PO TABS [3844]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-457-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.91,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200.5 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS [4421]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-464-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 284.5 TABLET"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS [300060]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-465-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 173 TABLET"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-473-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76 CAPSULE"}]},{"description":"LEVOTHYROXINE SODIUM 75 MCG PO TABS [4422]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-475-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 TABLET"}]},{"description":"SPIRONOLACTONE 50 MG PO TABS [11426]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-476-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 215 TABLET"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TAB-SR-24HR [37648]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-480-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-484-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-484-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 CAPSULE"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS [10403]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-486-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 102 TABLET"}]},{"description":"AMLODIPINE BESYLATE 5 MG PO TABS [9071]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-488-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 141 TABLET"}]},{"description":"NAPROXEN 500 MG PO TABS [5393]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 248 TABLET"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS [15113]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 CAPSULE"}]},{"description":"PREGABALIN 75 MG PO CAPS [42164]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-495-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"PREGABALIN 75 MG PO CAPS [42164]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-495-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 284 CAPSULE"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-496-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 329 TABLET"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-497-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 351.25 TABLET"}]},{"description":"ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS [2863]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-500-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"PREGABALIN 100 MG PO CAPS [42165]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-506-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.99,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 132 CAPSULE"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-508-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP [28775]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-524-79","type":"NDC"}],"standard_charges":[{"gross_charge":31.43,"discounted_cash":18.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 569 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-530-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39.3334 TABLET"}]},{"description":"CLONAZEPAM 0.25 MG PO TABS [300161]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-544-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 TABLET"}]},{"description":"CLONAZEPAM 0.5 MG PO TABS [9637]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-544-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 406 TABLET"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-550-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 136 TABLET"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-555-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 253 TABLET"}]},{"description":"METHOCARBAMOL 500 MG PO TABS [4971]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-559-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 488 TABLET"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-562-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"METHOCARBAMOL 750 MG PO TABS [4972]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-568-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.70,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 869 TABLET"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS [21290]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-570-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 TABLET"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS [21688]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-577-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 TABLET"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-579-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 106 TABLET"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-580-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1037 CAPSULE"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG PO TBEC [26224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-585-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.35,"discounted_cash":15.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 218 TABLET"}]},{"description":"RIFAMPIN 300 MG PO CAPS [11293]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-586-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"RIFAMPIN 300 MG PO CAPS [11293]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-586-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 94 CAPSULE"}]},{"description":"GABAPENTIN 300 MG PO CAPS [18308]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-591-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1156 CAPSULE"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS [3720]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-593-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 309 TABLET"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-595-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 299 TABLET"}]},{"description":"BUDESONIDE 3 MG PO CPEP [129861]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-596-33","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":52.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS [6657]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-598-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 TABLET"}]},{"description":"GABAPENTIN 400 MG PO CAPS [18307]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-602-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"GABAPENTIN 400 MG PO CAPS [18307]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-602-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 445 CAPSULE"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS [11599]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-614-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":"135","type":"ML"},"code_information":[{"code":"60687-616-44","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS [5178]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-617-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS [24216]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-622-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1839 TABLET"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-627-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 TABLET"}]},{"description":"LORAZEPAM 0.25 MG PO TABS [300005]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-627-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 TABLET"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-627-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 355 TABLET"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS [5005]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-631-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33 TABLET"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-638-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-638-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 73 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-642-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.52,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 106 TABLET"}]},{"description":"LORAZEPAM 2 MG PO TABS [4574]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-649-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"LISINOPRIL 1.25 MG PO TABS [300459]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-656-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LISINOPRIL 2.5 MG PO TABS [13089]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-656-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 TABLET"}]},{"description":"LEVETIRACETAM 500 MG PO TABS [26817]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-657-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.30,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 403.5 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 12.5-50 MG PO TABS [300152]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-661-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 77 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-661-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.74,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 711 TABLET"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-662-91","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90.3007 PUFF"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS [3772]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-664-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 190 TABLET"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-669-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS [8958]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-672-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS [3774]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1992 TABLET"}]},{"description":"FOLIC ACID 1 MG PO TABS [3233]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-681-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 968 TABLET"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-695-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 TABLET"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS [27049]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-711-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 273 TABLET"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-717-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.14,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-717-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.90,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 338 TABLET"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-722-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-722-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.28,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5134.5 TABLET"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-723-11","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 CAPSULE"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-734-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62 CAPSULE"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-736-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.40,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4431.5 TABLET"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-745-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.00,"discounted_cash":27.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 206 CAPSULE"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":"117.9","type":"ML"},"code_information":[{"code":"60687-762-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL HCL 25 MG PO TABS [300229]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-795-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-795-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 172 TABLET"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS [3700]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-822-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 TABLET"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS [3701]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60687-833-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 84 TABLET"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP [6487]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60758-119-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.69,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2290 NULL"}]},{"description":"THROMBIN 5000 UNITS EX SOLR [11548]","drug_information":{"unit":"1620000","type":"UN"},"code_information":[{"code":"60793-215-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY [148476]","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"60793-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":950.68,"discounted_cash":570.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY [148477]","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"60793-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":830.24,"discounted_cash":498.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN 5000 UNITS EX KIT [76939]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"60793-705-05","type":"NDC"}],"standard_charges":[{"gross_charge":494.2,"discounted_cash":296.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN [6644]","drug_information":{"unit":"4050","type":"ML"},"code_information":[{"code":"61314-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.94,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN [14471]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":37.03,"discounted_cash":22.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 NULL"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN [22982]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-030-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.36,"discounted_cash":39.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 NULL"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"61314-126-05","type":"NDC"}],"standard_charges":[{"gross_charge":113.37,"discounted_cash":68.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"61314-143-05","type":"NDC"}],"standard_charges":[{"gross_charge":39.47,"discounted_cash":23.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN [11562]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-227-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.6,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 NULL"}]},{"description":"TROPICAMIDE 1 % OP SOLN [8250]","drug_information":{"unit":"495","type":"ML"},"code_information":[{"code":"61314-355-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN [2025]","drug_information":{"unit":"80","type":"ML"},"code_information":[{"code":"61314-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.48,"discounted_cash":35.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN [2025]","drug_information":{"unit":"294.2","type":"ML"},"code_information":[{"code":"61314-396-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.71,"discounted_cash":12.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN [18621]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-547-01","type":"NDC"}],"standard_charges":[{"gross_charge":205.44,"discounted_cash":123.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57.5 NULL"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN [11596]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-628-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.01,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 NULL"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT [100964]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-631-36","type":"NDC"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":43.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 NULL"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN [3428]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-633-05","type":"NDC"}],"standard_charges":[{"gross_charge":28.37,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 NULL"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP [6487]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-637-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.24,"discounted_cash":35.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 780 NULL"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP [28810]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.37,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 NULL"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP [11567]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-647-05","type":"NDC"}],"standard_charges":[{"gross_charge":153.89,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 NULL"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN [9610]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61314-656-05","type":"NDC"}],"standard_charges":[{"gross_charge":54.34,"discounted_cash":32.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 NULL"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61570-131-55","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 NULL"}]},{"description":"CARIPRAZINE HCL 1.5 MG PO CAPS [129632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61874-115-11","type":"NDC"}],"standard_charges":[{"gross_charge":282.86,"discounted_cash":169.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 CAPSULE"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS [10001965]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"61958-2501-1","type":"NDC"}],"standard_charges":[{"gross_charge":789.84,"discounted_cash":473.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52 TABLET"}]},{"description":"REMDESIVIR 100 MG IV SOLR [140458]","drug_information":{"unit":"139","type":"ME"},"code_information":[{"code":"61958-2901-2","type":"NDC"}],"standard_charges":[{"gross_charge":719.54,"discounted_cash":431.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG PO TABS [10357]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62175-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 TABLET"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG PO TAB-SR-24HR [24470]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62175-270-37","type":"NDC"}],"standard_charges":[{"gross_charge":18.62,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TALC 3 G PL POWD [10002858]","drug_information":{"unit":"63","type":"GM"},"code_information":[{"code":"62327-333-03","type":"NDC"}],"standard_charges":[{"gross_charge":310.84,"discounted_cash":186.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS [21688]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-030-31","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"ROPINIROLE HCL 0.5 MG PO TABS [21800]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-031-31","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 99 TABLET"}]},{"description":"ROPINIROLE HCL 1 MG PO TABS [21689]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-032-31","type":"NDC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":10.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 332 TABLET"}]},{"description":"ROPINIROLE HCL 2 MG PO TABS [21690]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-033-31","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50.5 TABLET"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG PO CAPS [28278]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-063-60","type":"NDC"}],"standard_charges":[{"gross_charge":25.86,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52 CAPSULE"}]},{"description":"ARIPIPRAZOLE 2 MG PO TABS [70306]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-097-30","type":"NDC"}],"standard_charges":[{"gross_charge":168.4,"discounted_cash":101.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 TABLET"}]},{"description":"ARIPIPRAZOLE 2 MG PO TABS [70306]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-097-31","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 53 TABLET"}]},{"description":"ARIPIPRAZOLE 2.5 MG PO TABS [300074]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-098-30","type":"NDC"}],"standard_charges":[{"gross_charge":168.4,"discounted_cash":101.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ARIPIPRAZOLE 2.5 MG PO TABS [300074]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-098-31","type":"NDC"}],"standard_charges":[{"gross_charge":168.4,"discounted_cash":101.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS [36438]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-098-31","type":"NDC"}],"standard_charges":[{"gross_charge":168.68,"discounted_cash":101.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1375 TABLET"}]},{"description":"ARIPIPRAZOLE 10 MG PO TABS [34369]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-099-30","type":"NDC"}],"standard_charges":[{"gross_charge":167.18,"discounted_cash":100.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 TABLET"}]},{"description":"ARIPIPRAZOLE 10 MG PO TABS [34369]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-099-31","type":"NDC"}],"standard_charges":[{"gross_charge":167.81,"discounted_cash":100.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 572 TABLET"}]},{"description":"ARIPIPRAZOLE 15 MG PO TABS [34370]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":167.21,"discounted_cash":100.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97 TABLET"}]},{"description":"ARIPIPRAZOLE 15 MG PO TABS [34370]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-100-31","type":"NDC"}],"standard_charges":[{"gross_charge":167.53,"discounted_cash":100.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 94 TABLET"}]},{"description":"CELECOXIB 100 MG PO CAPS [24500]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-141-31","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":17.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 CAPSULE"}]},{"description":"CELECOXIB 200 MG PO CAPS [24501]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-142-31","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":26.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 67 CAPSULE"}]},{"description":"FEBUXOSTAT 40 MG PO TABS [91877]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-190-30","type":"NDC"}],"standard_charges":[{"gross_charge":68.85,"discounted_cash":41.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.45,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 CAPSULE"}]},{"description":"LURASIDONE HCL 20 MG PO TABS [108721]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-494-30","type":"NDC"}],"standard_charges":[{"gross_charge":197.4,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [102167]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-495-30","type":"NDC"}],"standard_charges":[{"gross_charge":196.61,"discounted_cash":117.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 TABLET"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":"576.64","type":"ML"},"code_information":[{"code":"62332-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":47.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL FUMARATE 2.5 MG PO TABS [300460]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-603-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"BISOPROLOL FUMARATE 5 MG PO TABS [18288]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62332-603-31","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 TABLET"}]},{"description":"HYDROCOD POLI-CHLORPHE POLI ER 10-8 MG/5ML PO SUER [152681]","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"62542-301-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUVOXAMINE MALEATE 50 MG PO TABS [10085]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.1,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"PROPAFENONE HCL 150 MG PO TABS [11146]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.32,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"FLECAINIDE ACETATE 50 MG PO TABS [10043]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-380-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.62,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"FLECAINIDE ACETATE 100 MG PO TABS [10041]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-381-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.58,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57.5 TABLET"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA [140149]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-431-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 270 NULL"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS [2516]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62559-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO TABS [300041]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 688 TABLET"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"METOPROLOL TARTRATE 6.25 MG PO TABS [300150]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-265-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1447.5 TABLET"}]},{"description":"METOPROLOL TARTRATE 50 MG PO TABS [5009]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-266-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.08,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 228 TABLET"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS [5008]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-267-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.70,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 178 TABLET"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-713-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS [3700]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"62584-733-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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IV SOLN [148488]","drug_information":{"unit":"139","type":"ML"},"code_information":[{"code":"67457-433-00","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":13.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN [39918]","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"67457-473-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.97,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN [9347]","drug_information":{"unit":"22.8","type":"ML"},"code_information":[{"code":"67457-675-02","type":"NDC"}],"standard_charges":[{"gross_charge":9550.23,"discounted_cash":5730.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]","drug_information":{"unit":"28","type":"ML"},"code_information":[{"code":"67457-839-02","type":"NDC"}],"standard_charges":[{"gross_charge":838.42,"discounted_cash":503.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":"58","type":"ML"},"code_information":[{"code":"67457-855-00","type":"NDC"}],"standard_charges":[{"gross_charge":30.73,"discounted_cash":18.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":"64","type":"ML"},"code_information":[{"code":"67457-855-02","type":"NDC"}],"standard_charges":[{"gross_charge":33.38,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [102515]","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"67457-940-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]","drug_information":{"unit":"3095","type":"ML"},"code_information":[{"code":"67457-953-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR [469]","drug_information":{"unit":"14","type":"GM"},"code_information":[{"code":"67850-021-00","type":"NDC"}],"standard_charges":[{"gross_charge":70.25,"discounted_cash":42.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":"16","type":"ME"},"code_information":[{"code":"67850-022-00","type":"NDC"}],"standard_charges":[{"gross_charge":115.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-124-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 NULL"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-124-40","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 NULL"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-124-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 NULL"}]},{"description":"TEMAZEPAM 15 MG PO CAPS [7753]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 CAPSULE"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS [9070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-197-90","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 167 TABLET"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-199-90","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 TABLET"}]},{"description":"FINASTERIDE 5 MG PO TABS [10037]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-288-90","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 TABLET"}]},{"description":"LINEZOLID 600 MG PO TABS [28224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-419-20","type":"NDC"}],"standard_charges":[{"gross_charge":937.6,"discounted_cash":562.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 47 TABLET"}]},{"description":"LINEZOLID 600 MG PO TABS [28224]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-419-33","type":"NDC"}],"standard_charges":[{"gross_charge":937.6,"discounted_cash":562.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ITRACONAZOLE 100 MG PO CAPS [10364]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-454-30","type":"NDC"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":75.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 CAPSULE"}]},{"description":"EZETIMIBE 10 MG PO TABS [34153]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-490-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":34.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 TABLET"}]},{"description":"EZETIMIBE 10 MG PO TABS [34153]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-490-90","type":"NDC"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 94 TABLET"}]},{"description":"SOLIFENACIN SUCCINATE 5 MG PO TABS [40392]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-527-30","type":"NDC"}],"standard_charges":[{"gross_charge":72.55,"discounted_cash":43.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SOLIFENACIN SUCCINATE 5 MG PO TABS [40392]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-527-90","type":"NDC"}],"standard_charges":[{"gross_charge":72.21,"discounted_cash":43.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"SOLIFENACIN SUCCINATE 10 MG PO TABS [40393]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-528-90","type":"NDC"}],"standard_charges":[{"gross_charge":72.55,"discounted_cash":43.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 TABLET"}]},{"description":"LURASIDONE HCL 20 MG PO TABS [108721]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-638-30","type":"NDC"}],"standard_charges":[{"gross_charge":264.9,"discounted_cash":158.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CHLORTHALIDONE 12.5 MG PO TABS [300090]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-696-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 TABLET"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-696-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 TABLET"}]},{"description":"LACOSAMIDE 50 MG PO TABS [92316]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-733-60","type":"NDC"}],"standard_charges":[{"gross_charge":59.55,"discounted_cash":35.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 156 TABLET"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"67877-753-60","type":"NDC"}],"standard_charges":[{"gross_charge":33.79,"discounted_cash":20.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 CAPSULE"}]},{"description":"CARVEDILOL 25 MG PO TABS [15748]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-152-00","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 101 TABLET"}]},{"description":"ANASTROZOLE 1 MG PO TABS [16205]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-155-04","type":"NDC"}],"standard_charges":[{"gross_charge":74.45,"discounted_cash":44.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"VENLAFAXINE HCL 25 MG PO TABS [12203]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-157-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"VENLAFAXINE HCL 75 MG PO TABS [12206]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-160-00","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 46 TABLET"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-162-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"QUETIAPINE FUMARATE 200 MG PO TABS [21825]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-182-00","type":"NDC"}],"standard_charges":[{"gross_charge":71.7,"discounted_cash":43.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS [1755]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-237-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 134 TABLET"}]},{"description":"CLONIDINE HCL 0.2 MG PO TABS [1756]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-238-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 61 TABLET"}]},{"description":"CLONIDINE HCL 0.3 MG PO TABS [1757]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-239-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"ZONISAMIDE 25 MG PO CAPS [36987]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-242-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"ZONISAMIDE 100 MG PO CAPS [27780]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-244-00","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":9.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 98 CAPSULE"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE [27697]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-246-16","type":"NDC"}],"standard_charges":[{"gross_charge":123.13,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 338.5 TABLET"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE [27697]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-246-17","type":"NDC"}],"standard_charges":[{"gross_charge":123.3,"discounted_cash":73.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 TABLET"}]},{"description":"FLUCONAZOLE 200 MG PO TABS [10045]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-254-04","type":"NDC"}],"standard_charges":[{"gross_charge":77.97,"discounted_cash":46.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 31 TABLET"}]},{"description":"BUPROPION HCL 75 MG PO TABS [9322]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-308-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 TABLET"}]},{"description":"BUPROPION HCL 100 MG PO TABS [9321]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-309-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 TABLET"}]},{"description":"BUPROPION HCL 50 MG PO TABS [300159]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-309-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LISINOPRIL 2.5 MG PO TABS [13089]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-332-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 253 TABLET"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-333-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 124 TABLET"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-334-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR [300296]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-356-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 38 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG PO TAB-SR-24HR [29858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-356-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 280 TABLET"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TAB-SR-24HR [30070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-357-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-361-05","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":20.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 524 TABLET"}]},{"description":"CEFDINIR 300 MG PO CAPS [22289]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-362-06","type":"NDC"}],"standard_charges":[{"gross_charge":31.98,"discounted_cash":19.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 285 CAPSULE"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-363-05","type":"NDC"}],"standard_charges":[{"gross_charge":107.34,"discounted_cash":64.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 87 TABLET"}]},{"description":"LABETALOL HCL 200 MG PO TABS [10374]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-382-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 TABLET"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-397-00","type":"NDC"}],"standard_charges":[{"gross_charge":18.29,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 292 TABLET"}]},{"description":"LEVETIRACETAM 250 MG PO TABS [26816]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-402-07","type":"NDC"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-413-06","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 CAPSULE"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-414-05","type":"NDC"}],"standard_charges":[{"gross_charge":44.93,"discounted_cash":26.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 178 CAPSULE"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-415-04","type":"NDC"}],"standard_charges":[{"gross_charge":45.80,"discounted_cash":27.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 CAPSULE"}]},{"description":"NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS [10724]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-423-00","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 CAPSULE"}]},{"description":"CETIRIZINE HCL 10 MG PO TABS [9506]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-436-16","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 317 TABLET"}]},{"description":"CETIRIZINE HCL 10 MG PO TABS [9506]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-436-96","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-438-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 265 TABLET"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-438-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 92 TABLET"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-438-96","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"LORATADINE 5 MG/5ML PO SOLN [102344]","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"68001-449-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE HCL 40 MG PO CAPS [29779]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-451-06","type":"NDC"}],"standard_charges":[{"gross_charge":49.59,"discounted_cash":29.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 221 CAPSULE"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG PO TAB-SR-24HR [30071]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-470-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.40,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 187 TABLET"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-476-46","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1590 NULL"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT [850]","drug_information":{"unit":"596.4","type":"GM"},"code_information":[{"code":"68001-477-47","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT [850]","drug_information":{"unit":"166","type":"GM"},"code_information":[{"code":"68001-477-48","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":16.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT [24696]","drug_information":{"unit":"113.6","type":"GM"},"code_information":[{"code":"68001-483-45","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 10 MG PO TABS [15065]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-494-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 356 TABLET"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD [24984]","drug_information":{"unit":"731","type":"GM"},"code_information":[{"code":"68001-505-55","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS [4993]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-557-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 TABLET"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-595-05","type":"NDC"}],"standard_charges":[{"gross_charge":45.57,"discounted_cash":27.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 174 CAPSULE"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68001-597-05","type":"NDC"}],"standard_charges":[{"gross_charge":107.16,"discounted_cash":64.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 TABLET"}]},{"description":"WARFARIN SODIUM 2.5 MG PO TABS [8750]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-027-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.99,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 87.2 TABLET"}]},{"description":"MISOPROSTOL 200 MCG PO TABS [10629]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-041-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.85,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PAROXETINE HCL 20 MG PO TABS [10855]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-045-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":10.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 259 TABLET"}]},{"description":"ISOSORBIDE DINITRATE 10 MG PO TABS [4064]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-082-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 73 TABLET"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-083-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 12.5-50 MG PO TABS [300152]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-093-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-094-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-097-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"ATORVASTATIN 5 MG PO TABS [300013]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-097-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-097-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.29,"discounted_cash":5.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 515 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-098-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 565 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-099-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-099-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 242 TABLET"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS [29778]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-103-09","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS [29778]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-103-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 CAPSULE"}]},{"description":"ACYCLOVIR 400 MG PO TABS [8971]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-108-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.84,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 TABLET"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-119-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 92 TABLET"}]},{"description":"MIRTAZAPINE 30 MG PO TABS [17465]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-120-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 TABLET"}]},{"description":"OMEPRAZOLE 20 MG PO CAP-DEL-REL [27694]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-128-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":6.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 CAPSULE"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TAB-CONT-REL [116324]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-157-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.77,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 126 TABLET"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL [116301]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-158-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 TABLET"}]},{"description":"ZOLPIDEM TARTRATE 2.5 MG PO TABS [300188]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.07,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76 TABLET"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-196-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-196-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PRIMIDONE 50 MG PO TABS [11129]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-202-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BENZONATATE 100 MG PO CAPS [988]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-214-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1132 CAPSULE"}]},{"description":"CLINDAMYCIN HCL 150 MG PO CAPS [1740]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-243-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 CAPSULE"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-248-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-269-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.32,"discounted_cash":15.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 TABLET"}]},{"description":"RISPERIDONE 0.25 MG PO TABS [25519]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-270-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.84,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 TABLET"}]},{"description":"RISPERIDONE 1 MG PO TABS [18313]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-272-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.97,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 TABLET"}]},{"description":"RISPERIDONE 2 MG PO TABS [18311]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-273-11","type":"NDC"}],"standard_charges":[{"gross_charge":44.36,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 294 TABLET"}]},{"description":"RISPERIDONE 3 MG PO TABS [18312]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-274-11","type":"NDC"}],"standard_charges":[{"gross_charge":51.3,"discounted_cash":30.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 115 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA ER 25-100 MG PO TAB-CONT-REL [122064]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-281-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 TABLET"}]},{"description":"HYDROXYUREA 500 MG PO CAPS [10236]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-284-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 CAPSULE"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-288-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-288-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 159 TABLET"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-291-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.95,"discounted_cash":16.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 TABLET"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS [97959]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-299-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.06,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2068 CAPSULE"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR [129900]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-313-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.93,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 229 CAPSULE"}]},{"description":"LAMOTRIGINE 25 MG PO TABS [13981]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-318-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 205 TABLET"}]},{"description":"LAMOTRIGINE 100 MG PO TABS [13982]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-319-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.27,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 460 TABLET"}]},{"description":"GLIMEPIRIDE 2 MG PO TABS [16356]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-326-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 131 TABLET"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-342-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.66,"discounted_cash":8.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 351 TABLET"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-344-11","type":"NDC"}],"standard_charges":[{"gross_charge":37.34,"discounted_cash":22.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 122.25 TABLET"}]},{"description":"LOSARTAN POTASSIUM 12.5 MG PO TABS [300325]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-346-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 TABLET"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS [14823]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-346-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.56,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 286 TABLET"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-347-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-347-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":9.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 928 TABLET"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE HCL 2.5 MG PO TABS [300199]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-354-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-354-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 393 TABLET"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TAB-CONT-REL [35943]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-360-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 TABLET"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS [6257]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-376-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 89 CAPSULE"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS [999]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-388-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 TABLET"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS [8958]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TAB-SR-24HR [77001]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-415-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 179 TABLET"}]},{"description":"HYDRALAZINE HCL 10 MG PO TABS [3698]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-447-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 TABLET"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-490-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 92 TABLET"}]},{"description":"SIMVASTATIN 10 MG PO TABS [11364]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-511-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.60,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 TABLET"}]},{"description":"SIMVASTATIN 5 MG PO TABS [11367]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-511-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":12.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SIMVASTATIN 20 MG PO TABS [11365]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-512-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.89,"discounted_cash":18.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 TABLET"}]},{"description":"OLANZAPINE 2.5 MG PO TABS [21057]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":37.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 47 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-536-11","type":"NDC"}],"standard_charges":[{"gross_charge":39.43,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-539-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 525 TABLET"}]},{"description":"TEMAZEPAM 7.5 MG PO CAPS [11500]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-549-11","type":"NDC"}],"standard_charges":[{"gross_charge":44.38,"discounted_cash":26.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 CAPSULE"}]},{"description":"CARBAMAZEPINE ER 200 MG PO TAB-SR-12HR [27635]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-561-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.55,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"GUAIFENESIN ER 600 MG PO TAB-SR-12HR [37651]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-572-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 962 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-590-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-590-95","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 58 TABLET"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TAB-SR-24HR [24268]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-592-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"ESCITALOPRAM OXALATE 10 MG PO TABS [33512]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-617-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.29,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 TABLET"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TAB-CONT-REL [10454]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-640-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TAB-CONT-REL [10454]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-640-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.90,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 126 TABLET"}]},{"description":"LITHIUM CARBONATE ER 450 MG PO TAB-CONT-REL [10455]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-655-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 TABLET"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":46.42,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 CAPSULE"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-683-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-683-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 CAPSULE"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [31863]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-699-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.99,"discounted_cash":11.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 TABLET"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TAB-SR-12HR [18386]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-708-95","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 259 TABLET"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR [27858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-709-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.35,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 CAPSULE"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-710-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.78,"discounted_cash":14.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 131 TABLET"}]},{"description":"VENLAFAXINE HCL ER 150 MG PO CAP-SR-24HR [27859]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-713-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"VENLAFAXINE HCL ER 150 MG PO CAP-SR-24HR [27859]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-713-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 71 CAPSULE"}]},{"description":"OLANZAPINE 5 MG PO TABS [17936]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-723-11","type":"NDC"}],"standard_charges":[{"gross_charge":61.01,"discounted_cash":36.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 84 TABLET"}]},{"description":"OLANZAPINE 10 MG PO TABS [17937]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-740-11","type":"NDC"}],"standard_charges":[{"gross_charge":108.29,"discounted_cash":64.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 198 TABLET"}]},{"description":"GUANFACINE HCL 0.5 MG PO TABS [300875]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-748-95","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRIAMTERENE-HCTZ 37.5-25 MG PO TABS [8132]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-750-95","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [85123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-752-19","type":"NDC"}],"standard_charges":[{"gross_charge":62.48,"discounted_cash":37.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 TABLET"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [85123]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-752-95","type":"NDC"}],"standard_charges":[{"gross_charge":139.19,"discounted_cash":83.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 102 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS [35184]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-753-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 TABLET"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS [35184]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-753-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LISINOPRIL 2.5 MG PO TABS [13089]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-765-95","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-776-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 462 TABLET"}]},{"description":"DIVALPROEX SODIUM 500 MG PO TBEC [2553]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-782-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":13.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1409 TABLET"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-808-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"TRAMADOL HCL 25 MG PO TABS [300229]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.04,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 803 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-813-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-813-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 481 TABLET"}]},{"description":"CARVEDILOL 6.25 MG PO TABS [15747]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-854-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"CARVEDILOL 6.25 MG PO TABS [15747]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-854-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1357 TABLET"}]},{"description":"LEVETIRACETAM 125 MG PO TABS [300098]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-859-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 19 TABLET"}]},{"description":"LEVETIRACETAM 250 MG PO TABS [26816]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-859-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 211 TABLET"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-875-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-875-11","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 275 TABLET"}]},{"description":"CYCLOSPORINE 25 MG PO CAPS [9707]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-879-95","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 CAPSULE"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-895-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.50,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.5 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-895-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 TABLET"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG PO TBEC [38062]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-907-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.4,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC [38063]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-918-95","type":"NDC"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"OXYCODONE HCL 10 MG PO TABS [85539]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-968-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE HCL 10 MG PO TABS [85539]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68084-968-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.17,"discounted_cash":4.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 185 TABLET"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"68094-001-59","type":"NDC"}],"standard_charges":[{"gross_charge":3.56,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":"25.8125","type":"ML"},"code_information":[{"code":"68094-015-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":"630","type":"ML"},"code_information":[{"code":"68094-043-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.00,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"68094-043-62","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL ACETATE 400 MG/10ML PO SUSP [76824]","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"68094-063-59","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP [10521]","drug_information":{"unit":"350","type":"ML"},"code_information":[{"code":"68094-063-59","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN 3 MG PO TABS [16830]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68094-110-59","type":"NDC"}],"standard_charges":[{"gross_charge":5.11,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 845 TABLET"}]},{"description":"MELATONIN 3 MG PO TABS [16830]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68094-110-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 TABLET"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":"1616.5738","type":"ML"},"code_information":[{"code":"68094-231-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"68094-231-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":"255.9","type":"ML"},"code_information":[{"code":"68094-494-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"68094-599-59","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":"142.8","type":"ML"},"code_information":[{"code":"68094-600-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML PO SOLN [3292]","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"68094-756-59","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68094-853-62","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 58 TABLET"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS [11628]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-166-11","type":"NDC"}],"standard_charges":[{"gross_charge":160.36,"discounted_cash":96.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 CAPSULE"}]},{"description":"SERTRALINE HCL 100 MG PO TABS [11350]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-353-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.37,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 TABLET"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":293.52,"discounted_cash":176.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 669 NULL"}]},{"description":"CEPHALEXIN 125 MG/5ML PO SUSR [9501]","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"68180-440-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-677-11","type":"NDC"}],"standard_charges":[{"gross_charge":84.45,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 31 CAPSULE"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS [9070]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-719-09","type":"NDC"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 TABLET"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-956-02","type":"NDC"}],"standard_charges":[{"gross_charge":44.42,"discounted_cash":26.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 NULL"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68180-969-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"AZATHIOPRINE 25 MG PO TABS [300014]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 TABLET"}]},{"description":"AZATHIOPRINE 50 MG PO TABS [9183]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":9.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 TABLET"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR [27858]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-035-16","type":"NDC"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":17.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 82 CAPSULE"}]},{"description":"MELOXICAM 7.5 MG PO TABS [20566]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.71,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 95 TABLET"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-096-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.74,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 66 TABLET"}]},{"description":"PAROXETINE HCL 10 MG PO TABS [16632]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-097-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.22,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76 TABLET"}]},{"description":"RISPERIDONE 1 MG PO TABS [18313]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-114-14","type":"NDC"}],"standard_charges":[{"gross_charge":28.87,"discounted_cash":17.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 TABLET"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS [97959]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.87,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 CAPSULE"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-138-14","type":"NDC"}],"standard_charges":[{"gross_charge":16.67,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 TABLET"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-140-14","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":24.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 TABLET"}]},{"description":"BUSPIRONE HCL 2.5 MG PO TABS [300397]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 TABLET"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS [9324]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 79 TABLET"}]},{"description":"CHOLESTYRAMINE LIGHT 4 G PO PACK [37482]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-529-60","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 PACKET"}]},{"description":"ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-569-28","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 86 TABLET"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN [9259]","drug_information":{"unit":"74","type":"ML"},"code_information":[{"code":"68382-860-02","type":"NDC"}],"standard_charges":[{"gross_charge":167.63,"discounted_cash":100.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROFLUMILAST 500 MCG PO TABS [104572]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68382-969-06","type":"NDC"}],"standard_charges":[{"gross_charge":82.45,"discounted_cash":49.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62 TABLET"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS [27049]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 437 TABLET"}]},{"description":"OXCARBAZEPINE 75 MG PO TABS [300301]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.3,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 396 TABLET"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE [27697]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-157-40","type":"NDC"}],"standard_charges":[{"gross_charge":122.98,"discounted_cash":73.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 102.5 TABLET"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-180-22","type":"NDC"}],"standard_charges":[{"gross_charge":11.30,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 836 NULL"}]},{"description":"NAPROXEN 250 MG PO TABS [5391]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"VERAPAMIL HCL ER 240 MG PO TAB-CONT-REL [13073]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 TABLET"}]},{"description":"VERAPAMIL HCL ER 120 MG PO TAB-CONT-REL [13184]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 TABLET"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS [21288]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-333-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"INDOMETHACIN 25 MG PO CAPS [3897]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.70,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 CAPSULE"}]},{"description":"COLESEVELAM HCL 625 MG PO TABS [28372]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-433-18","type":"NDC"}],"standard_charges":[{"gross_charge":22.08,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 TABLET"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":"64","type":"ML"},"code_information":[{"code":"68462-469-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.06,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL [5604]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-639-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4150 TABLET"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL [5604]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68462-639-45","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 TABLET"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [8981]","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"68516-5216-8","type":"NDC"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CHLORIDE 64 MG PO TBEC [10002436]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68585-00575","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 TABLET"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68682-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.29,"discounted_cash":5.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 157 TABLET"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS [2476]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68682-007-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 46 TABLET"}]},{"description":"PYRIDOSTIGMINE BROMIDE 30 MG PO TABS [10008112]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68682-302-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 TABLET"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68682-302-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN [7795]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"68682-920-64","type":"NDC"}],"standard_charges":[{"gross_charge":38.64,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 NULL"}]},{"description":"TRYPAN BLUE 0.06 % IO SOSY [151031]","drug_information":{"unit":"16.5","type":"ML"},"code_information":[{"code":"68803-612-05","type":"NDC"}],"standard_charges":[{"gross_charge":913.2,"discounted_cash":547.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRYPAN BLUE 0.06 % IO SOSY [151031]","drug_information":{"unit":"138.5","type":"ML"},"code_information":[{"code":"68803-612-10","type":"NDC"}],"standard_charges":[{"gross_charge":1016.58,"discounted_cash":609.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-316-02","type":"NDC"}],"standard_charges":[{"gross_charge":72.15,"discounted_cash":43.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP [28774]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-318-86","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CINACALCET HCL 30 MG PO TABS [38100]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-410-02","type":"NDC"}],"standard_charges":[{"gross_charge":161.55,"discounted_cash":96.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL [140725]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-524-44","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1400 NULL"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-533-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.35,"discounted_cash":20.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK [14825]","drug_information":{"unit":"12","type":"GM"},"code_information":[{"code":"69097-579-67","type":"NDC"}],"standard_charges":[{"gross_charge":515.3,"discounted_cash":309.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-677-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.41,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64 CAPSULE"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-678-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.90,"discounted_cash":25.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 152 CAPSULE"}]},{"description":"PREGABALIN 75 MG PO CAPS [42164]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-679-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.87,"discounted_cash":24.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 176 CAPSULE"}]},{"description":"PREGABALIN 100 MG PO CAPS [42165]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69097-681-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.16,"discounted_cash":24.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 359 CAPSULE"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN [8718]","drug_information":{"unit":"0.225","type":"ML"},"code_information":[{"code":"69097-708-96","type":"NDC"}],"standard_charges":[{"gross_charge":541.11,"discounted_cash":324.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG PO TABS [1656]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-1056-1","type":"NDC"}],"standard_charges":[{"gross_charge":41.50,"discounted_cash":24.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 111 TABLET"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [81249]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-1264-1","type":"NDC"}],"standard_charges":[{"gross_charge":77.33,"discounted_cash":46.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 CAPSULE"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ PO PACK [6434]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-1617-1","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 940.5 PACKET"}]},{"description":"LEVOTHYROXINE SODIUM 175 MCG PO TABS [10406]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-1839-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-2077-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 95 TABLET"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS [6657]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-2078-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 TABLET"}]},{"description":"PROPRANOLOL HCL 40 MG PO TABS [6658]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69238-2079-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 38 TABLET"}]},{"description":"CAPTOPRIL 6.25 MG PO TABS [300020]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69292-522-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"CAPTOPRIL 25 MG PO TABS [9402]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69292-524-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"FUROSEMIDE 40 MG PO TABS [3295]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 272 TABLET"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS [3861]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 TABLET"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO TABS [77049]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 235 TABLET"}]},{"description":"NIFEDIPINE 10 MG PO CAPS [5558]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"ETRAVIRINE 100 MG PO TABS [85207]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-285-20","type":"NDC"}],"standard_charges":[{"gross_charge":68.32,"discounted_cash":41.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 TABLET"}]},{"description":"LORAZEPAM 0.25 MG PO TABS [300005]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-904-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 TABLET"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-904-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 193 TABLET"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-905-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 196 TABLET"}]},{"description":"LORAZEPAM 2 MG PO TABS [4574]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69315-906-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 TABLET"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":"1560","type":"ML"},"code_information":[{"code":"69339-138-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":"510","type":"ML"},"code_information":[{"code":"69339-138-17","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":"1040","type":"ML"},"code_information":[{"code":"69339-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.96,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROBIOTIC PO PACK [133383]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69355-412-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.07,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49 PACKET"}]},{"description":"VISBIOME HIGH POTENCY PO PACK [138369]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69355-412-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.8,"discounted_cash":12.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 PACKET"}]},{"description":"SODIUM CHLORIDE 1 G PO TABS [7328]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69367-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33 TABLET"}]},{"description":"FA-PYRIDOXINE-CYANOCOBALAMIN 2.5-25-2 MG PO TABS [85946]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69367-224-09","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 758 TABLET"}]},{"description":"EPLERENONE 25 MG PO TABS [36983]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69367-307-09","type":"NDC"}],"standard_charges":[{"gross_charge":25.18,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 TABLET"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"69374-914-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 1 MG/10ML IV SOSY [10004334]","drug_information":{"unit":"670","type":"ML"},"code_information":[{"code":"69374-957-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 100 MG PO CAPS [988]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69452-143-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.29,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 289 CAPSULE"}]},{"description":"VALPROIC ACID 250 MG PO CAPS [8429]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69452-150-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.3,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 82 CAPSULE"}]},{"description":"ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS [2863]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69452-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 CAPSULE"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS [96737]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69452-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 89 CAPSULE"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS [9350]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69452-207-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":6.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 123 CAPSULE"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":"2676","type":"ML"},"code_information":[{"code":"69452-389-98","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN & MINERAL PO LIQD [98355]","drug_information":{"unit":"555","type":"ML"},"code_information":[{"code":"69618-00815","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN & MINERAL PO LIQD [98355]","drug_information":{"unit":"1065","type":"ML"},"code_information":[{"code":"69618-00858","type":"NDC"}],"standard_charges":[{"gross_charge":2.50,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69618-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 134 TABLET"}]},{"description":"SENNOSIDES 8.6 MG PO TABS [11349]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69618-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 187 TABLET"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS [24216]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69618-065-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 195 TABLET"}]},{"description":"DESMOPRESSIN ACETATE 0.1 MG PO TABS [16052]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69918-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.78,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 TABLET"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"69918-700-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.86,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN [144176]","drug_information":{"unit":"27.8","type":"ML"},"code_information":[{"code":"69918-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":364.20,"discounted_cash":218.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]","drug_information":{"unit":"7.05","type":"ML"},"code_information":[{"code":"69918-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":362.86,"discounted_cash":217.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TC-99 MAG-3 PER DOSE,UP TO 15 MCI [301031]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69945-096-20","type":"NDC"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 13 % EX CREA [90237]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"69968-219-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 627 NULL"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 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Pharmacy"}]},{"description":"AMOXICILLIN 500 MG PO CAPS [451]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"81964-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":4.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 CAPSULE"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"81964-221-14","type":"NDC"}],"standard_charges":[{"gross_charge":32.2,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 TABLET"}]},{"description":"LIDOCAINE HCL 3.5 % OP GEL 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Pharmacy"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN [153561]","drug_information":{"unit":"782","type":"ML"},"code_information":[{"code":"8290-306413","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN [153561]","drug_information":{"unit":"345","type":"ML"},"code_information":[{"code":"8290-306414","type":"NDC"}],"standard_charges":[{"gross_charge":9.03,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE FLUSH 0.9 % IV SOLN 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MISCELLANEOUS SUPPLIES--0270-SUP446227","code_information":[{"code":"0270","type":"RC"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2700001 - HC SUPPLY - GENERAL--0270--1","code_information":[{"code":"0270","type":"RC"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1713-0270-SUP423193","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1713-0270-SUP436341","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1713-0270-SUP436930","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1713-0270-SUP437278","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS 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SUPPLIES-C1713-0270-SUP438732","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1713-0270-SUP439670","code_information":[{"code":"0270","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1769-0270-SUP427398","code_information":[{"code":"0270","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1769-0270-SUP428062","code_information":[{"code":"0270","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2699999 - HC MISCELLANEOUS SUPPLIES-C1769-0270-SUP428135","code_information":[{"code":"0270","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2700001 - HC SUPPLY - GENERAL-C1769-0270-SUP431096","code_information":[{"code":"0270","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Supply"}]},{"description":"2700001 - HC SUPPLY - 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